The vexing problem of thrombosis in long-term mechanical circulatory support
The vexing problem of thrombosis in long-term mechanical circulatory support
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DOI：
10.1016/j.healun.2013.12.002
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发表时间：
2014-01-01
影响因子：
8.9
通讯作者：
Uber, Patricia A.
中科院分区：
文献类型：
--
作者：
Mehra, Mandeep R.;Stewart, Garrick C.;Uber, Patricia A.
耐用的左心室辅助装置（lvad）不仅延长了寿命，而且在难治性晚期心力衰竭患者的生活质量、症状控制和功能能力方面也得到了持续的改善。与器械相关的感染、出血、神经系统事件、右侧心力衰竭和器械故障等问题一直是依靠机械支持生活的患者的主要临床护理问题。即使在全球范围内加速采用耐用的lvad，我们也开始遇到由血栓形成引起的泵故障的日益严重的困境。2011年初，临床医生开始注意到HeartMate II (Thoratec Corp, Pleasanton， CA) LVAD的泵血栓发生率激增。到2012年，随着各中心和合作团体开始剖析这一新生现象，lvad内血栓形成问题开始占据大部分科学方向。从这个角度来看，我们描述了泵血栓形成的规模和影响，讨论了这一独特人群的长期和管理趋势，试图从根本上剖析问题，提供监测和治疗原则的指导，并概述了值得我们立即合作关注的问题。(C) 2014年国际心肺移植学会。版权所有。
Durable left ventricular assist devices (LVADs) have not only enhanced longevity but also conferred sustained improvements in quality of life, symptom control, and functional capacity in patients with medically refractory advanced heart failure. Problems with device-related infection, bleeding, neurologic events, right-sided heart failure, and device malfunction have dominated the clinical care of patients living on mechanical support. Even as adoption of durable LVADs accelerated globally, we began to encounter a growing dilemma of pump malfunction caused by thrombosis. In early 2011, clinicians began to notice a spike in the incidence of pump thrombosis with the HeartMate II (Thoratec Corp, Pleasanton, CA) LVAD. By 2012, the problem of thrombosis in LVADs began to consume most of the scientific direction as centers and collaborative groups began to dissect this nascent phenomenon. In this perspective, we describe the magnitude and implications of pump thrombosis, discuss secular and management trends in this unique population, attempt to dissect the problem at its root, offer guidance on surveillance and therapeutic principles, and outline issues that deserve our immediate and collaborative attention. (C) 2014 International Society for Heart and Lung Transplantation. All rights reserved.