Analysis of Platelet Function during Left Ventricular Support with the Incor and Excor System

Authors

  • Christian Etz
  • Henryk Welp
  • Markus Rothenburger
  • Tonny D. T. Tjan
  • Frauke Wenzelburger
  • Christoph Schmidt
  • Hans H. Scheld
  • Christof Schmid

DOI:

https://doi.org/10.1532/HSF98.20041073

Abstract

Improvements in pump technology and the scarcity of donor organs have led to an increased use of mechanical assist devices, but the problem of thromboembolism has still not been solved. We report on our initial experience with sequentially analyzing platelet function in patients provided with the Incor left ventricular assist device (LVAD) and the Excor LVAD system. Thirteen patients 5 to 61 years old with acute or end-stage heart failure were included in a pilot study. Five of the 10 Incor patients underwent LVAD placement under emergency conditions, and 5 were electively scheduled for surgery. All 3 patients with an Excor device had been connected to an extracorporeal membrane oxygenation system prior to insertion of the device. An anticoagulation protocol including heparin, aspirin, and clopidogrel was employed, and the patients were closely monitored with a special platelet-analyzing system that allows dose optimization for antiplatelet drugs. Initial platelet function was normal in only 2 patients (15%). During a follow-up period of 1770 days (cumulative >4.8 years), no early (<30 days) bleeding complications related to device implantation occurred. Late cerebral thromboembolic events were noted in 3 patients. One patient experienced severe stroke mandating neurosurgery during mechanical assist, and 1 patient experienced systemic embolism. The PAP platelet analyzer offers a cheap and reliable alternative to the more expensive thromboelastography method for adequately surveying the efficacy of aspirin and clopidogrel treatment, even if late thromboembolic events cannot be prevented.

References

Deng MC, Edwards LB, Hertz MI, Rowe AW, Kormos RL. 2003. Mechanical circulatory support device database of the International Society for Heart and Lung Transplantation: first annual report--2003.J Heart Lung Transplant 22:653-62.nDewald O, Fischlein T, Vetter HO, et al. 1997. Platelet morphology in patients with mechanical circulatory support. Eur J Cardiothorac Surg 12:634-41.nGoldstein DJ, Oz MC, Rose EA. 1998. Implantable left ventricular assist devices. N Engl J Med 339:1522-33.nSchmid C, Wilhelm M, Rothenburger M, et al. 2000. Effect of high dose platelet inhibitor treatment on thromboembolism in Novacor patients. Eur J Cardiothorac Surg 17:331-5.nSnyder TA, Watach MJ, Litwak KN, Wagner WR. 2002. Platelet activation, aggregation, and life span in calves implanted with axial flow ventricular assist devices. Ann Thorac Surg 73:1933-8.nSong X, Throckmorton AL, Untaroiu A, et al. 2003. Axial flow pumps. ASAIO J 49:355-64.nSpanier T, Oz M, Levin H, et al. 1996. Activation of coagulation and fibrinolytic pathways in patients with left ventricular assist devices. J Thorac Cardiovasc Surg 112:1090-7.nSzefner J. 1995. Control and treatment of hemostasis in cardiovascular surgery: the experience of La Pitie Hospital with patients on total artifiial heart. Int J Artif Organs 18:633-48.nVitali E, Lanfranconi M, Ribera E, et al. 2003. Successful experience in bridging patients to heart transplantation with the MicroMed DeBakey ventricular assist device. Ann Thorac Surg 75: 1200-4.nHetzer R, Müller JH, Weng Y, Meyer R, Dandel M. 2001. Bridging-to-recovery. Ann Thorac Surg 71:S109-13.nMatsubayashi H, Fastenau DR, McIntyre JA. 2000. Changes in platelet activation associated with left ventricular assist system placement. J Heart Lung Transplant 19:462-8.nRose EA, Gelijns AC, Moskowitz AJ, et al. 2001. Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med 345:1435-43.nRothenburger M, Wilhelm MJ, Hammel D, et al. 2002. Treatment of thrombus formation associated with the MicroMed DeBakey VAD using recombinant tissue plasminogen activator. Circulation 106:I-189-92.nSchmid C, Weyand M, Hammel D, Deng MC, Nabavi D, Scheld HH. 1998. Effect of platelet inhibitors on thromboembolism after implantation of a Novacor N100: preliminary results. Thorac Cardiovasc Surg 46:260-2.nSchmid C, Weyand M, Nabavi DG, et al. 1998. Cerebral and systemic embolization during left ventricular support with the Novacor N100 device. Ann Thorac Surg 65:1703-10.n

Published

2005-01-13

How to Cite

Etz, C., Welp, H., Rothenburger, M., Tjan, T. D. T., Wenzelburger, F., Schmidt, C., Scheld, H. H., & Schmid, C. (2005). Analysis of Platelet Function during Left Ventricular Support with the Incor and Excor System. The Heart Surgery Forum, 7(5), E423-E427. https://doi.org/10.1532/HSF98.20041073

Issue

Section

Articles

Most read articles by the same author(s)