Thrombosis during off pump LVAD placement in a patient with heparin induced thrombocytopenia using bivalirudin

Journal of Cardiothoracic Surgery

Chittoor Bhaskar Sai-Sudhakar²  Galina Dimitrova¹  Obaid Malik³  Richard Bryant¹  Hamdy Awad¹ 

[1] Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA;The Ohio State University Wexner Medical Center, Columbus, OH, USA;The Ohio State University College of Medicine, Columbus, OH, USA

关键词: HITT;    Heparin induced thrombocytopenia;    Off pump;    Pharmacology;    Stasis;    Bivalirudin;    LVAD;    Left ventricular assist device;    HeartMate II;   

Others  :  825496
DOI  :  10.1186/1749-8090-8-115

 received in 2012-07-22, accepted in 2013-04-16,  发布年份 2013

【 摘 要 】

Here we present our attempt at off pump HeartMate II left ventricular assist device (LVAD) implantation using the anticoagulant bivalirudin in a patient with heparin induced thrombocytopenia, which resulted in thrombosis within the LVAD device. This required that our procedure be converted to on pump, and a new HeartMate II LVAD device to be implanted. In our view, this thrombotic event may have been caused by a number of factors that include bivalirudin’s (1) short half-life of about 20 minutes, (2) decreased activity with blood stasis, (3) inability to prevent clot propagation, and (4) uncertainty with real-time monitoring of therapeutic levels. To prevent future thrombotic events, it may be beneficial to immediately deair the LVAD device prior to the coring of the left ventricle during off pump LVAD placement. In addition, a solution other than blood may be used for priming. If blood is used for priming of the LVAD device, the duration of blood stasis should not exceed 20 minutes when bivalirudin is being used for anticoagulation. Furthermore, this case emphasizes the importance of having a backup LVAD device available and ready to use during surgical procedures.

【 授权许可】

   
2013 Awad et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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