Percutaneous ventricular assist devices (pVADs) are increasingly being used because of improved experience and availability. The Impella (Abiomed), a percutaneous microaxial, continuous-flow, short-term ventricular assist device, requires meticulous postimplantation management to avoid the 2 most frequent complications, namely, bleeding and hemolysis. A standardized approach to the prevention, detection, and treatment of these complications is mandatory to improve outcomes. The risk for hemolysis is mostly influenced by pump instability, resulting from patient- or device-related factors. Upfront echocardiographic assessment, frequent monitoring, and prompt intervention are essential. The precarious hemostatic balance during pVAD support results from the combination of a procoagulant state, due to critical illness and contact pathway activation, together with a variety of factors aggravating bleeding risk. Preventive strategies and appropriate management, adapted to the impact of the bleeding, are crucial. This review offers a guide to physicians to tackle these device-related complications in this critically ill pVAD-supported patient population.
Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support: A Practical Approach / Van Edom, C. J.; Gramegna, M.; Baldetti, L.; Beneduce, A.; Castelein, T.; Dauwe, D.; Frederiks, P.; Giustino, G.; Jacquemin, M.; Janssens, S. P.; Panoulas, V. F.; Poss, J.; Rosenberg, A.; Schaubroeck, H. A. I.; Schrage, B.; Tavazzi, G.; Vanassche, T.; Vercaemst, L.; Vlasselaers, D.; Vranckx, P.; Belohlavek, J.; Gorog, D. A.; Huber, K.; Mebazaa, A.; Meyns, B.; Pappalardo, F.; Scandroglio, A. M.; Stone, G. W.; Westermann, D.; Chieffo, A.; Price, S.; Vandenbriele, C.. - In: JACC: CARDIOVASCULAR INTERVENTIONS. - ISSN 1936-8798. - 16:14(2023), pp. 1707-1720. [10.1016/j.jcin.2023.05.043]
Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support: A Practical Approach
Pappalardo F.;Chieffo A.;
2023-01-01
Abstract
Percutaneous ventricular assist devices (pVADs) are increasingly being used because of improved experience and availability. The Impella (Abiomed), a percutaneous microaxial, continuous-flow, short-term ventricular assist device, requires meticulous postimplantation management to avoid the 2 most frequent complications, namely, bleeding and hemolysis. A standardized approach to the prevention, detection, and treatment of these complications is mandatory to improve outcomes. The risk for hemolysis is mostly influenced by pump instability, resulting from patient- or device-related factors. Upfront echocardiographic assessment, frequent monitoring, and prompt intervention are essential. The precarious hemostatic balance during pVAD support results from the combination of a procoagulant state, due to critical illness and contact pathway activation, together with a variety of factors aggravating bleeding risk. Preventive strategies and appropriate management, adapted to the impact of the bleeding, are crucial. This review offers a guide to physicians to tackle these device-related complications in this critically ill pVAD-supported patient population.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
