Subscribe to RSS
DOI: 10.1055/s-2005-862112
Coagulation management and mechanical circulatory support: a comparison of different devices
Objectives: With increased use of axial flow ventricular assist devices, a higher thrombogenicity has been assumed. We aimed to compare the bleeding and thromboembolic complications of patients on pulsatile and axial flow systems.
Material and Methods: The last 40 patients supported by pulsatile systems (Group A: 20 Novacor, 20 Berlin Heart Excor) were compared with 40 patients on axial flow pumps (Group B: 20 DeBakey, 20 Berlin Heart Incor) implanted between 06/2000 and 08/2004. The groups were comparable; mean age was 52 years (3 months –77 years). Average support time was 118 days (1–1524 days). The groups were treated with a similar anticoagulation concept.
Results: In group A bleeding complications were seen in 15% of patients and re-exploration of the chest in 10%. Cerebral hemorrhage occurred in 5%. In group B 35% presented bleeding complications (α=7.7%) with re-exploration in 7.5% and cerebral hemorrhage in 12.5%.
Thromboembolic events occurred in group A in 17.5% of patients, with stroke in 15%. In Group B passage of thrombi through the pump was observed in 37.5% of patients, 25% had embolic complications and 15% presented stroke.
Conclusions: Axial flow ventricular assist devices have been in clinical use for 4 years, so that this report reflects the early experience. Embolic and bleeding complications were seen in all groups of patients without significant differences, although there was a trend towards a higher incidence of complications in the axial flow pump groups. Nevertheless, all systems (pulsatile and axial flow pumps) can be used with an acceptable incidence of bleeding and embolic complications.