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Pump Thrombosis

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Book cover Mechanical Circulatory Support in End-Stage Heart Failure

Abstract

Pump thrombosis is one of the most severe adverse events in the use of ventricular assist device (VAD) systems. The blood coagulation system is activated by all VAD systems via several mechanisms. The blood contact to the artificial materials of VAD pumps and cannulas triggers the coagulation cascade as well as high shear stress due to high flow velocities, small gaps, or high-speed moving parts (the impeller of rotary blood pumps) [1]. Areas of flow stagnation represent preferred thrombus developing sites as well as areas with recirculation vortices. Heat spots, e.g., produced by mechanical bearings, often are subjected to thrombus buildup when low-flow situations impair washout and thus the necessary cooling. To prevent thrombosis careful consideration of the three following factors in the use of VAD is important:

  • Low activation of the coagulation system by a good hydrodynamic design. This also applies to running the device in the specified optimal range of operation.

  • A good washout. Kinks and other causes obstructing the flow path like cannula malposition have to be avoided. A small clearance of the apical inflow cannula to the ventricle wall will likely promote the risk of wedge thrombus genesis.

  • Sufficient anticoagulation and anti-aggregation therapy are most important [2].

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Author information

Authors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany

    E. Potapov & F. Kaufmann

  2. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy

    A. M. Scandroglio & M. Pieri

Authors
  1. E. Potapov
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  2. F. Kaufmann
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  3. A. M. Scandroglio
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  4. M. Pieri
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Corresponding author

Correspondence to E. Potapov .

Editor information

Editors and Affiliations

  1. San Camillo-Forlanini Hospital, Rome, Italy

    Andrea Montalto

  2. Cardiac Surgery, S.Orsola-Malpighi Hospital, Bologna, Italy

    Antonio Loforte

  3. San Camillo-Forlanini Hospital, Rome, Italy

    Francesco Musumeci

  4. Deutsches Herzzentrum Berlin, Berlin, Germany

    Thomas Krabatsch

  5. Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky, USA

    Mark S. Slaughter

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© 2017 Springer International Publishing Switzerland

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Potapov, E., Kaufmann, F., Scandroglio, A.M., Pieri, M. (2017). Pump Thrombosis. In: Montalto, A., Loforte, A., Musumeci, F., Krabatsch, T., Slaughter, M. (eds) Mechanical Circulatory Support in End-Stage Heart Failure. Springer, Cham. https://doi.org/10.1007/978-3-319-43383-7_48

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  • DOI: https://doi.org/10.1007/978-3-319-43383-7_48

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43381-3

  • Online ISBN: 978-3-319-43383-7

  • eBook Packages: MedicineMedicine (R0)

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