Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support A Practical Approach

Charlotte J. Van Edom, Mario Gramegna, Luca Baldetti, Alessandro Beneduce, Thomas Castelein, Dieter Dauwe, Pascal Frederiks, Gennaro Giustino, Marc Jacquemin, Stefan P. Janssens, Vasileios F. Panoulas, Janine Pöss, Alexander Rosenberg, Hannah A.I. Schaubroeck, Benedikt Schrage, Guido Tavazzi, Thomas Vanassche, Leen Vercaemst, Dirk Vlasselaers, Pascal VranckxJan Belohlavek, Diana A. Gorog, Kurt Huber, Alexandre Mebazaa, Bart Meyns, Federico Pappalardo, Anna M. Scandroglio, Gregg W. Stone, Dirk Westermann, Alaide Chieffo, Susanna Price, Christophe Vandenbriele

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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.
Original languageEnglish
Pages (from-to)1707-1720
Number of pages14
JournalJACC: Cardiovascular Interventions
Volume16
Issue number14
Early online date24 Jul 2023
DOIs
Publication statusPublished - 24 Jul 2023

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