Correlation of Pre-Explant Lactate Dehydrogenase Concentrations and Findings During Post-Explant Pump Analysis of the HeartMate II Left Ventricular Assist Device. Ann Thorac Surg 2017 Apr;103(4):1207-1213
Date
10/17/2016Pubmed ID
27743635DOI
10.1016/j.athoracsur.2016.07.073Scopus ID
2-s2.0-85008627448 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
BACKGROUND: Analyses of the HeartMate II left ventricular assist device are routinely performed after explant if returned to the manufacturer. Findings from manufacturer-reported pump analyses have not been correlated with pre-explant serum lactate dehydrogenase (LDH) values.
METHODS: Between May 2004 and December 2014, 502 patients underwent primary HeartMate II implantation. Seventy pumps were explanted in 58 patients and returned to the manufacturer for pump analysis: 51 (73%) for suspected pump thrombosis, 12 (17%) for device-related infection, and 7 (13%) for percutaneous lead fracture. Median time from implant to explant was 12.4 months (range, 1 to 57 months).
RESULTS: Pump thrombus was confirmed in 53 of 70 pumps (76%). Stratified by major clinical indications for explant of suspected pump thrombus or infection and lead fracture, the presence of pump thrombus was identified in 47 of 51 (92%) and 6 of 19 (32%), respectively. The median of 1) all LDH values, 2) maximum LDH values, and 3) interval change in LDH between 6 and 2 months before device explant were 1,061, 1,940, and -27 IU/L with thrombus present and 533, 504, and 13 IU/L in the absence of thrombus. Density estimation of LDH concentrations identified that a LDH value of 1,155 IU/L in the 6 months preceding pump thrombus had a 78% sensitivity and 90% specificity for findings of pump thrombus at the time of pump analysis.
CONCLUSIONS: Pre-explant LDH concentrations significantly correlated with findings on manufacture-performed pump analysis. These data validate LDH surveillance as an important clinical tool for identification of pump thrombus.
Author List
Sood V, Alam O, Tchantchaleishvili V, Pagani FD, Aaronson KD, Haft J, Joyce DL, Joyce LD, Daly RC, Maltais S, Stulak JMMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Cohort Studies
Device Removal
Equipment Failure Analysis
Female
Heart Failure
Heart-Assist Devices
Humans
L-Lactate Dehydrogenase
Male
Middle Aged
Reproducibility of Results
Thrombosis
Young Adult
