Clare Wood

Successful treatment of rotary pump thrombus with the glycoprotein IIb/IIIa inhibitor tirofiban.

Despite advances in blood pump technology, thrombus formation within left ventricular assist devices (LVADs) is a life-threatening complication with few therapeutic options. A 38-year-old woman who underwent rotary LVAD implantation as a bridge to cardiac transplant developed labile flows (4 to >10 liters), associated with power spikes (4 to 12 watts) and an increase in plasma free hemoglobin (0.86 g/liter), consistent with pump thrombus at Day 140 post-LVAD implantation, despite thromboprophylaxis with aspirin and warfarin. Within 12 hours of commencing an intravenous infusion of tirofiban at a rate of 0.1 mug/kg/min, there were signs of improvement of pump dysfunction, and complete resolution was evident at Day 4 with, stable flows, power consumption and normalization of plasma free hemoglobin. Tirofiban may be considered as an alternative thrombolytic treatment strategy in rotary pump thrombus to avoid the need for LVAD replacement.

First Successful Bridge to Myocardial Recovery With a HeartWare HVAD

In this report we describe the first successful bridge to myocardial recovery with the HeartWare HVAD. Assessment for explantation included serial echocardiography, hemodynamic monitoring, metabolic analysis and manipulation of pump speed, both at rest and during exercise. A protocol for assessing the degree of myocardial recovery without stopping the device is described.

Successful Heart Transplant after Ten Hours Out-of-body Time using the TransMedics Organ Care System

OBJECTIVE We report the successful transplantation of a heart following an out-of-body time of 611 minutes into a recipient with dilated cardiomyopathy and left ventricular assist device implant. PATIENTS Our patient was urgently waiting for a cardiac transplant whilst receiving LVAD support. Recurrent VF and repeated AICD shocks necessitated this action. RESULTS Although requiring ECMO and inotropic support in the first 17 hours post-transplant, the patient was discharged from hospital on day 15 post-transplant with normal cardiac function. CONCLUSION We report some of the salient points of the process and discuss the utility of this technology to an Australian transplant unit.