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Title: | Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support | Authors: | Van Edom, Charlotte J. Gramegna, Mario Baldetti, Luca Beneduce, Alessandro Castelein, Thomas Dauwe , Dieter Frederiks, Pascal Giustino, Gennaro Jacquemin, Marc Janssens, Stefan P. Panoulas, Vasileios F. Poess, Janine Rosenberg, Alexander Schaubroeck, Hannah A. I. Schrage, Benedikt Tavazzi, Guido Vanassche, Thomas Vercaemst, Leen Vlasselaers, Dirk VRANCKX, Pascal Belohlavek, Jan Gorog, Diana A. Huber, Kurt Mebazaa, Alexandre Meyns, Bart Pappalardo, Federico Scandroglio, Anna M. Stone, Gregg W. Westermann, Dirk Chieffo, Alaide Price, Susanna Vandenbriele, Christophe |
Issue Date: | 2023 | Publisher: | ELSEVIER SCIENCE INC | Source: | JACC-Cardiovascular Interventions, 16 (14) , p. 1707 -1720 | 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 echocar-diographic 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.(c) 2023 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). | Notes: | Vandenbriele, C (corresponding author), Univ Hosp Leuven, Dept Cardiovasc Dis, Herestr 49, B-3000 Leuven, Belgium.; Vandenbriele, C (corresponding author), Guys & St Thomas NHS Fdn Trust, Guys & St ThomasNHS Fdn Trust, Dept Cardiol & Crit Care, London, England. christophe.vandenbriele@uzleuven.be |
Keywords: | bleeding;hemolysis;management;pVAD | Document URI: | http://hdl.handle.net/1942/42402 | ISSN: | 1936-8798 | e-ISSN: | 1876-7605 | DOI: | 10.1016/j.jcin.2023.05.043 | ISI #: | 001149781300001 | Rights: | 2023 THE AUTHORS. PUBLISHED BY EL SEVIER ON BEHALF OF THE AMERICAN COLLEGE OF CARDIOLOGY FO UNDATION. THIS IS AN OPEN ACCESS ARTICLE UNDER THE CC BY LICENSE ( http://creativecommons.org/licenses/by/4.0/ ) . | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support.pdf | Published version | 3.01 MB | Adobe PDF | View/Open |
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