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