Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support: A Practical Approach.
JACC Cardiovasc Interv
; 16(14): 1707-1720, 2023 07 24.
Article
en En
| MEDLINE
| ID: mdl-37495347
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.
Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Corazón Auxiliar
/
Intervención Coronaria Percutánea
Tipo de estudio:
Etiology_studies
Límite:
Humans
Idioma:
En
Año:
2023
Tipo del documento:
Article