Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support: A Practical Approach.

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.

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Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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Funding Support and Author Disclosures Drs Vandenbriele, Baldetti, Chieffo, Dauwe, Meyns, Panoulas, Pappalardo, Rosenberg, Scandroglio, Schaubroeck, Schrage, Stone, Vlasselaers, and Westermann have received research and/or travel funding and speaker fees from Abiomed outside this work. Drs Vandenbriele and Dauwe are supported by a grant from University Hospitals Leuven (Klinische Onderzoeks-en Opleidingsraad). Dr Beneduce has received speaker fees from Boston Scientific. Dr Chieffo has received consultant and speaker fees from Biosensor, Boston Scientific, Medtronic, Menarini, and Shockwave Medical. Dr Gorog has received speaker honoraria from AstraZeneca; and has received institutional research grants from Bayer, Medtronic, AstraZeneca, Werfen and Alpha MD. Dr Huber has received honoraria for consulting and lecturing from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Chiesi, Daiichi Sankyo, Novartis, Pfizer, and Sanofi. Dr Pöss has received research funding from the German Cardiac Society, the German Foundation of Heart Research, and the Dr Rolf M. Schwiete Foundation. Dr Schrage has received speaker fees from AstraZeneca. Dr Stone has received speaker honoraria from Medtronic, Pulnovo, Infraredx, and Abbott; has served as a consultant to Daiichi Sankyo, Valfix, TherOx, Robocath, HeartFlow, Ablative Solutions, Vectorious, Miracor, Neovasc, Ancora, Elucid Bio, Occlutech, CorFlow, Apollo Therapeutics, Impulse Dynamics, Cardiomech, Gore, Amgen, Adona Medical, Millennia Biopharma; and has equity or options in Ancora, Cagent, Applied Therapeutics, the Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, Valfix, and Xenter. Dr Stone’s daughter is an employee of IQVIA. Dr Stone’s employer, Mount Sinai Hospital, has received research support from Abbott, Abiomed, Bioventrix, Cardiovascular Systems, Philips, Biosense Webster, Shockwave, Vascular Dynamics, Pulnovo, and V-Wave. Dr Vranckx has received personal fees from Bayer, Daiichi Sankyo, CLS Behring, Pfizer–Bristol Myers Squibb, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.