%0 Journal Article
%T An acoustic method for systematic ventricular assist device thrombus evaluation with a novel artificial thrombus model
%A Alexander Stomps
%A Anamika Chatterjee
%A Axel Haverich
%A Birgit Glasmacher
%A Christina Feldmann
%A Ezin Deniz
%A G¨šnes Dogan
%A Jan D. Schmitto
%A Jasmin S. Hanke
%A L. Christian Napp
%A Regina Wendl
%A Sara Knigge
%J SCIE-indexed Journal
%D 2018
%R 10.21037/jtd.2018.04.11
%X Mechanical circulatory support with left ventricular assist devices (LVADs) is a state of the art therapy for the treatment of end stage heart failure, either as bridge-to-transplantation or as a destination therapy. Pump technology development over the years from pulsatile pumps to continuous flow devices has led to improved outcomes. Nevertheless infection, stroke and pump thrombosis (PT) remain important limitations in long-term LVAD support (1,2). Improved clinical management (3-5), innovative surgical techniques (6-8) as well as third generation pump designs including contactless suspension of the rotor (9-11) were important improvements but could not eliminate PT. The introduction of foreign material to the human body in combination with non-physiologic flow conditions can lead to activation of coagulation, and subsequently increase the risk of thrombus formation depending on patient-specific and management-specific factors (12,13). Thrombus deposits, consisting mainly of fibrin and platelets, can be found inside the device (inflow cannula, outflow graft or pump cavity) and contribute to a loss of performance. VAD thrombosis can result in significant hemolysis, stroke, decreased pump performance and hence insufficient ventricular support. Since medical therapy such as thrombolysis is often ineffective, advanced PT in patients routinely calls for risky and expensive pump replacement surgery. During replacement surgery an exchange from one to another LVAD type is feasible (14,15), in order to ensure that the patient is supported with the newest pump technology. Nevertheless, pump exchange carries the inherent risk of highly invasive open heart surgery and does not guarantee freedom of PT. Early diagnosis of PT is therefore critical to allow for timely non-invasive therapeutic interventions such as thrombolysis. Currently PT is often indirectly detected by elevated VAD power consumption and pathological laboratory parameters when thrombus consolidates in the pump (16-18). Innovative diagnostic methods such as acoustic spectrum-based thrombus detection are now being introduced into clinical care with promising preliminary results (19,20). However, in vitro studies are required to verify and validate their specificity and sensitivity under standardized conditions. Such studies require robust, reproducible and easily available thrombus models, which accurately simulate acoustic properties of physiological thrombus conditions
%U http://jtd.amegroups.com/article/view/20789/html