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World J Cardiol. Jul 26, 2020; 12(7): 334-341
Published online Jul 26, 2020. doi: 10.4330/wjc.v12.i7.334
Comprehensive review of hemolysis in ventricular assist devices
Christos A Papanastasiou, Konstantinos G Kyriakoulis, Christina A Theochari, Damianos G Kokkinidis, Theodoros D Karamitsos, Leonidas Palaiodimos
Christos A Papanastasiou, Theodoros D Karamitsos, 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki 54621, Greece
Konstantinos G Kyriakoulis, 3rd Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
Christina A Theochari, Department of Internal Medicine, Messinia General Hospital, Kalamata 24100, Greece
Damianos G Kokkinidis, Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, United States
Leonidas Palaiodimos, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, United States
Author contributions: All authors contributed equally to this manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with the contributions of the senior author or other coauthors to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Leonidas Palaiodimos, MD, MSc, Assistant Professor, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10461, United States. palaiodimosmd@gmail.com
Received: February 4, 2020
Peer-review started: February 4, 2020
First decision: March 24, 2020
Revised: May 2, 2020
Accepted: May 27, 2020
Article in press: May 27, 2020
Published online: July 26, 2020
Abstract

Ventricular assist devices (VADs) have played an important role in altering the natural history of end-stage heart failure. Low-grade hemolysis has been traditionally described in patients with VADs, indicating effective device functionality. However, clinically significant hemolysis could be crucial in terms of prognosis, calling for prompt therapeutic actions. The absence of solid and widely approved diagnostic criteria for clinically significant hemolysis, render the utilization of hemolysis laboratory markers challenging. Hemolysis incidence varies (5%-18%) depending on definition and among different VAD generations, being slightly higher in continuous-flow devices than in pulsatile devices. Increased shear stress of red blood cells and underlying device thrombosis appear to be the main pathogenetic pathways. No certain algorithm is available for the management of hemolysis in patients with VADs, while close clinical and laboratory monitoring remains the cornerstone of management. Imaging examinations such as echocardiography ramp test or computed tomography scan could play a role in revealing the underlying cause. Treatment should be strictly personalized, including either pharmacological (antithrombotic treatment) or surgical interventions.

Keywords: Ventricular assist device, Hemolysis, Thrombosis

Core tip: Ventricular assist devices are essential in end-stage heart failure management. Severe hemolysis can be a significant complication, leading to increased mortality and worse outcomes. The incidence of hemolysis varies (5%-18%) depending on different definitions of hemolysis and among different ventricular assist device generations. The main pathogenetic mechanisms include increased red blood cell shear stress or underlying device thrombosis. A personalized approach is crucial in the absence of certain algorithms for the management of this complication. Close clinical and laboratory monitoring in combination with imaging examinations could play a role in revealing the underlying cause. Treatment includes pharmacological (antithrombotic treatment) or surgical interventions.