**2. Complications**

The complications related to the different assistance systems are numerous [11, 28, 29]:


infectious complications are the most serious with 41% of deaths linked to sepsis [30]. Continuous-flow turbine systems have a clearly lower complication rate (infections, thromboses, mechanical problems) than pulsatile systems [31].

There are basically three disadvantages of continuous flow systems:


**315**

**Author details**

**3. Conclusion**

Mleyhi Sobhi\*, Miri Rim and Denguir Raouf

provided the original work is properly cited.

Hospital, University of Tunis el Manar, Tunisia

ventricular assist devices with fewer complications.

\*Address all correspondence to: mleyhisobhi@yahoo.com

Cardiovascular Surgery Department, Faculty of Medicine of Tunis, La Rabta

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Complications of Minimally Invasive Left Ventricular Assistance Device Implantation*

can give rise to thrombi, with the risk of systemic embolization.

tion and antiplatelet therapy alone may sometimes be sufficient [39].

• The continuous flow causes stasis in the aortic valve if it no longer opens; this

Thrombosis of the ventricular assist device (VAD) is associated with significant morbidity and mortality, usually requiring device replacement. Since 2011, there has been a sharp increase in the incidence of VAD thrombosis, from 2.2% before 2011 to 8.4% in 2013 [32]. The exact reason for this increase is unknown and numerous studies aim to identify it [33]. Diagnostic markers, including increased plasma lactate dehydrogenase (LDH), free plasma hemoglobin, or abnormal responses to programmed increases in pump speed (ramp test) [34] should allow early and more

The formation of thrombi in the aortic root in patients implanted with HeartMate II has been previously reported in the literature [36, 37]. The flow in the root of the aorta in patients with continuous flow LVAD has been shown experimentally to be relatively stagnant, especially when the aortic valve does not open [38] and such stasis often involves the non-coronary sinus and can be an important risk factor for thrombosis. Sachin Shah and colleagues [39] report a case of occlusion of the left common coronary trunk by aortic root thrombus in a patient with HeartMate II. The optimal strategy for the prevention of this complication is not yet well defined; however, special attention to anticoagulation and antiplatelet therapy in the postoperative period, as well as adjusting the pump speed to allow intermittent opening of the aortic valve may be important considerations. For those who develop an aortic root thrombus, but remain asymptomatic, intensification of anticoagula-

In conclusion, with the limited number of organ donors, long-term ventricular

Minimally invasive alternative approaches for implantation or explantation of left ventricular assist devices have become valid and reproducible. Nevertheless, complications, in particular thromboembolic still serious. Only multidisciplinary work associating surgeon, cardiologist and anesthetist with perfect knowledge of the management of these patients and these machines can prevent complications abd death.

support systems are slowly becoming an alternative to heart transplantation. Significant technical advances have allowed the development of small, space-saving

*DOI: http://dx.doi.org/10.5772/intechopen.95638*

accurate diagnosis. [35].

*Complications of Minimally Invasive Left Ventricular Assistance Device Implantation DOI: http://dx.doi.org/10.5772/intechopen.95638*

• The continuous flow causes stasis in the aortic valve if it no longer opens; this can give rise to thrombi, with the risk of systemic embolization.

Thrombosis of the ventricular assist device (VAD) is associated with significant morbidity and mortality, usually requiring device replacement. Since 2011, there has been a sharp increase in the incidence of VAD thrombosis, from 2.2% before 2011 to 8.4% in 2013 [32]. The exact reason for this increase is unknown and numerous studies aim to identify it [33]. Diagnostic markers, including increased plasma lactate dehydrogenase (LDH), free plasma hemoglobin, or abnormal responses to programmed increases in pump speed (ramp test) [34] should allow early and more accurate diagnosis. [35].

The formation of thrombi in the aortic root in patients implanted with HeartMate II has been previously reported in the literature [36, 37]. The flow in the root of the aorta in patients with continuous flow LVAD has been shown experimentally to be relatively stagnant, especially when the aortic valve does not open [38] and such stasis often involves the non-coronary sinus and can be an important risk factor for thrombosis. Sachin Shah and colleagues [39] report a case of occlusion of the left common coronary trunk by aortic root thrombus in a patient with HeartMate II.

The optimal strategy for the prevention of this complication is not yet well defined; however, special attention to anticoagulation and antiplatelet therapy in the postoperative period, as well as adjusting the pump speed to allow intermittent opening of the aortic valve may be important considerations. For those who develop an aortic root thrombus, but remain asymptomatic, intensification of anticoagulation and antiplatelet therapy alone may sometimes be sufficient [39].

### **3. Conclusion**

In conclusion, with the limited number of organ donors, long-term ventricular support systems are slowly becoming an alternative to heart transplantation. Significant technical advances have allowed the development of small, space-saving ventricular assist devices with fewer complications.

Minimally invasive alternative approaches for implantation or explantation of left ventricular assist devices have become valid and reproducible. Nevertheless, complications, in particular thromboembolic still serious. Only multidisciplinary work associating surgeon, cardiologist and anesthetist with perfect knowledge of the management of these patients and these machines can prevent complications abd death.

## **Author details**

Mleyhi Sobhi\*, Miri Rim and Denguir Raouf Cardiovascular Surgery Department, Faculty of Medicine of Tunis, La Rabta Hospital, University of Tunis el Manar, Tunisia

\*Address all correspondence to: mleyhisobhi@yahoo.com

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
