Is hemolysis a predictor of complications in patients implanted with a left ventricular assist device?

• DOI: 10.5455/azjcvs.2024.02.05
• Publication Date: 2024-03-23T15:56:17Z
• Authors: Veli Tackin; Ilhan Golbasi; Unal Atas; Ismail Kakillioglu; Ersin Ozer; Rauf Onder; Sebahat Ozdem; Ikbal Kucukcetin; Omer Bayezid

Aim: Life-threatening complications such as intra-device thrombus, infection, bleeding, kidney and liver failure are frequently encountered due to the use of left ventricular assist devices (LVADs). We aimed to determine the incidence of hemolysis in patients implanted with LVAD, the mechanical complications detected in patients with hemolysis, and whether hemolysis can be used as a predictor of complications. Material and Methods: In this single-center, retrospective clinical research study, we evaluated 40 patients with HeartWare (HeartWare International, Inc., MA, USA) LVAD implants to assess the incidence of hemolysis and its association with mechanical complications. Hemolysis parameters, including lactate dehydrogenase (LDH), bilirubin, serum-free hemoglobin (sfHg), corrected reticulocyte count (CRC), and haptoglobin, were measured in venous blood samples obtained from patients attending cardiovascular outpatient clinics. Patients were divided into two groups( group 1:without hemolysis,n=32; group 2: with hemolysis,n=8) based on the presence or absence of hemolysis, and demographic data, comorbidities, and laboratory results were compared. The time elapsed after implantation of the patients was min: 90 days, max: 3147 days. Results: Hemolysis was detected in 20% (8 out of 40) of the patients included in the study. Patients with hemolysis demonstrated higher CRC, LDH, and total bilirubin levels(p<0,005), and lower haptoglobin levels compared to those without hemolysis(p<0,001). Intra-device thrombus was detected as a mechanical complication in 2 patients with hemolysis. One patient died and the other was discharged after medical treatment. Conclusion: Our findings suggest that routine monitoring of hemolysis parameters in LVAD recipients may aid in the early detection of mechanical complications, such as pump thrombosis, before symptomatic manifestation, thus potentially reducing mortality. Assessing multiple parameters, including LDH, bilirubin, sfHg, CRC, and haptoglobin, is crucial for accurate hemolysis diagnosis and its association with mechanical complications. It should be supported by large series of studies with longer and similar follow-up periods and a larger number of patients.