Authors

• Jure Samardžić — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-9346-6402
• Marijan Pašalić — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-3197-2190
• Ivo Planinc — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-0561-6704
• Hrvoje Gašparović — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-2492-3702
• Dora Fabijanović — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-2633-3439
• Mate Petričević — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-2083-7751
• Maja Čikeš — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-4772-5549
• Boško Skorić — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-5979-2346
• Bojan Biočina — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-3362-9596
• Davor Miličić — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-9101-1570

Keywords

heart failure, mechanical circulatory support, platelet reactivity, outcomes

DOI

Full Text

**Introduction:** Long term mechanical circulatory support (MCS) is intended for heart failure patients who are not eligible for heart transplantation or who cannot wait for adequate donor due to severity of their condition. It is known that hemostasis in these patients is deranged and that significant number of patients develop bleeding and thromboembolic events. Development of adequate and reliable models which could predict these events might improve treatment and outcomes of patients. MCS, as well as heart failure, affects platelet reactivity (PR) which have an important role in hemostatic balance. (1, 2) We sought to investigate correlation between PR before MCS implantation and long term clinical outcomes. **Patients and Methods:** We analyzed PR before implantation using Multiplate function analyzer (ASPI and ADP tests) in patients who underwent long term MCS implantation in our institution. Measurement was performed in 19 patients (12 HeartMate II, 4 HeartMate III, 2 HeartWare, 1 TAH Syncardia) who underwent the procedure in the period between July 2013 and February 2016. Median follow up was 11 months, mean 13.7 months (range 1-31 months). We analyzed correlation between PR and overall mortality, as well as ischemic and big bleeding events after the surgical treatment has ended. **Results:** In total, 9 patients died (47.3%), 6 patients had significant bleeding (31.5%) while 3 patients had an ischemic event (15.7%). There was no statistically significant correlation between preimplantation PR and overall mortality, ischemic and bleeding events (**Figure 1**). Figure 1. Preimplantation platelet reactivity affects on clinical outcomes. **Conclusion:** Results indicate that preimplantation PR is not connected with mortality, nor bleeding and ischemic events. Further investigations on a larger number of patients are warranted to confirm these results. Future studies should be using comprehensive analysis not only to measure platelet activation pathways but other coagulation parameters as well continuously, to eventually improve prediction and prevention of events in both short term and long term period after MCS implantation.

Literature

1. Draper KV, Huang RJ, Gerson LB. GI bleeding in patients with continuous-flow left ventricular assist devices: a systematic review and meta-analysis. Gastrointest Endosc. 2014;80(3):435–46e1. https://doi.org/10.1016/j.gie.2014.03.040
2. Lahpor J, Khaghani A, Hetzer R, Pavie A, Friedrich I, Sander K, et al. European results with a continuous-flow ventricular assist device for advanced heart-failure patients. Eur J Cardiothorac Surg. 2010;37(2):357–61. https://doi.org/10.1016/j.ejcts.2009.05.043