Hemolysis during short-term mechanical circulatory support: from pathophysiology to diagnosis and treatment.

INTRODUCTION: Despite advances in heart failure therapies and percutaneous coronary interventions, survival for cardiogenic shock remains poor. Percutaneous ventricular assist devices (pVAD) are increasingly used, but current evidence remains conflicting. The Impella is an example of such a device, based on a catheter mounted micro-axial continuous flow pump, that has been rapidly adopted in routine practice. An important aspect of postimplantation care is the prevention of complications. Hemolysis is one of the most frequent complications seen with this device.

AREAS COVERED: In this review, we discuss the pathophysiology, diagnosis and treatment of hemolysis in patients supported with a pVAD. A practical algorithm for rapid identification of hemolysis and the underlying cause is presented, allowing for early treatment and prevention of further complications.

EXPERT OPINION: Hemolysis remains a threat to patients supported with any mechanical circulatory support device. Prevention as well as treatment demands for sufficient knowledge about the device, the optimal position, and hemodynamics. Future studies should try to clarify some of the elements that are still unclear, such as optimal anticoagulation, the location of pentoxifylline, or extracorporeal removal of free hemoglobin. This could help to optimize outcomes in clinical practice as well as future studies.