Comprehensive review of hemolysis in ventricular assist devices

Table 1 Basic characteristics of different types of left ventricular assist devices

Type of LVAD	Example	Pump design	Characteristics	Hemolysis
First-generation	HeartMate I	Pulsatile flow	Larger blood contacting surfaces, multiple moving parts	Increase
Second-generation	HeartMate II	Continuous – axial flow	Smaller size	Increase
Third-generation	HeartWare	Continuous – centrifugal flow	Noncontact bearing (magnetic levitation)	Increase

LVAD: Left ventricular assist device.

Table 2 Baseline characteristics, demographics and results of studies investigating hemolysis in left ventricular assist devices

Ref.	Study design	Device	No of patients	Definition of hemolysis	Outcome	Resulta
Xia et al[37], 2019	Retrospective (data obtained from the INTERMACS registry 2012-2013)	Continuous flow LVADs	1116	NA	Short-term survival (< 3 yr)	aOR: 3.57 (1.84-6.93)
Katz et al[5], 2015	Retrospective (data obtained from the INTERMACS registry 2006-2012)	Continuous flow LVADs	4850	PfHg > 40 mg/dL and clinical signs of hemolysis	Mortality (mean of follow-up: 11.1 mo)	OR: 1.19 (1.146-2.52)
Ravichandran et al[10], 2014	Retrospective	HeartMate II	100	Hgb < 10 g/dL, haptoglobin < 8 g/dL and LDH > 250 U/L	1-yr mortality	OR: 11.3 (3.56-35.93)
Cowger et al[30], 2014	Retrospective	HeartMate II	182	SfHg > 40 mg/dL and clinical signs of hemolysis	1-yr mortality	HR: 4.3 (2.1-8.9)

^aThe numbers in parentheses indicate 95% confidence interval. aOR: Adjusted odds ratio; LVAD: Left ventricular assist device; HMII: HeartMate II; PsHg: Plasma-free hemoglobin; sfHg: Serum-free hemoglobin.