Blood Pressure Control in Continuous Flow Left Ventricular Assist Devices: Efficacy and Impact on Adverse Events

HeartMate 3—a “Step” in the right direction

“…Additionally, strict blood pressure control is increasingly recognized as a therapeutic goal to reduce the rates of hemorrhagic and embolic stroke (20,21). Will a more focused effort on blood pressure control also improve pulsatility, thereby preventing both GI bleeding and the development of aortic insufficiency?…”

Physiological Impact of Continuous Flow on End-Organ Function: Clinical Implications in the Current Era of Left Ventricular Assist Devices

“…Though high blood pressure is thought to perpetuate afterload for the pump and has been suggested to contribute to neurological events, recent data from an aggressive blood pressure control protocol using home Doppler blood pressure measurements showed that patients not on any antihypertensive medications had a higher incidence of neurological adverse events compared to those on medications. 20 In fact, despite the fact that the blood pressure was higher in the group on ≥ 2 medications compared to the other groups, there was no increase in neurologic events. Such findings suggest a role of hypoperfusion in cerebral accidents in CF-LVAD patients.…”

“…9 Lack of renal autoregulation at lower flows and hypoperfusion of the kidneys has also been suggested based on observations that at 1 month post-implant, patients who are not on any antihypertensive medications had lower blood pressure and lower creatinine clearance compared to those on medications. 20 …”

Continuous Flow Left Ventricular Assist Devices: Shared Care Goals of Monitoring and Treating Patients

“…Of these, 88% required one or two antihypertensive medications, with no difference between axial and centrifugal flow devices in the percentage of those requiring BP mediations. 8 The early initiation of betaadrenergic receptor blockade in patients with a preimplant history of ventricular tachycardia or with early postimplant suture noted reflective of a recent implant (left in place for ~ 3 months); (C) mild to moderate redness with associated drainage (dry/crusted) around the exit site; and (D) extensive redness extending beyond the exit site consistent with cellulitis; typically associated with tenderness. houstonmethodist.org/debakey-journal supraventricular tachycardia or ventricular tachycardia can be helpful.…”