2014
DOI: 10.1007/s11748-014-0480-0
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Clinical management for complications related to implantable LVAD use

Abstract: More than 250 continuous flow LVADs have been implanted in Japan during the last 3 years, with 1-year survival rates of 90%. These excellent results cannot be achieved without VAD teams who know the detail of surgical techniques and perioperative management. Preoperative optimization of RV function is essential and intraoperative managements are focused on adequate balance between right and left ventricle to prevent right ventricular (RV) failure. For postoperative RV failure early institution of temporary RV … Show more

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Cited by 42 publications
(30 citation statements)
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“…Anticoagulation therapy is nearly universally required for continuous‐flow devices to prevent in situ device thrombus formation and cardioembolic phenomena . Anticoagulation is often initiated 1 day after surgery and when platelet counts are normal . International normalized ratio (INR) and platelet counts should be carefully monitored.…”
Section: Discussionmentioning
confidence: 99%
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“…Anticoagulation therapy is nearly universally required for continuous‐flow devices to prevent in situ device thrombus formation and cardioembolic phenomena . Anticoagulation is often initiated 1 day after surgery and when platelet counts are normal . International normalized ratio (INR) and platelet counts should be carefully monitored.…”
Section: Discussionmentioning
confidence: 99%
“…LVAD thrombosis risk is predicted to be 2% , with a rate of thrombosis reported as 0.02 to 0.03 event per patient‐year and a rate of ischemic stroke of 0.06 to 0.13 event per patient‐year . Stroke should be suspected clinically if patients complain of new onset of headaches, nausea, vomiting, or sensory or motor changes or appear to have an altered mental status . If ischemic stroke is discovered, then the INR should be optimized .…”
Section: Discussionmentioning
confidence: 99%
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“…Also, RV dimension and motion or inferior vena cava diameter were regularly evaluated using echocardiography. Furthermore, we performed standard strategies for treatment of RVF after LVAD implantation as follows: (i) maintained optimal preload by preventing excess infusion or LVAD flow and aggressive diuretic therapy, ultrafiltration, and intra-aortic balloon pumping (IABP); (ii) reduced afterload routinely using NO inhalation and a pulmonary vascular dilator, such as milrinone or sildenafil; (iii) increased RV contraction by inotropic support and (iv) maintained optimal heart rate using a pacemaker [11]. …”
Section: Methodsmentioning
confidence: 99%