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

Estep, Jerry D.; Trachtenberg, Barry; Loza, Laurie; Bruckner, Brian A.

doi:10.14797/mdcj-11-1-33

Cited by 29 publications

(18 citation statements)

References 15 publications

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“…These pumps differ in technical design, but all are continuous-flow pumps and have the following analogous components [3][4][5]10]: (1) an inflow cannula surgically implanted into the LV apex, conducting blood from the LV to the pump; (2) a pump enclosure that houses an impeller that circulates blood; (3) an outflow graft carrying blood from the pump to the aorta and systemic circulation; and (4) a surgically tunnelled driveline that connects the pump to an external controller that operates and monitors the pump function [2].…”

Section: Principles Of Lvadmentioning

confidence: 99%

“…According to the most recent guidelines of the International Society of Heart and Lung Transplant and in order to prevent stroke and LVAD dysfunction (related to afterload increasing), the mean blood pressure in MCS patients should be less than or equal to 80 mm Hg with a typical goal range between 70 and 80 mm Hg [10].…”

Section: Which Medication and Specific Care Are Required In Vad Patiementioning

confidence: 99%

“…Infection is the second most common cause of death after cardiac failure in MCS patients [10,16,17]. The driveline exit sites need special attention.…”

Section: Frequent Complications In Mcs Patientsmentioning

confidence: 99%

“…It can be difficult to record BP using traditional measurements in LVAD patients with a reduced or absent pulse pressure [10]. A Doppler ultrasound probe that detects flow at any point during the cardiac cycle and measures an opening pressure may be useful.…”

Section: Arrhythmiamentioning

confidence: 99%

“…In cases of shock, an arterial catheter should be inserted under ultrasonographic guidance for continuous mean arterial pressure monitoring (continuous flow makes blind placement difficult) [3][4][5]10].…”

Section: Arrhythmiamentioning

confidence: 99%

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Understanding Left Ventricular Assist Devices

et al. 2018

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Background/Aims: Long-term mechanical assist devices are now commonly used in the treatment of severe heart failure to unload the failing ventricle, maintain sufficient end-organ perfusion and improve functional capacity. Depending on the assisted ventricles, 3 categories of long-term assist devices are available: left ventricular assist device (LVAD), biventricular assist device and total artificial heart. Improvements in technology, especially the advent of smaller, durable continuous flow pumps, have led to the use of LVADs in a much broader population of patients in the last 10 years. Both the number of patients living with LVADs and the life expectancy of these patients are increasing. Regarding this growing number of patients with LVAD, intensivists need to understand the physiology of the devices, their functioning, potential complications and their management. Methods: We performed a narrative review of relevant medical literature regarding the physiology of patients with LVAD and management of common complications relevant to the critical care physicians. Results: The most frequent complications occurring in the LVAD patients after the post-operative period are bleeding, driveline infections, thrombosis, device malfunction, right ventricular failure and arrhythmias. Bleeding is the most frequent adverse event in LVAD due to a combination of anticoagulation and acquired von Willebrand disease secondary to shear stress produced within the pump. Their management includes antiplatelet therapy arrest, reduction of the anticoagulation regimen and specific therapy if feasible. Infection is the second most common cause of death after cardiac failure in LVAD patients. All infections must be aggressively treated to avoid seeding the device. Device thrombosis can develop even when patients are adequately anticoagulated and taking antiplatelet therapy because the LVAD is responsible for a chronic hypercoagulable state. Conclusion: Management of these unique patients in the ICU is best accomplished with a multidisciplinary team that includes specialists in advanced heart failure, LVAD nurse coordinators and intensivists.

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Section: Principles Of Lvadmentioning

confidence: 99%

Section: Which Medication and Specific Care Are Required In Vad Patiementioning

confidence: 99%

“…Infection is the second most common cause of death after cardiac failure in MCS patients [10,16,17]. The driveline exit sites need special attention.…”

Section: Frequent Complications In Mcs Patientsmentioning

confidence: 99%

Section: Arrhythmiamentioning

confidence: 99%

Section: Arrhythmiamentioning

confidence: 99%

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Understanding Left Ventricular Assist Devices

et al. 2018

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Continuous flow left ventricular assist devices do not worsen endothelial function in subjects with chronic heart failure: a pilot study

Cortese

Ciccone

Gesualdo³

et al. 2021

ESC Heart Failure

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Aims To evaluate endothelial function in subjects with left ventricular assist devices (LVADs), comparing them with subjects with chronic heart failure with reduced ejection fraction on the list for heart transplant (HT) and with HT patients with a normal systolic cardiac function to identify any differences. Methods We enrolled 28 subjects with LVAD, 55 subjects with HT, and 42 subjects with heart failure on the transplant list. The subjects underwent a general physical examination, assessment of laboratory blood parameters, and assessment of endothelial function through flow-mediated dilation (FMD) of brachial artery. Results The three groups were homogeneous as regards age, gender, smoke abuse, C-reactive protein (CRP) and FMD parameters (P = ns). In LVAD group percentage of FMD change showed an inverse correlation with CRP (rho: À0.5, P: 0.003), a well-known marker of inflammation and tissue damage. Conclusions Continuous flow related to LVAD seems to not worsen endothelial function. Endothelial function was not affected by cardiovascular risk factors (hypertension, hypercholesterolaemia, diabetes, obesity, and tobacco habit), by the functional status expressed by New York Heart Association class, by the left ventricular systolic function and by the presence or absence of ischaemic heart disease in all the populations analysed. CRP was the only factor able to influence percentage of FMD change in patient with LVAD, reinforcing the hypothesis that inflammation is the main determinant of endothelial function.

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A longitudinal comparison of health‐related quality of life in rural and urban recipients of left ventricular assist devices

Alonso

Faulkner

Pozehl

et al. 2020

Research in Nursing & Health

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Left ventricular assist devices (LVAD) are a common treatment for advanced heart failure (HF) to improve ventricular function, symptoms, and health‐related quality of life (HRQOL). Many LVAD recipients travel long distances from rural areas for LVAD implantation and follow‐up care. Individuals with HF in rural settings who have not undergone LVAD implantation have reported poor HRQOL. However, to date, no studies have compared HF‐specific or generic HRQOL in rural and urban LVAD recipients. The purpose of this study was to compare generic and HF‐specific HRQOL longitudinally from preimplantation to 1‐, 3‐, and 6‐ months postimplant in a cohort of rural and urban LVAD recipients (n = 95; rural n = 32 and urban n = 63). We measured generic HRQOL using the European Quality of Life Visual Analog Scale and HF‐specific HRQOL with the quality of life domain of the Kansas City Cardiomyopathy Questionnaire (KCCQ). Latent growth curve modeling identified two phases of change in generic and HF‐specific HRQOL: the initial response to LVAD between preimplantation and 1‐month postimplant and the subsequent change between 1‐ and 6‐months postimplant. Comparable improvements in generic HRQOL were noted in rural and urban LVAD recipients during both phases of change. Urban LVAD recipients had greater initial improvements in HF‐specific HRQOL (KCCQ) compared with rural recipients (13.0 ± 5.6, p = .02), but subsequent improvements were similar among rural and urban recipients. Ongoing assessment of generic and HF‐specific HRQOL is necessary during LVAD therapy.

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

Cited by 29 publications

References 15 publications

Understanding Left Ventricular Assist Devices

Understanding Left Ventricular Assist Devices

Continuous flow left ventricular assist devices do not worsen endothelial function in subjects with chronic heart failure: a pilot study

A longitudinal comparison of health‐related quality of life in rural and urban recipients of left ventricular assist devices

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