Guidance on the management of left ventricular assist device (LVAD) supported patients for the non‐LVAD specialist healthcare provider: executive summary

Abstract

The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD supported patients. Device-related, and patient-device interaction complications impose a significant burden on the medical system exceeding the capacity of LVAD implanting centres. The probability of an LVAD supported patient presenting with medical emergency to a local ambulance team, emergency department medical team and internal or surgical wards in a non-LVAD implanting centre is increasing. The purpose of this paper is to supply the immediate tools needed by the non-LVAD specialized physician -ambulance clinicians, emergency ward physicians, general cardiologists, and internists -to comply with the medical needs of this fast-growing population of LVAD supported patients. The different issues discussed will follow the patient's pathway from the ambulance to the emergency department, and from the emergency department to the internal or surgical wards and eventually back to the general practitioner.

Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature

“…Major bleedings, including surgical bleeding, and neurological events (ischaemic and haemorrhagic stroke) are among the most common disabling and life‐threatening events after LVAD implantation. Because there are no randomized clinical trials to guide antithrombotic recommendations for neurological and bleeding events in LVAD patients, management decisions (fibrinolysis for ischaemic stroke and temporary interruption or even reversal of anticoagulation for haemorrhagic stroke and major bleeding) should be taken in Heart Team 115 …”

October 2021 at a glance: focus on imaging, biomarkers and comorbidities

“…Patients ineligible for heart transplantation may receive a left ventricular assist device (LVAD) as a destination therapy, and this is leading to an increasing number of patients with LVAD 33 . Guidance for the management of these patients, especially in non‐specialized settings, is published in this issue 34 …”

Laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis in a patient with a left ventricle assist device: A case report and brief review of the literature (with video)

“…To facilitate blood circulation in the failing heart, the left ventricle assist device (LVAD) was developed and used as a bridge to transplant or destination therapy. The LVAD is an alternative to heart transplantation and can be a bridge to recovery or a bridge to heart transplantation 1–3 in patients with left ventricular failure. The use of LVADs prolongs survival in patients with heart failure 3 .…”

“…The LVAD is an alternative to heart transplantation and can be a bridge to recovery or a bridge to heart transplantation 1–3 in patients with left ventricular failure. The use of LVADs prolongs survival in patients with heart failure 3 . In Japan, LVADs became a health insurance option for patients on the heart transplant waiting list in 2011.…”

“…In Japan, LVADs became a health insurance option for patients on the heart transplant waiting list in 2011. However, the number of patients on the transplant waiting list and, consequently, the number of patients with LVADs is increasing due to the continuing shortage of donor hearts 3–5 . Adequate anticoagulation is essential in patients with LVADs, as clots inside the LVAD can be fatal.…”