Implication of Hemodynamic Assessment during Durable Left Ventricular Assist Device Support

Abstract

Durable left ventricular assist device therapy has improved survival in patients with advanced heart failure refractory to conventional medical therapy, although the readmission rates due to device-related comorbidities remain high. Left ventricular assist devices are designed to support a failing left ventricle through relief of congestion and improvement of cardiac output. However, many patients still have abnormal hemodynamics even though they may appear to be clinically stable. Furthermore, such abnormal hemodynamics are associated with an increased risk of future adverse events including recurrent heart failure, gastrointestinal bleeding, stroke, and pump thrombosis. Correction of residual hemodynamic derangements post-implantation may be a target in improving longitudinal clinical outcomes during left ventricular assist device support. Automatic and timely device speed adjustments considering a patients’ hemodynamic status (i.e., with a smart pump) are potential improvements in forthcoming devices.

Restoring sinus rhythm in a patient with atrial flutter and left ventricular assist device: does it really matter?

“…This is important, as maintenance of appropriate hemodynamic output of ventricular assistance devices has been shown to significantly lower rates of hospital readmission and heart failure exacerbation. 3 …”

Mechanisms of Acute Right Ventricular Injury in Cardiothoracic Surgical and Critical Care Settings: Part 2

“…76 Malalignment of the inflow cannula secondary to suboptimal 13 positioning can cause septal shift leading to tricuspid incompetence, precipitating ventricular arrhythmias and inadequate LV decompression leading to left atrial hypertension. 77 Improper de-airing techniques may lead to right coronary artery embolization. 78 Left ventricular assist device outflow graft obstruction from varying etiologies may result in a low flow state and RV hypoperfusion.…”