Left ventricular assist device therapy in advanced heart failure: patient selection and outcomes

Gustafsson, Finn; Rogers, Joseph G.

doi:10.1002/ejhf.779

Cited by 233 publications

(195 citation statements)

References 64 publications

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“…Despite lack of evidence and in order to favour weaning, the treatment recommendation is similar to the recommend use of agents indicated for heart failure patients [2].…”

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

confidence: 95%

“…It is estimated that 2000 pumps are implanted annually in Europe. The most recent data analysis from the LVAD registry showed a 1-year survival of 80% [2]. LVADs also improve the quality of life [9].…”

Section: Indications For Long-term Mcsmentioning

confidence: 99%

“…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 [2]. It is estimated that 2000 pumps are implanted annually in Europe.…”

Section: Indications For Long-term Mcsmentioning

confidence: 99%

“…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%

“…Long-term mechanical circulatory supports (MCS) are being used increasingly for patients at risk of dying from heart failure and cardiogenic shock [1,2].…”

Section: Introductionmentioning

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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“…Despite lack of evidence and in order to favour weaning, the treatment recommendation is similar to the recommend use of agents indicated for heart failure patients [2].…”

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

confidence: 95%

Section: Indications For Long-term Mcsmentioning

confidence: 99%

Section: Indications For Long-term Mcsmentioning

confidence: 99%

Section: Principles Of Lvadmentioning

confidence: 99%

“…Long-term mechanical circulatory supports (MCS) are being used increasingly for patients at risk of dying from heart failure and cardiogenic shock [1,2].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Understanding Left Ventricular Assist Devices

et al. 2018

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Strategies of Wait-listing for Heart Transplant vs Durable Mechanical Circulatory Support Alone for Patients With Advanced Heart Failure

et al. 2020

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IMPORTANCEGiven the shortage of donor hearts and improvement in outcomes with left ventricular assist device (LVAD) therapy, a relevant but, to date, unanswered question is whether select patients with advanced heart failure should receive LVAD destination therapy as an alternative to heart transplant.OBJECTIVE To determine whether a strategy of LVAD destination therapy is associated with similar survival benefit as wait-listing for heart transplant with or without LVAD therapy among patients with advanced heart failure.

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