Medical Management of Patients With Continuous-Flow Left Ventricular Assist Devices

DeVore, Adam D.; Mentz, Robert J.; Patel, Chetan B.

doi:10.1007/s11936-013-0283-0

Cited by 26 publications

(25 citation statements)

References 78 publications

(66 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…The most important factor in preventing the morbidity of infections is anchoring the device to help stabilize the driveline, thus minimizing trauma and tension at the exit site [2][3][4][5]. The patient is following a sterile dressing care regimen in accordance with the protocol and has to monitor the driveline exit site for redness, drainage, tenderness and open areas at the site.…”

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

confidence: 99%

“…The most frequent complications occurring in the MCS patients are bleeding, driveline infections, thrombosis, device malfunction, right ventricular failure and arrhythmias [3][4][5]. Patients with MCS can also be admitted in ICU for non-specific aetiologies [3][4][5].…”

Section: Why Do Patients With Lvad Come In Icu?mentioning

confidence: 99%

“…The implanting hospital and VAD coordinator should be contacted for each MCS patient requiring admission in ICU [2][3][4][5]. Some patients may be managed by non-LVAD specialists after advices and agreement of implanting hospital physicians, whereas patients presenting complication needing cardiac interventions including an HTx in high emergency should be transferred to the implanting hospital (Table 2) [11].…”

Section: Why Do Patients With Lvad Come In Icu?mentioning

confidence: 99%

“…As a result, intensivists who might not have been trained in managing advanced heart failure patients, are increasingly likely to encounter patients requiring MCS at various points in their disease trajectory, especially during subsequent admissions for complications [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Understanding Left Ventricular Assist Devices

et al. 2018

View full text Add to dashboard Cite

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.

show abstract