Left Ventricular Device Emergencies

Basics

Left Ventricular Assist Device (LVAD)

Portable mechanical pump support for the patient with heart failure (HF)
Components
- Inflow cannula from the left ventricle
- Outflow cannula to the aorta
- Pump: Continuous flow
  - Axial or centrifugal
  - Patient has no palpable pulse due to LVAD continuous blood flow
- Percutaneous driveline: Connects pump to system control
- System controller:
  - Regulates motor power and speed
  - Performs diagnostic monitoring
  - Alarm display
  - Stores data for download
- Batteries: Powers system control and pump
- Power base unit: Charges batteries and powers control and pump
Goals of VAD therapy:
- Bridge to transplantation (BTT): Support cardiac function prior to heart transplant
- Destination therapy (DT): Support cardiac function for the rest of a patient's life
- Bridge to recovery (BTR): Support cardiac function temporarily to give the heart recovery time

23 million patients with HF worldwide
5.1 million patients with HF in the U.S.
Up to 150,000 patients classified with severe HF, with heart transplant being treatment of choice when medical management has failed
<3,000 heart transplants performed annually in the U.S.
Annual mortality rate for patient awaiting heart transplant has dropped continuously from 17% in 2001 due to LVAD as BTT

Common LVAD-associated emergencies

Anemia (0.5–18% of patients)
- Acquired von Willebrand disease type 2A due to shear stress on red blood cells
- Anticoagulation
Bleeding
- Intracranial hemorrhage (ICH) (11%)
- Gastrointestinal (22–40%)
  - Arteriovenous malformations (AVMs)
  - Angiodysplasias
- Hematuria
- Epistaxis
Infection (30–50% of patients)
- Driveline: Most common (17–30%)
- Pump pocket (2–10%)
- Cannula or device (0.6%)
- Bloodstream (20–27%)
Thrombosis (35%)
- Pump thrombosis can result in pump/device failure

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