5-Minute Emergency Consult
Left Ventricular Device Emergencies
Left Ventricular Device Emergencies is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Left Ventricular Assist Device (LVAD)Description
- 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
Epidemiology
Epidemiology
- 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
Etiology
Common LVAD-associated emergenciesEtiology
- 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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Basics
Description
Left Ventricular Assist Device (LVAD)Description
- 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
Epidemiology
Epidemiology
- 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
Etiology
Common LVAD-associated emergenciesEtiology
- 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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Citation
Schaider, Jeffrey J., et al., editors. "Left Ventricular Device Emergencies." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307744/all/Left_Ventricular_Device_Emergencies.
Left Ventricular Device Emergencies. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307744/all/Left_Ventricular_Device_Emergencies. Accessed February 5, 2023.
Left Ventricular Device Emergencies. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307744/all/Left_Ventricular_Device_Emergencies
Left Ventricular Device Emergencies [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 February 05]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307744/all/Left_Ventricular_Device_Emergencies.
* Article titles in AMA citation format should be in sentence-case
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