left ventricular assist device (LVAD)
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Introduction
Mechanical left ventricular assist device.
Indications
- NYHA class 4 heart failure
- prior to cardiac transplantation
- recovery from cardiogenic shock
- primary therapy*
- in connection with combination drug therapy#
* case of placing LVAD in 73 yo woman with BP of 161/112 mm Hg, HR of 144/min, LVEF of 20%, moderate mitral regurgitation[15]
Contraindications
Procedure
- continuous flow device superior to pulsatile flow device[3]
- intrapericardial centrifugal flow device non inferior to axial flow device[9]
- centrifugal-flow device superior to an axial-flow device[11]
Complications
- infection
- bleeding
- device malfunction
- stroke
- device thrombosis[5]
- magnetically levitated centrifugal-flow HeartMate 3 significantly reduced rates of thrombotic pump malfunction[8]
- ventricular thrombus
- acquired von-Willebrand's disease (vWD)[4]
* 52% 1 year survival vs 25% with medical management
# combination drug therapy
- start lisinopril, losartan, spironolactone, carvedilol
- monitor for hyperkalemia
- after achieving maximal regression of LV dilatation, add clenbuterol & replace carvedilol with bisoprolol
Management
- anticoagulation with warfarin to prevent ventricular thrombus[6]
More general terms
Additional terms
- cardiac transplantation; heart transplant
- heart failure (HF)
- New York Heart Association classification of heart failure
References
- ↑ Journal Watch 21(24):197, 2001 Rose EA et al for the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) Study Group. Long-term mechanical left ventricular assistance for end-stage heart failure. NEJM 345:1435, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11794191
- ↑ Birks EJ et al Left ventricular assist device and drug therapy for the reversal of heart failure. N Engl J Med 2006 355:1873
Renlund DG & Kfoury AG When the failing, end-stage heart is not end-stage. N Engl J Med 2006, 355:1922 - ↑ 3.0 3.1 Slaughter MS et al. for the HeartMate II Investigators. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009 Dec 3;361(23):2241-51. Epub 2009 Nov 17. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19920051 <Internet> http://dx.doi.org/10.1056/NEJMoa0909938
Fang JC. Rise of the machines - Left ventricular assist devices as permanent therapy for advanced heart failure. N Engl J Med 2009 Nov 17 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19920052 <Internet> http://dx.doi.org/10.1056/NEJMe0910394 - ↑ 4.0 4.1 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- ↑ 5.0 5.1 Starling RC et al. Unexpected abrupt increase in left ventricular assist device thrombosis. N Engl J Med 2014 Jan 2; 370:33 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24283197
- ↑ 6.0 6.1 Brock AS et al A Not-So-Obscure Cause of Gastrointestinal Bleeding N Engl J Med 2015; 372:556-561. February 5, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25651250 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcps1302223
- ↑ Garbade J, Barten MJ, Bittner HB, Mohr FW. Heart transplantation and left ventricular assist device therapy: two comparable options in end-stage heart failure? Clin Cardiol. 2013 Jul;36(7):378-82 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23595910
- ↑ 8.0 8.1 Mehra MR et al. A fully magnetically levitated circulatory pump for advanced heart failure. N Engl J Med 2016 Nov 16 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27959709 <Internet> http://www.nejm.org/doi/10.1056/NEJMoa1610426
- ↑ 9.0 9.1 Rogers JG et al. Intrapericardial left ventricular assist device for advanced heart failure. N Engl J Med 2017 Feb 2; 376:451. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28146651 Free Article <Internet> http://www.nejm.org/doi/10.1056/NEJMoa1602954
Hetzer R, Delmo Walter EM. Mechanical circulatory support devices - in progress. N Engl J Med 2017 Feb 2; 376:487 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28146667 <Internet> http://www.nejm.org/doi/10.1056/NEJMe1613755 - ↑ 10.0 10.1 Bansal N, Hailpern SM, Katz R et al. Outcomes associated with left ventricular assist devices among recipients with and without end-stage renal disease. JAMA Intern Med 2017 Dec 18; PMID: https://www.ncbi.nlm.nih.gov/pubmed/29255896
Thomas SS et al. The Renal Challenge With Left Ventricular Assist Device Therapy-When Enough Is Enough. JAMA Intern Med. 2017 Dec 18. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29255894 - ↑ 11.0 11.1 Mehra MR, Goldstein DJ, Uriel N et al. Two-year outcomes with a magnetically levitated cardiac pump in heart failure. N Engl J Med 2018; 378:1386-1395. April 12, 2018. ePub Mar 11 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29526139 <Internet> http://www.nejm.org/doi/10.1056/NEJMoa1800866
- ↑ Robertson J, Long B, Koyfman A. The emergency management of ventricular assist devices. Am J Emerg Med. 2016 Jul;34(7):1294-301. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27162114
- ↑ Stokes MB, Bergin P, McGiffin D. Role of long-term mechanical circulatory support in patients with advanced heart failure. Intern Med J. 2016 May;46(5):530-40. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26010730
- ↑ Stokes MB, Saxena P, Mariani JA et al Left Ventricular Assist Device (LVAD) as a Bridge to Recovery for Tachycardia-Mediated Cardiomyopathy. J Card Surg. 2015 Nov;30(11):871-3. dEpub 2015 Sep 8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26350745
- ↑ 15.0 15.1 Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019