Skip to main content

Advertisement

SpringerLink
Log in

Postoperative care after left ventricular assist device implantation: considerations for the cardiac surgical intensivist

  • Review Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Heart failure is a leading cause of morbidity and mortality, the incidence of which is predicted to continue to increase as the population ages. Left ventricular assist devices (LVADs) in particular have emerged as important therapies for the support of patients with advanced heart failure needing short- or long-term mechanical circulatory support. With over 5000 implantations per year, LVADs are the most commonly used durable devices worldwide. In this article, we provide an overview of the intensive care management of patients with LVADs during the early post-implantation period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  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;378:1386–95.

    Article  PubMed  Google Scholar 

  2. Han JJ, Acker MA, Atluri P. Left ventricular assist devices. Circulation. 2018;138:2841–51.

    Article  PubMed  Google Scholar 

  3. Kirklin JK, Pagani FD, Kormos RL, et al. Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017;36:1080–6. https://doi.org/10.1016/j.healun.2017.07.005.

    Article  PubMed  Google Scholar 

  4. Tchoukina I, Smallfield MC, Shah KB. Device management and flow optimization on left ventricular assist device support. Crit Care Clin. 2018;34:453–63.

    Article  PubMed  Google Scholar 

  5. Slaughter MS. Long-term continuous flow left ventricular assist device support and end-organ function: prospects for destination therapy. J Card Surg. 2010;25:490–4.

    Article  PubMed  Google Scholar 

  6. Nepomuceno RG, Goldraich LA, De S, et al. Critical care management of the acute postimplant LVAD patient. Can J Cardiol. 2020;36:313–6.

    Article  PubMed  Google Scholar 

  7. Roberts SM, Hovord DG, Kodavatiganti R, Sathishkumar S. Ventricular assist devices and non-cardiac surgery. BMC Anesthesiol. 2015;15:185.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sen A, Larson JS, Kashani KB, et al. Mechanical circulatory assist devices: a primer for critical care and emergency physicians. Crit Care. 2016;20:153.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Huard P, Kalavrouziotis D, Lipes J, et al. Does the full-time presence of an intensivist lead to better outcomes in the cardiac surgical intensive care unit? J Thorac Cardiovasc Surg. 2020;159:1363-1375.e7.

    Article  PubMed  Google Scholar 

  10. Benoit MA, Bagshaw SM, Norris CM, et al. Postoperative complications and outcomes associated with a transition to 24/7 intensivist management of cardiac surgery patients. Crit Care Med. 2017;45:993–1000.

    Article  PubMed  Google Scholar 

  11. Liu H, Jones TE, Jeng E, Peng KL, Peng YG. Risk stratification and optimization to prevent right heart failure during left ventricular assist device implantation. J Cardiothorac Vasc Anesth. 2021;35:3385–93.

    Article  PubMed  Google Scholar 

  12. Addetia K, Lang R, Patel A, Mor-Avi V, Spencer K. Abstract 13965: Are TAPSE and S’ reliable measures of right ventricular performance? Circulation. 2013;128:A13965.

    Google Scholar 

  13. Unsworth B, Casula RP, Kyriacou AA, et al. The right ventricular annular velocity reduction caused by coronary artery bypass graft surgery occurs at the moment of pericardial incision. Am Heart J. 2010;159:314–22.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Angleitner P, Simon P, Kaider A, et al. Impact of bleeding revision on outcomes after left ventricular assist device implantation. Ann Thorac Surg. 2019;108:517–23.

    Article  PubMed  Google Scholar 

  15. Leebeek FWG, Muslem R. Bleeding in critical care associated with left ventricular assist devices: pathophysiology, symptoms, and management. Hematology Am Soc Hematol Educ Program. 2019;2019:88–96.

  16. Whitehouse KR, Avula D, Kahlon T, et al. Apixaban: alternative anticoagulation for HeartMate 3 ventricular assist device. ASAIO J. 2022;68:318–22.

    Article  PubMed  Google Scholar 

  17. Currigan DA, Hughes RJA, Wright CE, Angus JA, Soeding PF. Vasoconstrictor responses to vasopressor agents in human pulmonary and radial arteries: an in vitro study. Anesthesiology. 2014;121:930–6.

    Article  CAS  PubMed  Google Scholar 

  18. Koo B, Wang D, Guerrero Miranda C, Negassa A, Tauras J. Abstract 14068: Effect of tricuspid regurgitation on thermodilution cardiac output assessment. Circulation. 2016;134:A14068.

    Google Scholar 

  19. Bonno EL, Viray MC, Jackson GR, Houston BA, Tedford RJ. Modern right heart catheterization: beyond simple hemodynamics. Adv Pulm hypertens. 2020;19:6–15.

    Article  Google Scholar 

  20. Ali H-JR, Kiernan MS, Choudhary G, et al. Right ventricular failure post-implantation of left ventricular assist device: prevalence, pathophysiology, and predictors. ASAIO J. 2020;66:610–9.

    Article  CAS  PubMed  Google Scholar 

  21. Handoko ML, De Man FS, Oosterveer FPT, Bogaard H-J, Vonk-Noordegraaf A, Westerhof N. A critical appraisal of transpulmonary and diastolic pressure gradients. Physiol Rep. 2016;4:e12910.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Collier TE, Kataria V, Modrykamien A. Inhaled epoprostenol utilization pattern after implementation of an administration policy. Proc (Bayl Univ Med Cent). 2019;33:10–4.

    PubMed  Google Scholar 

  23. Blanco I, Gimeno E, Munoz PA, et al. Hemodynamic and gas exchange effects of sildenafil in patients with chronic obstructive pulmonary disease and pulmonary hypertension. Am J Respir Crit Care Med. 2010;181:270–8.

    Article  CAS  PubMed  Google Scholar 

  24. Li S, Beckman JA, Welch NG, et al. Accuracy of Doppler blood pressure measurement in continuous-flow left ventricular assist device patients. ESC Heart Fail. 2019;6:793–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Coromilas EJ, Takeda K, Ando M, et al. Comparison of percutaneous and surgical right ventricular assist device support after durable left ventricular assist device insertion. J Card Fail. 2019;25:105–13.

    Article  PubMed  Google Scholar 

  26. Kiernan MS, Grandin EW, Brinkley M, et al. Early right ventricular assist device use in patients undergoing continuous-flow left ventricular assist device implantation: incidence and risk factors from the Interagency Registry for Mechanically Assisted Circulatory Support. Circ Heart Fail. 2017;10:e003863.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wang Y, Simon MA, Bonde P, et al. Decision tree for adjuvant right ventricular support in patients receiving a left ventricular assist device. J Heart Lung Transplant. 2012;31:140–9.

    Article  PubMed  Google Scholar 

  28. Patil NP, Mohite PN, Sabashnikov A, et al. Preoperative predictors and outcomes of right ventricular assist device implantation after continuous-flow left ventricular assist device implantation. J Thorac Cardiovasc Surg. 2015;150:1651–8.

    Article  PubMed  Google Scholar 

  29. Amato MBP, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372:747–55.

    Article  CAS  PubMed  Google Scholar 

  30. Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8.

    Article  PubMed  Google Scholar 

  31. Fischer M-O, Brotons F, Briant AR, et al. Postoperative pulmonary complications after cardiac surgery: the VENICE International Cohort Study. J Cardiothorac Vasc Anesth. 2022;36:2344–51.

    Article  PubMed  Google Scholar 

  32. Caroff DA, Li L, Muscedere J, Klompas M. Subglottic secretion drainage and objective outcomes: a systematic review and meta-analysis. Crit Care Med. 2016;44:830–40.

    Article  PubMed  Google Scholar 

  33. Restrepo RD, Wettstein R, Wittnebel L, Tracy M. Incentive spirometry: 2011. Respir Care. 2011;56:1600–4.

    Article  PubMed  Google Scholar 

  34. Lafortuna CL, Fazio F. Acute effect of inhaled salbutamol on mucociliary clearance in health and chronic bronchitis. Respiration. 1984;45:111–23.

    Article  CAS  PubMed  Google Scholar 

  35. Frohock JI, Wijkstrom-Frei C, Salathe M. Effects of albuterol enantiomers on ciliary beat frequency in ovine tracheal epithelial cells. J Appl Physiol (1985).2002;92:2396-402.

  36. Huynh TT, Liesching TN, Cereda M, et al. Efficacy of oscillation and lung expansion in reducing postoperative pulmonary complication. J Am Coll Surg. 2019;229:458-466.e1.

    Article  PubMed  Google Scholar 

  37. Romeiro FG, Okoshi K, Zornoff LAM, Okoshi MP. Gastrointestinal changes associated to heart failure. Arq Bras Cardiol. 2012;98:273–7.

    PubMed  Google Scholar 

  38. Krack A, Sharma R, Figulla HR, Anker SD. The importance of the gastrointestinal system in the pathogenesis of heart failure. Eur Heart J. 2005;26:2368–74.

    Article  CAS  PubMed  Google Scholar 

  39. Corey S, Sean PP, Hung-Mo L, et al. Safety of parenteral nutrition in patients receiving a ventricular assist device. ASAIO J. 2014;60:376–80.

    Article  Google Scholar 

  40. Harvey L, Holley CT, John R. Gastrointestinal bleed after left ventricular assist device implantation: incidence, management, and prevention. Ann Cardiothorac Surg. 2014;3:475–9.

    PubMed  PubMed Central  Google Scholar 

  41. Goldstein DJ, Naka Y, Horstmanshof D, et al. Association of clinical outcomes with left ventricular assist device use by bridge to transplant or destination therapy intent: the multicenter study of MagLev technology in patients undergoing mechanical circulatory support therapy with HeartMate 3 (MOMENTUM 3) randomized clinical trial. JAMA Cardiol. 2020;5:411–9.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Taube C, Holz O, Mücke M, Jörres RA, Magnussen H. Airway response to inhaled hypertonic saline in patients with moderate to severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164:1810–5.

  43. Albrecht HH, Dicpinigaitis PV, Guenin EP. Role of guaifenesin in the management of chronic bronchitis and upper respiratory tract infections. Multidiscip Respir Med. 2017;12:31.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, USA

    Stamatis Baronos, Robert Charles Whitford & Kandis Adkins

Authors
  1. Stamatis Baronos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert Charles Whitford
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kandis Adkins
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kandis Adkins.

Ethics declarations

Ethical approval

Ethical board approval was not required for this review article.

Informed consent

As no patient information was utilized for this review article, no informed consent was required.

Conflict of interest

The authors declare no conflicts of interest.

Statement of human and animal rights

This review article does not contain studies with human or animal participants performed by any of the authors.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baronos, S., Whitford, R.C. & Adkins, K. Postoperative care after left ventricular assist device implantation: considerations for the cardiac surgical intensivist. Indian J Thorac Cardiovasc Surg 39 (Suppl 1), 182–189 (2023). https://doi.org/10.1007/s12055-022-01434-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-022-01434-y

Keywords

Search

Navigation