Medical Management of Patients With Continuous-Flow Left Ventricular Assist Devices
- 384 Downloads
The prevalence of patients living with advanced heart failure continues to rise. For a subset of these patients, continuous-flow left ventricular assist devices (LVADs) are a life-saving therapy. Given the efficacy and durability of contemporary LVAD devices, their use has increased exponentially in recent years. The medical management of patients with an LVAD is an area of expertise for advanced heart failure clinicians, but a general understanding of the initial approach to, and stabilization of, LVAD patients is an important skillset for many health care providers. The rapidly changing field of the medical management of LVAD patients is largely based on clinical experience and limited published data. In this manuscript, we integrate the available published data on the medical management of LVAD patients with the growing clinical experience.
KeywordsMechanical support Ventricular assist devices Advanced heart failure
Compliance with Ethics Guidelines
Conflict of Interest
Dr. Adam D. DeVore declares no potential conflicts of interest relevant to this article.
Dr. Robert J. Mentz served as a consultant for HeartWare and had travel/accommodations expenses covered or reimbursed by Thoratec.
Dr. Chetan B. Patel served as a consultant for and had travel/accommodations expenses covered or reimbursed by HeartWare. Dr. Patel had travel/accommodations expenses covered or reimbursed by Thoratec.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 5.INTERMACS Quarterly Statistical Report. Centers for Medicare & Medicaid Services. 2013 1st Quarter. 2013, The data collection and analysis center University of Alabama at Birmingham.Google Scholar
- 6.•Kirklin JK et al. Fifth INTERMACS annual report: risk factor analysis from more than 6,000 mechanical circulatory support patients. J Heart Lung Transplant. 2013;32(2):141-56. The most recent report from INTERMACS, a registry of patients receiving mechanical circulatory support. These annual reports provide valuable information on type of mechanical support utilized, adverse events, and survival ratesPubMedCrossRefGoogle Scholar
- 8.•Feldman D et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013;32(2):157-87. Recently published guidelines by the International Society of Heart and Lung Transplantation (ISHLT) for patients treated with mechanical circulatory support. These are the most comprehensive treatment guidelines published to datePubMedCrossRefGoogle Scholar
- 17.Fitzpatrick 3rd JR et al. Early planned institution of biventricular mechanical circulatory support results in improved outcomes compared with delayed conversion of a left ventricular assist device to a biventricular assist device. J Thorac Cardiovasc Surg. 2009;137(4):971–7.PubMedCentralPubMedCrossRefGoogle Scholar
- 19.Hillis LD et al. ACCF/AHA Guideline for coronary artery bypass graft surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2011;58(24):e123–210.PubMedCrossRefGoogle Scholar
- 21.HeartWare Ventricular Assist System Instructions for Use (USA). http://www.heartware.com/clinicians/instructions-use/instructions-use-usa.
- 22.HeartMate II LVAS Operating Manual, Featuring GoGear System Components (105747.A). http://www.thoratec.com/medical-professionals/resource-library/ifus-manuals/heartmate-ll-lvad.aspx#levelFour.
- 30.•Uriel N et al. Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices: the Columbia ramp study. J Am Coll Cardiol. 2012;60(18):1764-75. The first rigorous study of an echocardiographic-based protocol to determine optimal LVAD speed settings and to evaluate for device thrombosisPubMedCentralPubMedCrossRefGoogle Scholar
- 32.•Aaronson KD et al. Use of an intrapericardial, continuous-flow, centrifugal pump in patients awaiting heart transplantation. Circulation. 2012;125(25):3191-200. Results from ADVANCE, a multicenter trial of the HeartWare HVAD in patients receiving an LVAD as a bridge to transplantation. The control arm for the study was a similar group of patients in INTERMACS. The results of this study led to the FDA approval of the HeartWare HVAD for this indication.PubMedCrossRefGoogle Scholar
- 46.Yancy CW et al. ACCF/AHA Guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013.Google Scholar
- 74.Wang TS et al. Valvular heart disease in patients supported with left ventricular assist devices. Circ Heart Fail. 2013.Google Scholar