Left ventricular assist device management in patients chronically supported for advanced heart failure.

Division of Cardiovascular Medicine, Section of Cardiac Surgery, University of Michigan Health System, Ann Arbor, MI 48109, USA.
Current opinion in cardiology (Impact Factor: 2.59). 03/2011; 26(2):149-54. DOI: 10.1097/HCO.0b013e3283438258
Source: PubMed

ABSTRACT This review summarizes management strategies to reduce morbidity and mortality in heart failure patients supported chronically with implantable left ventricular assist devices (LVADs).
As the population of patients supported with long-term LVADs has grown, patient selection, operative technique, and patient management strategies have been refined, leading to improved outcomes. This review summarizes recent findings on LVAD candidate selection, and discusses outpatient strategies to optimize device performance and heart failure management. It also reviews important device complications that warrant close outpatient monitoring.
Managing patients on chronic LVAD support requires regular patient follow-up, multidisciplinary care teams, and frequent laboratory and echocardiographic surveillance to ensure optimal outcomes.

  • [Show abstract] [Hide abstract]
    ABSTRACT: The prevalence of heart failure is increasing and the prognosis in the terminal phase is dismal. The gold-standard therapy in end-stage heart failure remains cardiac transplantation at the present time, but there is a great excess of eligible candidates compared with the number of donor organs, so alternative strategies are needed. The usefulness of left ventricular assist device as destination therapy is one of the objectives pursued since the first devices began to be developed; the technological and design improvements in ventricular assist devices in the last 20 years has allowed its use in these patients. Data from multicenter trials and registries have demonstrated an improvement in survival and quality of life in patients with advanced heart failure when they are implanted as outpatient long-term support. The REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) trial entailed the scientific confirmation of that benefit and other later studies support it. The present article discusses many aspects of ventricular assistance as destination therapy: lessons learned with the different devices along the years, the complications and morbidity associated with them or the specific designed clinical trials. There is a special emphasis on destination therapy patient’s selection and on specific risk scores for ventricular assistance; other options for long-term support less used as the total artificial heart or implantable micro-pumps are also briefly considered.
    07/2011; 18(3):175–188. DOI:10.1016/S1134-0096(11)70053-5
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ventricular assist devices (VAD) have become an established therapy for patients with end-stage heart failure. The two main reasons for this development are the shortage of appropriate donor organs and the increasing number of patients waiting for heart transplantation (HTX). Furthermore, the enormous advances in the technical equipment and the rising clinical experience have improved the implantation technique, the durability and the long-term patient outcomes.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Renal impairment is a frequent complication of cardio-renal syndrome that increases mortality and morbidity. This is even more likely when renal replacement therapy is required, precluding in many cases transplantation and seriously limiting life expectancy. We describe the first case of refractory heart failure in a patient with a left ventricular assist device (LVAD) implanted as destination therapy. He underwent intermittent hemodialysis (HD) treatment as an outpatient with good quality of life.
    Clinical nephrology 07/2013; 82(6). DOI:10.5414/CN107894 · 1.23 Impact Factor

Full-text (2 Sources)

Available from
May 31, 2014