Left ventricular assist device complications

Background

• Developed in 1960s and used as a bridge to Cardiac Transplant
• Indication is New York Heart Association class 4 heart failure, ejection fraction <25%, VO2 max less than 15 among other criteria.

Mechanism of Action

• External pump unit outside body with intake channel (blood is drained from the apex of the left ventricle) and output channel (blood is ejected into the aorta). Bypasses left ventricle function. BiVAD bypasses both ventricles.

Special Considerations

• Patient does not have a pulse due to the mechanics of the device
• Listen to the heart to hear if the pump is working

Complications

1. Driveline infections
2. Bleeding (many patients are anticoagulated on the LVAD)
3. Pump Thrombosis (due to inappropriate anticoagulation)
4. Bleeding
   1. Acquired Von Willebrand disease (similar to patients on dialysis or with aortic stenosis)
   2. Hypercoagulability due to coumadin
      1. Consider heparin if device thrombus is a high probability or seen on bedside echo
5. Dead Battery for Device
   1. usually a button to check remaining battery charge
6. Arrythmias
7. Acute Infarction

Devices Overview

1. HeartMate I or XVE
   1. Use: Destination Therapy
   2. Flow Type: Pulsatile
   3. Pulse: Has pulse but may not match ECG rhythm
   4. Backup Method: Hand Pump
   5. Battery: 12volt MiMH - 10hrs
   6. Defib/Cardioversion: Use hand pump during defib/cardioversion

Sources

mylvad pdf