Medical Management of LVAD Patients: A Practical Guide for the Non-Expert Clinician

This article provides a concise overview of the medical management of LVAD patients aimed for non-expert clinicians. Our presentation includes the basics of LVAD physiology, design and operation, patient selection, patient assessment, medical management, adverse event identification and management, multidisciplinary care, and management of special circumstances such as non-cardiac surgery, cardiac arrest, and end-of-life care. The clinical examination of LVAD patients is unique in terms of blood-pressure and heart-rate assessment, LVAD ‘hum’ auscultation, driveline/insertion-site inspection, and device-parameter recording. Important potential device-related adverse events include stroke, gastrointestinal bleeding, hematological disorders, device infection, LVAD dysfunction, arrhythmias and heart failure. Special considerations include the approach to the unconscious or pulseless patient, non-cardiac surgery and palliative care. An understanding of the principles presented in this paper will enable the non-expert clinician to be effective in collaborating with an LVAD center in the assessment, medical management, and follow up of LVAD patients. Future opportunities and challenges include the improvement of device designs, greater application of minimally-invasive surgical implantation techniques, and management of health economics in cost-constrained systems like that of Canada and many other jurisdictions.
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research

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CONCLUSION: Acute myocardial infarction and hypertrophic cardiomyopathy patients who were obese exhibited worse long-term outcomes than those without obesity. PMID: 31674878 [PubMed - as supplied by publisher]
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
Conclusions: Neither LVADs nor IABP improves short or long-term survival in hr-PCI patients. LVADs are more likely to reduce repeat revascularization after PCI, but to increase the risk of bleeding events than IABP.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research
AbstractSelf-terminating atrial arrhythmias are commonly detected on continuous rhythm monitoring, e.g. by pacemakers or defibrillators. It is unclear whether the presence of these arrhythmias has therapeutic consequences. We sought to summarize evidence on the prevalence of atrial high-rate episodes (AHREs) and their impact on risk of stroke. We performed a comprehensive, tabulated review of published literature on the prevalence of AHRE. In patients with AHRE, but without atrial fibrillation (AF), we reviewed the stroke risk and the potential risk/benefit of oral anticoagulation. Atrial high-rate episodes are found in 10...
Source: Europace - Category: Cardiology Source Type: research
Medtronic’s HeartWare HVAD pump system could get a significant boost after performing well in the LATERAL clinical trial. The Dublin-based company presented results from the study at the American Society for Artificial Internal Organs 65th Annual Conference, that showed patients who received the system had 95% freedom from disabling stroke at two years. The medtech giant now plans to launch a global registry to collect additional clinical evidence to further characterize survival, adverse events, and economic benefits of the HVAD System. The HVAD Pump is a left ventricle assist device (LVAD) approved in t...
Source: MDDI - Category: Medical Devices Authors: Tags: Cardiovascular Source Type: news
Medtronic (NYSE:MDT) today touted stroke data from the Lateral trial of its HeartWare HVAD left ventricular assist device involving implantation via thoracotomy instead of open surgery. With a thoracotomy implantation, surgeons insert the pump via a small, lateral incision between the left ribs and make a second small incision to accommodate the pump’s outflow graft. Fridley, Minn.-based Medtronic said Lateral results presented at the annual meeting of the American Society for Artificial Internal Organs showed that 95% of thoractomy patients were free from disabling stroke at two years. Adverse events were more ...
Source: Mass Device - Category: Medical Devices Authors: Tags: Cardiac Assist Devices Cardiovascular Clinical Trials Featured Medtronic Source Type: news
Authors: Eisen HJ Abstract Congestive heart failure is a major cause of morbidity and mortality as well as a major health care cost in the developed world. Despite the introduction of highly effective heart failure medical therapies and simple devices such as cardiac resynchronization therapy that reduce mortality, improve cardiac function and quality of life, there remains a large number of patients who do not respond to these therapies or whose heart failure progresses despite optimal therapy. For these patients, cardiac transplantation is an option but is limited by donor availability as well as co-morbidities w...
Source: Korean Circulation Journal - Category: Cardiology Tags: Korean Circ J Source Type: research
AbstractBackgroundDigitalis glycosides are employed for rate control of atrial fibrillation. Recent studies suggested potential harmful effects of digitalis monotherapy and combination with antiarrhythmic drugs. The aim of the present study was to assess the prevalence and potential impact of digitalis therapy on outcome in patients undergoing catheter ablation of supraventricular arrhythmias.Methods and resultsThe German Ablation Registry is a nationwide, prospective registry with a 1-year follow-up investigating 12,566 patients receiving catheter ablations of supraventricular arrhythmias in 52 German centres. The present...
Source: Clinical Research in Cardiology - Category: Cardiology Source Type: research
Most years I write an update on any big developments in AF ablation. This year’s version will be a short one. I have little new to report. But it’s worth reviewing some basic issues. We still do not know the cause of atrial fibrillation (AF). That makes it hard to fix with ablation. Knowledge Deficits: To explain why not knowing the cause of AF impairs our ability to ablate it, it’s useful to compare AF ablation to WPW ablation. Wolfe-Parkinson-White or WPW syndrome causes rapid heart rates because of an extra pathway from the top to the bottom (atria and ventricle) of the heart. You can cure WPW by ablat...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs
Publication date: September 2018Source: IJC Heart &Vasculature, Volume 20Author(s): Ting-Yung Chang, Jo-Nan Liao, Tze-Fan Chao, Jennifer Jeanne Vicera, Chin-Yu Lin, Ta-Chuan Tuan, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Fa-Po Chung, Shih-Ann ChenAbstractAtrial fibrillation (AF) has become the most prevalent arrhythmia and it will increase the risk of ischemic stroke, heart failure, mortality, sudden cardiac death, myocardial infarction, and dementia. Stroke prevention with oral anticoagulant is crucial for management of AF patients. Vitamin K antagonist, which inhibits the clotting factors II, VII, IX an...
Source: IJC Heart and Vasculature - Category: Cardiology Source Type: research
The HeartWare Ventricular Assist System (HVAD) provides significant improvements in survival and quality of life, and here, we seek to evaluate temporal differences in the adverse event (AE) rates. Patients (n = 382) in the ADVANCE bridge-to-transplant and continued access protocol trial were assessed for bleeding, cardiac arrhythmia, infection, ischemic and hemorrhagic stroke, and right heart failure during predetermined time periods (≤30,>30–180,>180–365,>365–730,>730–1,095 days) after HVAD implant. The Kaplan–Meier survival at 30 days, 6 months, 1, 2, and 3 years was 98%, 90%...
Source: ASAIO Journal - Category: Medical Devices Tags: Adult Circulatory Support Source Type: research
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