Ambulatory Care of Patients With Left Ventricular Assist Devices

Abstract

Background-Left ventricular assist devices (LVAD) have revolutionized the treatment of patients with acute and chronic heart failure as they provide a high quality of life. We report on our experience with patients receiving ambulatory care after LVAD implantation. Methods and Results-Since July 1995, 46 patients with a mean age of 45Ϯ11 years underwent implantation of an electrically driven LVAD with portable controller and batteries. Sixteen (35%) patients bridged Ͼ30 days were treated in part on an outpatient basis. After LVAD implantation, they were treated in the hospital for 86Ϯ32 days (range 40 to 153 days). Afterward, they received ambulatory care for 74Ϯ76 days (range 2 to 301 days, total experience 1206 days). In 13 cases, the outpatient treatment was interrupted by 1.7Ϯ1.7 readmissions, for a total of 32Ϯ42 days (median 19 days). Reasons for readmission included systemic or drive line infections (incidence 0.0066 per outpatient day), suspected or true thromboembolic events (incidence 0.0066 per outpatient day), and suspected malfunction of the LVAD. One patient supported as alternative to transplantation died after cerebral bleeding after 244 days, 1 patient with a history of acute myocarditis had ventricular fibrillation during LVAD assist while being at home for 177 days and died in a low output state, 10 patients were given transplantation after a mean support interval of 206Ϯ88 days, and 4 patients currently await heart transplantation. Conclusions-Outpatient treatment after LVAD implantation is feasible, and severe complications are uncommon.

Pre-operative prediction of post–VAD implant mortality using easily accessible clinical parameters

“…4,5 During the ICU stay, mortality is often dependent on the clinical preoperative status. 6 Therefore, pre-operative candidate selection is highly important in obtaining a successful outcome.…”

Influence of Inflow Cannula Length in Axial-flow Pumps on Neurologic Adverse Event Rate: Results From a Multi-center Analysis

“…[1][2][3][4] Furthermore, long-term mechanical circulatory support has gained a high level of acceptance with a satisfactory technical reliability of the devices. However, the rate of cerebrovascular events is still a matter of concern.…”

Bleeding and Thrombotic Events in Patients Undergoing Mechanical Circulatory Support: A Review of Literature

“…There is evidence indicating that the majority of thromboembolic events in patients with VADs occur in spite of the INR being within the target range. 33,71 Point-ofcare testing may provide more comprehensive insight into viscoelastic blood clot properties and platelet aggregability. However, use of these devices is hampered by the fact that there is no standardized "nomogram" that should direct anticoagulation and antiplatelet therapy as well as transfusion therapy in adjusting bleeding and thromboembolic risks.…”