Early outcomes with durable left ventricular assist device replacement using the HeartMate 3

Heart Failure Association of the European Society of Cardiology position paper on the management of left ventricular assist device‐supported patients for the non‐left ventricular assist device specialist healthcare provider: Part 2: at the emergency department

“…Left ventricular assist device thrombus that is located within the pump has a very distinct appearance ( Figure 1 ); once seen, one can better understand the catastrophic consequences of this event. 88 …”

“…Primary coronary intervention approach favouring rapid symptomatic relief, reducing risk of malignant arrhythmia, and protection of right ventricular function have been reported. 88 Although the levels of the two biomarkers: N‐terminal pro‐brain natriuretic peptide and troponin are expected to decline or increase respectively because of left ventricular unloading or the occurrence of myocardial infarction, the clinical significance of these two biomarkers in LVAD‐supported patients has not been thoroughly explored yet. Chest pain in most cases is of non‐cardiac origin and difficult to diagnose.…”

Approaches to ventricular assist device exchange: Resternotomy versus limited incisions

“…In addition to perioperative optimization of volume status, pulmonary HM II > HM II -Sternotomy with higher RBC transfusion rates (4.7 units vs 0.3 units) -Sternotomy with longer OR times (534.2 min vs 200.5 min) -Sternotomy with longer CPB times (151.5 min vs 33.1 min) -Sternotomy with higher rates of tracheostomy (41.7% vs 0%) -Sternotomy with higher rates of AKI and HD (33.3% vs 0%) vascular resistance, and entropy, there is some postulation that avoiding resternotomy may minimize the incidence of RV dysfunction. 8 Some of the mechanisms that may be involved include decreased bleeding and fluid shifts, and less disruption of right ventricular geometry with limited incisions.…”

Hemostatic Challenges in Pediatric Critical Care Medicine—Hemostatic Balance in VAD

“…In adult patients, Bartoli et al reported LVAD thrombosis in 2–13% patients with a continuous-flow LVAD, 4–13% with axial-flow devices, and 2% with centrifugal-flow devices ( 34 ). The incidence of pump thrombosis reported in adult patients on LVAD continuous flow devices ranged from 0.014 to 0.03 events per patient-year ( 35 ), The HeartMate III device had no reported pump thrombosis for the first 6 months in a large prospective trial ( 36 ), and in another retrospective large study ( 37 ) though there are case reports of pump thrombosis at 1 year ( 38 ).…”