Echocardiographic Assessment of Left Ventricular Assist Device Outflow Velocity During Percutaneous Decommissioning

Abstract

Left ventricular assist devices (LVADs) have been used as an effective therapeutic option in patients with advanced heart failure, either as a bridge to transplantation or, in some patients, as a bridge to recovery. LVAD withdrawal with ventricular recovery represents the optimal outcome for patients previously implanted with an LVAD. In this E-Challenge, the authors present a case of percutaneous decommissioning of an LVAD, in which TEE provided critical, real-time perioperative evaluation. The authors also review the current perspectives on LVAD decommissioning in terms of patient selection and surgical techniques.

The Hero of Haarlem: Seeking Simple Solutions to Failures of Complex Systems

“…This concept was well-illustrated by Liu et al 2 in their recent E-Challenge in the Journal of Cardiothoracic and Vascular Anesthesia, which describes an ingenious and simple solution to the problem of left ventricular overcirculation after left ventricular assist device (LVAD) decommissioning. The minimally invasive surgical technique left both the inflow cannula and outflow graft patent, creating a low-resistance circuit that resulted in left ventricular volume overload and systemic hypoperfusion.…”