Left Ventricular Assist Device: What the Internist Needs to Know. A Review of the Literature

Boruah, Pranjal; Saqib, Najam; Barooah, Jumee; Baruah, Dhiraj; Sharma, Parikshit S.

doi:10.7759/cureus.4399

Cited by 4 publications

(5 citation statements)

References 47 publications

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“…The surgical treatment options for adults living with heart failure are increasingly becoming more common -due to the rising percentage of patients refractory to medical managementimproving survival rates in those subjects who are not candidates for heart transplantation [1]. Left ventricular assist device (LVAD) implantation has four primary indications, i) bridge to transplantation, ii) destination therapy (lifelong support), iii) bridge to myocardial recovery, iv) bridge to candidacy (temporary support) [2]. Postoperative rehabilitation is a cornerstone of the pathway of care contributing to improving functional capacity and reducing readmission rates following implantation [3].…”

Section: Introductionmentioning

confidence: 99%

Postoperative outcomes following rehabilitation in patients with left ventricular assist devices

Polastri¹,

Boschi²,

Brillanti

et al. 2020

Monaldi Arch Chest Dis

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Postoperative rehabilitation is a cornerstone of the recovery pathway following left ventricular assist device implantation (LVAD), and patients are expected to conduct an autonomous life thanks to improved technology and increased knowledge of mechanical circulatory support. The primary purpose of the present study was to quantify clinical changes related to rehabilitation, in patients with LVAD: functional capacity, disability, and quality of life were identified as reliable outcomes to detect such changes. The current study was a scoping review conducted searching three primary databases, namely PubMed, Scopus, and Cochrane Library, from their inception until January 2020. After the selection process was completed, 12 citations were included in the present study. Three hundred eight three patients were included in the current analysis. Functional capacity, disability, and quality of life were investigated in 157, 215, 18 patients, respectively. Significant differences were found before and after rehabilitation. The mean walked distance at 6-Minute Walk Test improved from 319±96 to 412.8±86.2 metres (p<0.001), the mean score of the Functional Independence Measure from 68.4±11.8 to 92.5±10.8 points (p<0.001), the mean score of the Short Form-36 physical component from 32.7±29.9 to 55.5±24.7 points (p=0.009) and the mental component from 55.8±19.8 to 75.4±21.4 points (p=0.002). Postoperative rehabilitation is effective at improving functional capacity, disability, and quality of life in patients with left ventricular assist device; all these three domains are particularly expressive of the entity of patients’ functional recovery.

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Section: Introductionmentioning

confidence: 99%

Postoperative outcomes following rehabilitation in patients with left ventricular assist devices

Polastri¹,

Boschi²,

Brillanti

et al. 2020

Monaldi Arch Chest Dis

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“…Bleedings and arrhythmias tend to precipitate immediately after the intervention, while infections and neurologic events appear to have a gradual beginning. 15 According to the 8th annual INTERMACS report, the rate of rehospitalization has been estimated to be 60% at 6 months postimplantation and 65% to 80% at 1 year after the procedure. 16 This manuscript will further focus on reviewing the most important device-specific complications.…”

Section: Lvad-related Complicationsmentioning

confidence: 99%

Left Ventricular Assist Device-Related Complications

Clément¹,

Anghel

Sascău

et al. 2020

Journal of Cardiovascular Emergencies

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Left ventricular assist device (LVAD) has emerged as a safe, durable, and revolutionary therapy for end-stage heart failure patients. Despite the appearance of newer-generation devices that have improved patient outcomes, the burden of adverse events remains significant. Although the survival rate for patients with LVAD is appreciated to be 81% at 1 year and 70% at 2 years, the incidence of adverse events is also high. Over time, both early and late postimplant complications have diminished in terms of prevalence and impact; however, complications, such as infections, bleeding, right heart failure, pump thrombosis, aortic insufficiency, or stroke, continue to represent a challenge for the practitioner. Therefore, the aim of this review is to highlight the most recent data regarding the current use of LVAD in the treatment of end-stage heart failure, with a specific focus on LVAD-related complications, in order to improve device-related outcomes. It will also revise how to mitigate the risk and how to approach specific adverse events. Withal, understanding the predisposing risk factors associated with postimplant complications, early recognition and appropriate treatment help to significantly improve the prognosis for patients with end-stage heart failure.

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“…Currently, left ventricular assist device (LVAD) implantation is considered the most effective treatment for end-stage advanced heart failure (AHF). [1] LVAD implantation is increasingly used in patients with AHF as a bridge therapy to cardiac transplantation or end-stage treatment. [2] Continuous flow (CF)-LVADs are the devices wherein blood can be drawn via the cannula located in the apical region of the left ventricle (LV) and is transmitted to the aorta with the help of a constant-speed rotor (Fig.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oral amiodarone and propranolol in maintenance therapy of postimplantation tachycardia: An observational study

Arslan,

Özkaya,

Aytemiz

et al. 2024

Medicine

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Left ventricular assist devices (LVADs) are widely used as end-stage therapy in patients with advanced heart failure, whereas implantation increases the risks of development of sustained ventricular tachycardia at the later postimplantation stage. Therefore, this study aimed to evaluate the clinical efficacy of orally administered amiodarone and propranolol in 3 patients with ventricular tachycardia (VT) after LVAD implantation who were resistant to initial anti-antiarrhythmic drugs. This retrospective cohort study consisted of the initial evaluation of the clinical data of 14 adult patients who underwent implantation of LVAD between January 2019 and March 2021. A total of 3 patients with resistant VT were finally included. In all cases, the patients were initially administered amiodarone in the different doses intravenously to stabilize the critical condition, whereas its oral form along with that of propranolol was used as maintenance therapy in the first 2 cases. In the third case, amiodarone was withdrawn because of the risk of development of hyperthyroidism, while oral propranolol was used in the treatment. The assessment in the 16-month follow-up period after discharge did not show presence of non-sustained and sustained VT in all 3 cases. In the ventricular arrhythmia-free group, the total mortality rate within the follow-up period was 11.1 ± 7.78 months in the 3 patients. We suggest that maintenance oral therapy of propranolol and amiodarone can significantly decrease the risks of complications in patients with VT after implantation of ventricular assist device in the long term.

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Left Ventricular Assist Device: What the Internist Needs to Know. A Review of the Literature

Cited by 4 publications

References 47 publications

Postoperative outcomes following rehabilitation in patients with left ventricular assist devices

Postoperative outcomes following rehabilitation in patients with left ventricular assist devices

Left Ventricular Assist Device-Related Complications

Oral amiodarone and propranolol in maintenance therapy of postimplantation tachycardia: An observational study

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