Left Ventricular Assist Devices and Pregnancy: Systematic Review of Existing Literature and Case Report

Yadalam, Adithya; Yoo, Bianca W; Horton, John P; Krishna, Iris; Vega, J. David; Bhatt, Kunal; Gupta, Dhiraj; Abdou, Mahmoud H.

doi:10.1016/j.cpcardiol.2022.101469

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…Interagency Report on Mechanically Assisted Circulatory Support (INTERMACS) analysis showed an increased risk of mortality and complications like rehospitalization, bleeding, stroke or pump thrombosis in women compared to men [47]. Pregnancy in an LVAD patient should be considered a contraindication due to hemodynamic alterations that can worsen right or biventricular heart failure, increased prothrombotic risk that can predispose to pump thrombosis, challenges with anticoagulation management and preterm labor [5]. Limited case series on pregnancy outcomes in an LVAD patient have been published [10,[48][49][50][51][52].…”

Section: Left Ventricular Assist Devicesmentioning

confidence: 99%

“…Pregnancies in women with left ventricular assist devices (LVAD) is a contraindication due to worsening biventricular heart failure from volume expansion, increased thrombotic risk during pregnancy, and challenges with anticoagulation management. Pregnancies during LVAD support are limited to case series [5]. Hence, preconception counseling and contraception should be provided to these patients.…”

Section: Introductionmentioning

confidence: 99%

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Management of pregnancy in left ventricular assist device and heart transplant recipients: a concise review

Marek-Iannucci

Uber

Rajapreyar

2023

Current Opinion in Cardiology

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Purpose of reviewWomen of reproductive age are increasingly undergoing heart transplantation (HT) or left ventricular assist device (LVAD) implantation for advanced heart failure. This review is intended to give an overview of the current state of the art management of pregnancy in patients with LVAD or HT recipients.Recent findingsHeart transplant recipients are at increased risk for graft rejection, renal dysfunction, preeclampsia and worsening of comorbidities (hypertension and diabetes). Patients with LVAD are at higher risk of thromboembolic events, infections, right ventricular failure and require close surveillance during pregnancy. Preconception counseling must be offered to all women of reproductive age group with HT or LVAD to avoid unplanned pregnancies.SummaryA multidisciplinary approach with close antepartum and postpartum surveillance is recommended.

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Section: Left Ventricular Assist Devicesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of pregnancy in left ventricular assist device and heart transplant recipients: a concise review

Marek-Iannucci

Uber

Rajapreyar

2023

Current Opinion in Cardiology

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“…Although available data on pregnancy outcomes in patients with LVADs are limited to case reports and case series, some recommendations based on expert opinion are possible. 2,12–14 Pregnancy should be managed in a level IV maternity care center with experience in LVAD management by a multidisciplinary team that includes maternal-fetal medicine specialists, LVAD coordinators, cardiology with LVAD experience, anesthesiology, hematology, neonatology, and cardiothoracic surgery. Patients should be extensively counseled about potential life-threatening complications and the option of pregnancy termination should be discussed.…”

Section: Other Aspects Of Pregnancy In Patients With Left Ventricular...mentioning

confidence: 99%

“…1 The use of cardiac support devices has become more prevalent among females of reproductive age, and despite the fact that pregnancy is contraindicated in some of these patients, including those with left ventricular assist devices (LVADs), obstetricians and maternal-fetal medicine specialists inevitably will be exposed to pregnant individuals treated with implantable cardioverter defibrillators, permanent pacemakers, implantable loop recorders, and LVADs. 2…”

mentioning

confidence: 99%

Care and Monitoring of Pregnant Patients With Left Ventricular Assist Devices

Pacheco,

Saad,

Lick

et al. 2023

Obstetrics &Amp; Gynecology

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Cardiovascular disease is one of the leading causes of maternal mortality in the United States. Although still rare, pregnancy in patients with left ventricular assist devices (LVADs) is becoming more common. Typical indications for the use of LVADs in reproductive-aged females include ischemic cardiomyopathy, nonischemic (familial) dilated cardiomyopathy, peripartum cardiomyopathy, and some forms of myocarditis. An LVAD drains blood through a cannula placed into the apex of the left ventricle and then returns it to the proximal aorta bypassing the aortic valve allowing hemodynamic support in parallel with the native circulation. The physiologic changes associated with pregnancy, mainly increased blood volume and hypercoagulability, may adversely affect patients with LVADs, leading to many experts recommending against pregnancy. Maternal-fetal medicine specialists should have a central role within a multidisciplinary team required to provide optimal care for this high-risk group of patients.

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