Transcript Left Ventricular Assist Devices: A Primer

Left Ventricular Assist Devices:
The What and the Who
Lance E. Sullenberger MD FACC FACP
Capital Cardiology Associates
But
USHeart
HeartFailure
Transplants
Increasing…
Stable
Left Ventricular Assist Device
Pulsatile Flow
• Not a true artificial
heart.
• Assists the left
ventricle in passing
oxygenated blood
through the body.
• Initially was a
pulsatile device
(similar to native
heart…)
Left Ventricular Assist Device
Continuous (Axial) Flow
Pulsatile Flow is Out
Axial Flow is In
The Down Side
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•
•
Infection
Bleeding
Thrombosis
Embolism
Battery issues
Hemolysis
Who Gets an LVAD?
• Bridge to Recovery
• Bridge to Transplant
• Destination Therapy
Bridge to Recovery
• Acute Myocarditis
• Acute Myocardial
Infarction
• Peripartum
Cardiomyopathy
• Younger
• Previously healthy
• Few comorbidities
Bridge to Transplant
Destination Therapy
REMATCH Trial
• •Can’t
a TX
129get
patients
– Older
• Ineligible for cardiac
– Hepatitis
transplant
– DM with small vessel
• Class
IV CHF
disease
½ received
• •Might
not getLVAD
a TX
issues medical
• –½Renal
received
–therapy
PHTN alone
• Complex surgical
Warning Signs!!
Inability to Take CHF Therapy
Low Sodium
Cardiorenal Syndrome
Warning Signs!
Recurrent Admissions
Low Blood Pressure
Hyponatremia
Poor Renal Function
Use of Continuous
Inotropes
• Increasing diuretic
dose
• Worsening Heart
Failure Class
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Bring It Home….
Thank You!!!
LANCE SULLENBERGER MD
[email protected]