Left Ventricular Assist Device

Aka: Left Ventricular Assist Device, LVAD, Biventricular Assist Device, BiVAD

1. See Also
   1. Implantable Defibrillator
   2. Pacemaker
   3. Cardiac Resynchronization Implantable Device
2. Indications: Congestive Heart Failure
   1. NYHA Class 4 Heart Failure
   2. Ejection Fraction <25%
   3. VO2 Max <15
3. Mechanism
   1. Blood is shunted from ventricle to external pump and back to outflow tract
   2. Left Ventricular Assist Device (LVAD)
      1. Shunts blood from left ventricle apex via external pump to aorta
   3. Biventricular Assist Device (BiVAD)
      1. Shunts blood from both ventricles via external pump
4. Complications
   1. Infections
   2. Bleeding
      1. Anticoagulation
         1. A majority of patients with LVAD or BiVAD are anticoagulated (e.g. Coumadin)
         2. Coumadin may be transiently stopped for major bleeding without serious risk of Thromboembolism in the short-term
      2. Acquired Von Willebrand's Disease
         1. May present with Gastrointestinal Bleeding as well as bleeding from other sites
   3. Pump failure
      1. Presents with a pulseless patient in extremis
      2. Auscultate chest to confirm that the pump is working (blender-like sound)
      3. Check tubes, cables and controller
      4. Check battery power remaining (press button on battery)
         1. Patient should have extra batteries with the pump
         2. Patient may have power pack that allows for AC plug-in
      5. Evaluate pump output
         1. Obtain mean arterial pressure via doppler Ultrasound
         2. Obtain EKG to assess for acute Myocardial Infarction or arrhythmia
         3. Obtain Echocardiogram to assess for interval changes from prior Echocardiogram
   4. Pump thrombosis
      1. Pump may become clogged with clot
      2. Consider Heparin
   5. Heart Failure exacerbation despite pump operating
      1. Consider Endotracheal Intubation
         1. May decrease Pulmonary Hypertension
         2. May improve Respiratory Acidosis and Metabolic Acidosis
      2. Consider pressors
5. References
   1. Swadron and Shinar in Majoewsky (2012) EM:RAP 12(4): 4-5