16 Perioperative care of LVAD

• Published in: Heart Asia 2018-04, Vol.10 (Suppl 1), p.A6
• Main Author: Kerk, Ka Lee
• Format: Article
• Language: English
• ISSN: 1759-1104
• DOI: 10.1136/heartasia-2018-apahff.16

IntroductionContinuous-flow left ventricular assist devices (LVAD) have emerged as the standard of care for advanced heart failure patients requiring long-term mechanical circulatory support or as bridge to transplant. Evidence-based clinical management of LVAD is becoming increasingly important for optimising outcomes.Preoperative managementPre-implant optimisation of comorbid conditions is vital in minimising the incidence and severity of post-operative adverse events and for enhancing survival.1 This includes psychosocial and behavioural screening prior to surgery. Pre-operative education will prepare patient to be self-reliant after device implant.2 Intraoperative managementTransoesophageal echocardiography (TEE) is essential for identifying valvular pathology and intracardiac defect which may require correction during LVAD implant.1,3 Inotropic support should be tailored to the TEE and pulmonary artery catheter findings. A combination of inotropes, inodilators, vasoconstrictors and nitric oxide may be needed and used with care to protect and preserve right ventricular function.Postoperative managementThe principles of long-term care include assessment and management of VAD function, haemodynamics, anticoagulation, arrhythmias, infections, and psychosocial factors.1,4 Echocardiography is critical in determining optimal pump position and speed setting, and in diagnosing problems with the patient-pump interface.5 Immobilising the percutaneous lead and exit site care to prevent exit site trauma reduces infection risk.1 Cardiac rehabilitation is an important component in returning patients to the community.SummaryThe success of LVAD support depends on not only surgical implant technique but also judicious pre-operative evaluation/preparation and vigilant management of both immediate and long term post-operative issues. This can be accomplished through the comprehensive care from a multidisciplinary team.References. Slaughter, et al. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant2010;29:4S:S1–S39.. Martonik H. Caring for patients with a left ventricular assist device. American Nurse Today2017;12:5.. Sanjay OP. Perioperative management of left ventricular assist devices. Ann Card Anaesth2016;19:S1:19–20.. Feldman, et al. The 2013 international society for heart and lung transplantation guidelines for mechanical circulatory support: Executive summary. J Heart Lung Transplant2013;32:157