Is hypotension normal in patients with a Left Ventricular Assist Device (LVAD)?

From the Guidelines

It is normal for patients with a Left Ventricular Assist Device (LVAD) to have lower blood pressure readings, typically maintaining systolic blood pressures between 80-100 mmHg, due to the device's continuous pumping and altered flow pattern. This is because the LVAD reduces the pulsatility of blood flow, making it challenging to measure blood pressure using standard cuffs 1. As a result, healthcare providers often use mean arterial pressure (MAP) as a better indicator of perfusion in LVAD patients, with a target of 70-80 mmHg.

Key Considerations

• LVAD patients require careful management of blood pressure to optimize forward flow and prevent adverse events, such as neurological events and end-organ damage 1.
• Medications like angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and mineralocorticoid receptor antagonists may be used to decrease afterload and improve pump function 1.
• Regular monitoring and communication with the healthcare team are crucial to ensure the LVAD is functioning properly and organs are receiving adequate blood flow.

Monitoring and Management

• Patients should be aware of their target blood pressure range, established by their LVAD team based on their individual clinical situation.
• Symptoms like dizziness, fatigue, or confusion with low blood pressure readings should be reported to the healthcare provider immediately.
• The use of diuretics, hydralazine/nitrates, and phosphodiesterase type 5 inhibitors may be necessary to manage symptoms of right ventricular failure and fluid retention 1.

From the Research

LVAD and Blood Pressure

• LVADs are designed to provide continuous flow, which can affect blood pressure regulation 2
• Studies have shown that patients with LVADs can have lower blood pressure due to the continuous flow nature of the device 2
• In fact, one study found that the target mean arterial pressure for patients with LVADs is ≤ 80 mm Hg 2

Complications Associated with LVADs

• LVADs can be associated with various complications, including bleeding, cerebrovascular events, infection, right ventricular failure, dysrhythmia, and aortic regurgitation 3
• These complications can be related to the device itself or associated with the underlying condition being treated 3
• Management of these complications requires a team-based approach and consultation with an LVAD specialist 3

Blood Pressure Management in LVAD Patients

• Blood pressure management is crucial in patients with LVADs to prevent adverse events such as stroke and aortic insufficiency 2
• Antihypertensive medications, such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and beta blockers are commonly used to manage blood pressure in LVAD patients 2
• Close monitoring of blood pressure and adjustment of medications as needed is essential to achieve optimal blood pressure control 2

Clinical Examination of LVAD Patients

• The clinical examination of LVAD patients is unique and requires assessment of blood pressure, heart rate, and LVAD function 4
• The examination should also include auscultation of the LVAD "hum", inspection of the driveline and insertion site, and recording of device parameters 4
• Understanding the principles of LVAD function and management is essential for non-expert clinicians to provide effective care for LVAD patients 4