From the Guidelines
Left Ventricular Assist Device (LVAD) Indication
The need for a Left Ventricular Assist Device (LVAD) is primarily caused by advanced heart failure.
- Patients with end-stage heart failure have a poor quality of life and a high mortality rate, making them potential candidates for LVAD implantation 1.
- The technical improvements and proven success of implantable LVADs have made them a reasonable treatment option for these patients, either as a bridge to cardiac transplantation (CTX) or as destination therapy 1.
- Severe heart failure, characterized by symptoms such as congestion and reduced cardiac output, is a key indicator for LVAD implantation 1.
- Patients with left ventricular ejection fraction (LVEF) ≤25% and NYHA function class IIIB/IV are considered candidates for LVAD therapy 1.
- The decision to implant an LVAD is crucial and should be made after careful patient selection, taking into account factors such as renal, pulmonary, or hepatic dysfunction, as well as active infection or cardiogenic shock 1.
- The use of LVADs as destination therapy for patients ineligible for cardiac transplantation has become more common, with nearly 20,000 LVADs implanted to date in the United States 1.
- The European Society of Cardiology recommends that LVADs be implanted and managed at tertiary heart failure centers with appropriately trained specialist heart failure physicians and surgeons 1.
From the Research
Left Ventricular Assist Device (LVAD) Indications
The need for a Left Ventricular Assist Device (LVAD) arises in patients with advanced heart failure, particularly those who are inotrope-dependent with pure or predominant left ventricular (LV) dysfunction 2. The primary goal of LVAD implantation is to provide short- or long-term circulatory support, improving survival and reducing morbidity in selected patients with advanced heart failure 3.
Patient Selection and Assessment
Patient selection for LVAD implantation involves careful assessment of their heart failure status, including the severity of LV dysfunction and the presence of other comorbidities 4. The timing of LVAD implantation is crucial, as early implantation may expose patients to unnecessary risks, while delayed implantation may increase the risk of developing irreversible right ventricular and/or end-organ dysfunction 2.
Common Complications and Management
Common complications associated with LVAD therapy include:
- Bleeding: often due to anticoagulation and acquired von Willebrand disease secondary to shear stress produced within the pump 4
- Infections: driveline infections and device-related infections, which must be aggressively treated to avoid seeding the device 4
- Thrombotic issues: device thrombosis can develop even with adequate anticoagulation and antiplatelet therapy 4
- Neurologic events: stroke and other neurologic complications 3, 4
- Ventricular arrhythmias: common after LVAD implantation, particularly in the early post-operative period 5
Management and Follow-up
Effective management of LVAD patients requires a multidisciplinary team approach, including specialists in advanced heart failure, LVAD nurse coordinators, and intensivists 4. Regular follow-up and monitoring are essential to identify and manage potential complications, as well as to optimize device function and patient outcomes 3, 6.