Cardiologist Chris Hayward talks about LVAD (Left ventricular assist devices) for the Sydney Intensive Network. The audio is found on www.intensivecarenetwork.com
3. LVAD indications
Need LVAD - Bridge to transplant, destination or recovery
NYHA IV for 60–90 days
Maximal tolerated medical therapy +/- CRT / ICD
Chronic inotrope dependence
LVEF <25%, PCWP 20 mmHg
SBP 80–90 mm Hg or CI 2 L/min/m2 or renal or RV function
Consider LVAD
NYHA IV for 30 days
Maximal tolerated medical therapy and CRT/ICD if indicated
Intermittent inotrope dependence
LVEF <25%, Peak VO2 <12 mL/kg/min
Indication to enable HTx
PVR <5 Woods units, reversible secondary PHT to chronic HF
Reversible GFR <25–30 mL/min/1.73 m2
Lund et al EJHF 2010
4. Contraindications
Cardiac issues
Non-systolic HF
Cor pulmonale, Severe RV dysfunction or Multi-organ failure
Moderate or severe aortic regurgitation that will not be corrected
Mechanical aortic valve that will not be converted to bioprosthesis
Hypertrophic cardiomyopathy, VSD or congenital heart disease
Non-cardiac issues
Terminal co-morbidity; e.g. renal disease (haemodialysis or Crt > 250umol/L)
Metastatic or advanced cancer, severe liver disease, severe lung disease or home O2,
severe PVD, or unresolved CVA or severe neuromuscular disorder
Active uncontrolled systemic infection or risk of infection
Active severe bleeding / platelet count <50 000 x109/L, HITTS
Management issues
Intolerance to the anticoagulant regimen specific to device
Body surface area 1.2–1.5 m2 or other dimensional or technical limitation
Inability to grasp risks and benefits and provide informed consent / interpret alarms
Psychosocial limitations, driveline / medication non-compliance
Lund et al EJHF 2010
15. • Medical history
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•
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Aetiology HF
Hospitalisations
Past chest surgery
• Treatment
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Medications
Devices
ICU support
• Risk of RV failure
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Echo – RV function
RHC – PHT
RVSWI
• Outcome Risks
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•
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Day/Month/Year
Footnote to go here
Renal function
Bleeding risk
Infection risk
Social support
Page 15
27. The Future
MVAD 1/3 size of HVAD
no need for median sternotomy
same impeller technology
promising in animal studies
IV-VAD 1/10 size of HVAD
Intravascular pump – percutaneous
Not intended to provide full cardiac support
TETS - Transcutaneous Energy Transfer
System
Implanted battery pack to be charged across the skin
Will eliminate need for drivelines