Abstract
With increasing durations of left ventricular assist device (LVAD) support, patients are pursuing greater levels of independence. To improve quality of life, we have introduced a selective approach to allow patients to drive. We have developed a protocol to test a patient's ability to enact emergency procedures within two minutes following LVAD malfunction. After instituting anticoagulation, LVAD output is decreased to a minimal rate to avoid blood stasis yet not significantly augment native cardiac output. With the TCI Heartmate® VE LVAD (Thermo Cardiosystems, Woburn, MA) this involves instituting hand pumping once every ten seconds. The patient is evaluated for signs and symptoms of inadequate cardiac output; blood pressure, heart rate and rhythm are monitored in the supine, sitting, and standing positions. Patients with a history of hemodynamically compromising arrhythmias are excluded. Five patients have been tested, all supported by TCI Heartmate® VE LVADs for an average duration of 154 days (38–251 days). Four of five have been cleared to drive. The current driving experience has been uneventful. Based on our early experiences, employing careful precautions, we have found driving to be safe and emotionally beneficial for LVAD patients.
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