Abstract
Ambulatory patients with a left ventricular assist device (LVAD) are increasing in number, and so is their life expectancy. Thus, there is an increasing need for care of these patients by non-LVAD specialists, such as providers in the emergency department, urgent care centers, community-based hospitals, outpatient clinics, etc. Non-LVAD specialists will increasingly come across LVAD patients and should be equipped with the knowledge and skills to provide initial assessment and management for these complex patients. These encounters may be for LVAD-related or unrelated issues. However, there are limited data and guidelines to assist non-LVAD specialists in caring for these complex patients. The aim of our review, targeting primary care providers (both inpatient and outpatient), general cardiologists, and other providers is to describe the current status of durable LVAD therapy in adults, patient selection, management strategies, complications and to summarize current outcome data.
Highlights
Heart failure (HF) affects an estimated 6.5 million people in the United States currently
While patients are still distinguished by upfront strategy of bridge to transplantation (BTT) or destination therapy (DT), there is significant dual crossover that occurs once they are on left ventricular assist device (LVAD) therapy
Coumadin is recommended for all LVADs and the international normalized ratio (INR) should be checked frequently
Summary
Heart failure (HF) affects an estimated 6.5 million people in the United States currently. LVADs to support patients with end-stage HF with reduced ejection fraction (HFrEF) have continued to evolve, with improvement in technology, durability and miniaturization. These devices are a life-saving option for advanced HF patients who are either not candidates for a heart transplant or too high-risk to safely wait for a transplant on medical therapy alone. First-generation pulsatile LVADs were volume-displacement pumps, using a diaphragm and unidirectional valves to mimic the pulsatile cardiac cycle through diastolic filling and systolic emptying of the device These devices were large, noisy and had limited durability due to multiple mechanical parts that were subject to wear and tear [12].
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