Ventricular Support Research Articles

Circulating biomarkers of the CS4P and CLIP scores are not altered in a pig model of acute cardiogenic shock and additional short-term circulatory support

BackgroundCardiogenic shock (CS) is the leading cause of death in patients with myocardial infarction with a mortality rate greater than 50%. Recently, the CS 4 Proteins (CS4P) and CLIP scores have been developed to predict survival in CS patients. However, their impact in acute CS and additional short-term left ventricular (LV) circulatory support as prognostic markers is currently not known. Methods and resultsCS was induced in a porcine model by injecting microsphere particles into the left main coronary artery. Mechanical circulatory support was performed by additional percutaneous LV unloading using an Impella microaxial flow-pump for 30 minutes. Serum samples were collected at baseline, following the onset of CS, and additional LV unloading. Serum levels of biomarkers of the CS4P (beta-2-microglobulin, ALDOB, L-FABP, SerpinG1) and the CLIP scores (Cystatin C, Lactate, Interleukin-6, NT-proBNP) were neither different at any time point investigated nor did they correlate with cardiac output. ConclusionThe CS4P and CLIP scores do not reflect immediate whole-body dysregulation in acute CS and have not been able to predict the potential reversal following additional short-term mechanical support by LV unloading in our experimental model. The impact of both scores as prognostic markers after the immediate onset of CS and following additional short-term LV unloading to identify patients at greatest risk remains to be determined.

Venopulmonary extracorporeal membrane oxygenation for right ventricular support as a bridge to lung transplantation: A narrative review

This review evaluates the effectiveness of veno-pulmonary support with an oxygenator using extracorporeal membrane oxygenation as a bridge to lung transplantation strategy in patients undergoing veno-venous extracorporeal membrane oxygenation while awaiting lung transplantation. Examining indications, contraindications, and clinical outcomes, the study highlights potential benefits, drawing insights from successful cases in South Korea and the United States. Despite limited sample sizes, veno-pulmonary support with an oxygenator using extracorporeal membrane oxygenation emerges as a promising approach for further investigation in lung transplantation support. The review emphasizes its role in improving hemodynamic status, preventing complications during extended waiting periods, and presenting a cost-effective alternative to traditional methods, especially in developing countries. While in-hospital mortality rates range from 0% to 10%, comparable to other approaches, cautious optimism surrounds veno-pulmonary support with an oxygenator using extracorporeal membrane oxygenation, urging expanded research to solidify its standing in enhancing patient outcomes, reducing costs, and promoting transplant success.

On-Line Estimation of Circulatory State under Ventricular Assist Device Support Using an Unscented Kalman Filter

On-Line Estimation of Circulatory State under Ventricular Assist Device Support Using an Unscented Kalman Filter

Первый опыт выполнения чрескожных коронарных вмешательств высокого риска с использованием трансаортальной системы кратковременной поддержки левого желудочка PulseCath IVAC 2L

Первый опыт выполнения чрескожных коронарных вмешательств высокого риска с использованием трансаортальной системы кратковременной поддержки левого желудочка PulseCath IVAC 2L

Mechanical Support Strategies for High-Risk Procedures in the Invasive Cardiac Catheterization Laboratory: A State-of-the-Art Review.

Thanks to advancements in percutaneous cardiac interventions, an expanding patient population now qualifies for treatment through percutaneous endovascular procedures. High-risk interventions far exceed coronary interventions and include transcatheter aortic valve replacement, endovascular management of acute pulmonary embolism and ventricular tachycardia ablation. Given the frequent impairment of ventricular function in these patients, frequently deteriorating during percutaneous interventions, it is hypothesized that mechanical ventricular support may improve periprocedural survival and subsequently patient outcome. In this narrative review, we aimed to provide the relevant evidence found for the clinical use of percutaneous mechanical circulatory support (pMCS). We searched the Pubmed database for articles related to pMCS and to pMCS and invasive cath lab procedures. The articles and their references were evaluated for relevance. We provide an overview of the clinically relevant evidence for intra-aortic balloon pump, Impella, TandemHeart and ECMO and their role as pMCS in high-risk percutaneous coronary intervention, transcatheter valvular procedures, ablations and high-risk pulmonary embolism. We found that the right choice of periprocedural pMCS could provide a solution for the hemodynamic challenges during these procedures. However, to enhance the understanding of the safety and effectiveness of pMCS devices in an often high-risk population, more randomized research is needed.

Multi-device complete revascularization of severely calcified multi-vessel coronary artery disease with left ventricular support of Impella CP under Swan-Ganz catheter monitoring.

Multi-device complete revascularization of severely calcified multi-vessel coronary artery disease with left ventricular support of Impella CP under Swan-Ganz catheter monitoring.

Treatment Strategies and Outcomes of Right Ventricular Failure Post Left Ventricular Assist Device Implantation: An INTERMACS Analysis.

Right heart failure (RHF) management after left ventricular assist device (LVAD) implantation includes inotropes, right ventricular mechanical support, and heart transplantation. The purpose of this study is to compare different RHF treatment strategies in patients with a magnetically levitated centrifugal LVAD. A total of 6,632 Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) patients from 2013 to 2020 were included. Of which, 769 (69.6%) patients (group 1) were supported with inotropes (≥14 days post-LVAD implantation), 233 (21.1%) patients (group 2) were supported with temporary right ventricular assist device (RVAD) that was implanted during LVAD implant, 77 (7.0%) patients (group 3) with durable centrifugal RVAD implanted during the LVAD implant, and 26 (2.4%) patients (group 4) were supported with RVAD (temporary or permanent), which was implanted at a later stage. Groups 1 and 4 had higher survival rates in comparison with group 2 (hazard ratio [HR] = 0.513, 95% confidence intervals [CIs] = 0.402-0.655, p < 0.001, versus group 1) and group 3 (HR = 0.461, 95% CIs = 0.320-0.666, p < 0.001, versus group 1). Patients in group 3 showed higher heart transplantation rates at 12 and 36 months as compared with group 1 (40.4% and 46.6% vs. 21.9% and 37.4%, respectively), group 2 (40.4% and 46.6% vs. 25.8% and 39.3%, respectively), and group 4 (40.4% and 46.6% vs. 3.8% and 12.0%, respectively). Severe RHF post-LVAD is associated with poor survival. Patients with LVAD who during the perioperative period are in need of right ventricular temporary or durable mechanical circulatory support constitute a group at particular risk. Improvement of devices tailored for right ventricular support is mandatory for further evolution of the field.

Temporary Right Ventricular Support Using the Existing Bypass Circuit During LVAD Implantation

BackgroundRight-sided heart failure after left ventricular assist device (LVAD) implantation carries high morbidity. We sought to develop a technique for expedient short-term right ventricular (RV) support with the cardiopulmonary bypass (CPB) circuit already in use during the LVAD implantation procedure. MethodsPatients at high risk for RV failure during LVAD implantation were supported by a modified CPB circuit. A standard CPB circuit was modified to include a series of 4 wye (Y) bridge connections, allowing the ability to exclude the venous reservoir and oxygenator and to flow venous blood or arterialized blood in the same CPB outflow line. ResultsFrom 2019 to 2022 at a single institution, 6 patients were identified as high risk for early RV failure. Preoperative mean clinical values included central venous pressure of 16.3 ± 3.2 mm Hg, pulmonary capillary wedge pressure of 26.7 ± 3.2 mm Hg, tricuspid annular plane systolic excursion of 1.2 ± 0.23 cm, RV stroke work index of 311.7 ± 32.5, and central venous pressure/pulmonary capillary wedge pressure of 0.61 ± 0.10. All 6 patients were successfully weaned from CPB to LVAD support without the need for RV support at the conclusion of the implantation procedure. ConclusionsWe describe a configuration that supports the right ventricle during the critical period after CPB when it is at high risk of failure while the patient is being resuscitated with transfusions and volume. This technique provides flexibility in the management of complex, critically ill patients with RV failure, increasing the possibility of intraoperative RV recovery and successful separation from CPB during LVAD implantation.

Abstract 18803: Extended Duration Impella Support: A Review of 107 Patients Successfully Supported With Impella 5.5 Device at a Single Institution

Introduction: Impella 5.5 is an FDA-approved microaxial, continuous flow pump intended to provide left ventricular hemodynamic support for 14 days. We report 107 consecutive patients supported with this device, many for extended durations. Methods: The outcomes of consecutive patients supported with Impella 5.5 at an academic hospital from March 2021 to June 2023 are included. Results: 107 patients required 112 Impella 5.5 devices. The majority of patients had a heart failure etiology of NICMP (57, 53%), followed by ICMP (36, 34%), post cardiotomy shock (6, 5%), other (4, 4%), planned post cardiotomy cardiac protection (3, 3%), and congenital heart disease (1, 1%). 60 patients (56%) were SCAI D, 30 patients (28%) SCAI E, and 17 patients (16%) were SCAI C. The majority patients (70,65%) were Intermacs 2. The majority of Impella 5.5 devices were placed as a bridge to decision (55 patients, 51%), followed by BTT (28 patients, 26%), BTR (16 patients, 15%), Bridge to LVAD (7 patients, 7%), and one patient (1%) device was placed for post cardiotomy cardiac protection. 11 patients required interval escalation to concomitant VA-ECMO. Patients requiring ECPELLA were placed on PVA ECMO after an average of 22 days of impella support, and average time of support on ECPELLA was 5.4 days. All patients transitioned to cardiac replacement therapy. Among patients with explant data, 43 supported for &lt; 2 weeks, 38 for 2-4 weeks, and 17 for &gt; 4 weeks. Longest duration of support was 92 days. Of patients reaching a primary endpoint, 42 were transplanted (39%), 21 patients died (20%), 18 patients received durable VAD (17%), 12 were discharged without transplant or VAD (11%), 10 were transferred while on support (9%) and 4 patients are still supported (4%). With respect to complications, 5 patients suffered from strokes, 3 pump thrombosis, 2 had fiber optic cable malfunctions, 2 had purge line leaks, and there were 3 patients with a broken optical sensor, and 2 arterial (brachial and axillary) thrombus. Conclusion: The Impella 5.5 device is a left ventricular support device placed most frequently to successfully stabilize patients undergoing evaluation for advanced therapies who were failing despite inotropic therapy.

Abstract 18267: Successful C-Section Delivery at 36 Weeks in a Patient With a Heartmate 3 LVAD

Introduction: Pregnancy in patients with advanced heart failure requiring left ventricular assist device (LVAD) support is risky and discouraged, though there are cases of successful deliveries. Hypothesis: A 29-year-old G3P2002 female with history of embolic cerebrovascular accident, postpartum hemorrhage, peripartum cardiomyopathy status-post HeartMate 3 (HM3) LVAD, became pregnant after intrauterine device dislodgement. She elected to continue the pregnancy against the advice of maternal-fetal medicine (MFM). A multidisciplinary team convened to plan for delivery. Methods: Warfarin and sacubitril-valsartan were stopped due to teratogenicity. Therapeutic anticoagulation with enoxaparin injections was started. Aspirin was continued. Low-dose digoxin was added for right ventricular support. A multidisciplinary team involving anesthesiology, MFM, and advanced heart failure (AHF) was convened. Through patient-centered shared decision-making, cesarean delivery was planned for 36 weeks. She was seen by MFM and AHF every two weeks with LVAD speed optimization under transthoracic echocardiogram (TTE) guidance and anti-Xa monitoring. Results: The patient was electively admitted at 35 weeks for pre-delivery optimization. Enoxaparin was switched to an unfractionated heparin infusion. Betamethasone was administered to facilitate fetal lung maturation. Twice-daily fetal non-stimulation tests were performed. LVAD speed was optimized with TTE guidance. Continuous hemodynamic monitoring was performed perioperatively with a Swan-Ganz catheter and arterial line. Femoral veno-arterial sheaths were placed in case extracorporeal membrane oxygenation was needed. Anesthesia was administered via spinal-epidural approach. LVAD speed was modulated as needed. A healthy neonate was delivered by cesarean section without complication at 36 weeks and 3 days. Conclusions: Pregnancy during LVAD support remains an extremely high-risk clinical situation, though this case demonstrates that it is possible to carry such a pregnancy to near-term.

Abstract 17145: Impact of Preoperative Levosimendan in Patients With Severe Heart Failure Undergoing Left Ventricular Assist Device Support: A Meta-Analysis

Introduction: Left ventricular assist devices (LVADs) are frequently employed as a bridge to transplant or destination therapy. The implementation of preventive preoperative measures can have a beneficial impact on the prognosis of patients undergoing LVAD implantation. However, the role of levosimendan in this context remains uncertain. Goals: To evaluate the efficacy of preoperative levosimendan in reducing complications after LVAD implantation. Methods: We systematically searched PubMed, Scopus, and Cochrane Library for studies comparing the use of levosimendan before LVAD implantation vs. standard of care alone in May 2023. Statistical analyses were performed using Review Manager 5.4.1. Heterogeneity was assessed with I2 statistics. Results: Four studies comprising 4032 patients who underwent LVAD implantation were included, of whom 15,2% were on preoperative levosimendan. There was no significant difference between groups in 30-day mortality (OR, 0.95 [95% CI, 0.70-1.28], I2=0%, p=0.73 - Fig. 1A), right ventricular failure (OR, 0.92 [95% CI, 0.47-1.80], I2=69%, p=0.81 - Fig. 1B), or length of intensive care unit (ICU) stay (mean difference, 2.63 [95% CI, -2.07-7.33], I2=92%, p=0.27 - Fig. 1C). Conclusions: In this meta-analysis, the preoperative use of levosimendan was not associated with reduced mortality, right ventricular failure, or length of ICU stay in patients undergoing LVAD implantation.

Abstract 18152: Clinical Impact and Mechanism of De Novo Aortic Insufficiency During Percutaneous Ventricular Assist Device Support for Cardiogenic Shock

Introduction: Recently, percutaneous ventricular assist device (p-LVAD) has been widely applicable for cardiogenic shock. Clinically significant aortic insufficiency (AI) is contraindication for p-LVAD, nevertheless p-LVAD itself can cause de novo AI (dAI) during the support. However the detail of dAI during p-LVAD support was not fully investigated. The aim of this study was to evaluate the clinical impact of AI during p-LVAD support and also investigate the mechanism and risk factor of dAI. Methods: Seventy-seven consecutive patients who underwent p-LVAD support (average age 66.7 years, Impella CP/2.5 in 65 and 5.5/5.0 in 12 cases) from 2018 to 2022 were retrospectively evaluated. The average support periods was 8.0±6.9 days. dAI was defined as development of AI ≥ moderate during p-LVAD support. Aortic valve pathology was examined using autopsy specimens in eight patients. Results: Three patients had AI ≥ moderate before p-LVAD support and underwent surgical intervention (AVR in 2 and AV repair in 1) during p-LVAD support. dAI was observed in 8 patients (10.3%, moderate in 7 and severe in 1). Moderate dAI in four of these patients improved after cardiac recovery and weaning of p-LVAD support. However, in 3 other patients with dAI ≥ moderate developed hemodynamic instability and deceased due to heart failure. In only a patient, moderate dAI remained after p-LVAD weaning with stable hemodynamics. Progression of AI after p-LVAD removal was not observed in all patients. In-hospital mortality was higher in the patient with dAI (75.0 vs. 47.8%, p=0.14). Pathological evaluation revealed hemorrhagic change at LV side of aortic valve with hemosiderin-laden macrophages in 3 autopsy specimens, which suggested contact of p-LVAD catheter. The univariate analysis identified mild AI before p-LVAD support as independent risk factor for dAI (Odd ratio 5.5, 95%CI 0.074-0.45, p&lt;0.001). Conclusions: Our study demonstrated that de novo AI frequently occurred during p-LVAD support and had a negative impact on hemodynamics and prognosis. Interference with aortic valve by the p-LVAD catheter may cause and exacerbate AI, even in the cases with pre-existing mild AI. Surgical intervention is essential to improve hemodynamics for severe and permanent AI during p-LVAD support.

Abstract 16114: Heart Failure Hospitalizations and In-Hospital Outcomes Among Patients With Schizophrenia - Nationwide Study

Introduction: There is limited data regarding hospital outcomes in patients admitted with heart failure (HF) exacerbation and schizophrenia. Hypothesis: We sought to determine the characteristics and in-hospital outcomes of patients with schizophrenia admitted due to HF exacerbation in the United States. Methods: We performed a retrospective cohort study using the National Inpatient Sample database from January to December 2019. Patients with HF exacerbation (defined by ICD-10 codes) were categorized into two groups: patients with versus without schizophrenia and associated psychoses (defined by ICD-10 codes). Baseline variables and in-hospital outcome trends were compared between the 2 groups. Using logistic regression, we assessed the odds of use of invasive ventricular support device, and of in-hospital mortality. Results: In total, 9,780 hospitalizations for HF in patients with schizophrenia were identified, equivalent to 0.76% of all HF hospitalizations (n = 1,295,395). Patients with schizophrenia were younger (mean age 60 vs 71 years, p&lt;0.05), more likely to be men (57% vs 52%, p&lt;0.05), and more likely to have chronic pulmonary disease, obesity or be currently smoking. Comparing to overall HF patients, those with schizophrenia were more likely to be African American and live in zip codes at the lowest quartile of national income. After adjusting for patient-level, hospital-level demographics, and coexisting clinical conditions in a multivariable logistic regression there was no significant difference in the odds of in-hospital mortality between the two groups (OR 0.99, 95% CI, 0.63-1.60; P=0.99). No discrepancies in access to invasive ventricular support device were found (OR 0.42, 95% CI, 0.15 - 1.06, P=0.07). Conclusions: Patients with HF exacerbation and schizophrenia are more than one decade younger than overall HF population. Our study did not find difference in the odds of in-hospital mortality in patients admitted with HF exacerbation and schizophrenia in the United States.

Clinical Outcomes of SARS-CoV-2 Infection in Pediatric Patients on Ventricular Assist Device Support: An ACTION Registry Analysis.

Adult patients on left ventricular assist device (LVAD) support have increased morbidity and mortality after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. There are no reported clinical data describing outcomes among pediatric patients on ventricular assist device (VAD) support infected with SARS-CoV-2. We conducted a retrospective study using the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry to evaluate patient characteristics and clinical outcomes after SARS-CoV-2 infection. A total of 22 children on VAD support (median age at infection 10.6 years) from 16 centers tested positive for SARS-CoV-2. Cardiomyopathy (59.1%) and congenital heart disease (40.9%) were the most common primary diagnoses. The type of support included LVAD in 19 (86.4%), biventricular assist device (BIVAD) in one (4.5%), and single ventricle VAD in two (9%) patients. At the time of infection, 50% were outpatients, 23% were inpatients on a general cardiology floor, and 27% were in the cardiac intensive care unit (CICU). Most patients (82%) were symptomatic at time of diagnosis, but only 13% required escalation of respiratory support, and 31% received SARS-CoV-2 therapies. Notably, no mortality occurred, and significant morbidity was rare after SARS-CoV-2 infection in pediatric patients on VAD support.

Cardiological Challenges Related to Long-Term Mechanical Circulatory Support for Advanced Heart Failure in Patients with Chronic Non-Ischemic Cardiomyopathy.

Long-term mechanical circulatory support by a left ventricular assist device (LVAD), with or without an additional temporary or long-term right ventricular (RV) support, is a life-saving therapy for advanced heart failure (HF) refractory to pharmacological treatment, as well as for both device and surgical optimization therapies. In patients with chronic non-ischemic cardiomyopathy (NICM), timely prediction of HF's transition into its end stage, necessitating life-saving heart transplantation or long-term VAD support (as a bridge-to-transplantation or destination therapy), remains particularly challenging, given the wide range of possible etiologies, pathophysiological features, and clinical presentations of NICM. Decision-making between the necessity of an LVAD or a biventricular assist device (BVAD) is crucial because both unnecessary use of a BVAD and irreversible right ventricular (RV) failure after LVAD implantation can seriously impair patient outcomes. The pre-operative or, at the latest, intraoperative prediction of RV function after LVAD implantation is reliably possible, but necessitates integrative evaluations of many different echocardiographic, hemodynamic, clinical, and laboratory parameters. VADs create favorable conditions for the reversal of structural and functional cardiac alterations not only in acute forms of HF, but also in chronic HF. Although full cardiac recovery is rather unusual in VAD recipients with pre-implant chronic HF, the search for myocardial reverse remodelling and functional improvement is worthwhile because, for sufficiently recovered patients, weaning from VADs has proved to be feasible and capable of providing survival benefits and better quality of life even if recovery remains incomplete. This review article aimed to provide an updated theoretical and practical background for those engaged in this highly demanding and still current topic due to the continuous technical progress in the optimization of long-term VADs, as well as due to the new challenges which have emerged in conjunction with the proof of a possible myocardial recovery during long-term ventricular support up to levels which allow successful device explantation.

Postoperative Pulmonary Artery Pulsatility Index Improves Prediction of Right Ventricular Failure After Left Ventricular Assist Device Implantation

This study evaluated whether the postoperative pulmonary artery pulsatility index (PAPi) is associated with postoperative right ventricular dysfunction after durable left ventricular assist device (LVAD) implantation. Single-center retrospective observational cohort study. The University of Kansas Medical Center, a tertiary-care academic medical center. Sixty-seven adult patients who underwent durable LVAD implantation between 2017 and 2019. All patients underwent open cardiac surgery with cardiopulmonary bypass under general anesthesia with pulmonary artery catheter insertion. Clinical and hemodynamic data were collected before and after surgery. The Michigan right ventricular failure risk score and the European Registry for Patients with Mechanical Circulatory Support score were calculated for each patient. The primary outcome was right ventricular failure, defined as a composite of right ventricular mechanical circulatory support, inhaled pulmonary vasodilator therapy for 48 hours or greater, or inotrope use for 14 days or greater or at discharge. Thirty percent of this cohort (n=20) met the primary outcome. Preoperative transpulmonary gradient (odds ratio [OR] 1.15, 95% CI 1.02-1.28), cardiac index (OR 0.83, 95% CI 0.71-0.98), and postoperative PAPi (OR 0.85, 95% CI 0.75-0.97) were the only hemodynamic variables associated with the primary outcome. The addition of postoperative PAPi was associated with improvement in the predictive model performance of the Michigan score (area under the receiver operating characteristic curve 0.73 v 0.56, p=0.03). An optimal cutoff point for postoperative PAPi of 1.56 was found. The inclusion of postoperative PAPi offers more robust predictive power for right ventricular failure in patients undergoing durable LVAD implantation, compared with the use of existing risk scores alone.

Perioperative Morbidity and Outcomes in Pediatric Patients Transitioned From Extracorporeal Membrane Oxygenation to Ventricular Assist Device Support: A Study of the Society of Thoracic Surgeons Congenital Heart Surgery Database.

As a bridge to transplant strategy, children transitioned from extracorporeal membrane oxygenation (ECMO) to ventricular assist device (VAD) have higher waitlist mortality compared with those who receive de novo VAD. However, the contribution of the immediate perioperative period and differences in the two groups are not well studied. We performed a nested case-control study between children receiving de novo VAD (group 1) and those transitioned from ECMO to VAD (group 2) between 2014 and 2019 using The Society of Thoracic Surgeons (STS) database. A total of 735 children underwent VAD placement with 498 in group 1 and 237 in group 2. Patients in group 2 were significantly younger, smaller, and significantly sicker, were twice as likely to transition to biventricular VAD and need unplanned reoperations. Overall mortality was 16% for group 1 and 34% for group 2 ( p < 0.01). Regression analysis showed that ECMO use (odds ratio [OR], 2.17 [1.3-3.4]), ventilator need (OR, 2.2 [1.3-3.9]), and cardiogenic shock (OR, 1.8 [1.2-2.8]) were all independent preoperative predictors of VAD mortality while dialysis need (OR, 25.5 [8.6-75.3]), stroke (OR, 6.2 [3.1-12.6]), and bleeding (OR, 1.9 [1.1-3.4]) were independent postoperative predictors of VAD mortality within 30 days (all p < 0.05). The study demonstrated significant baseline differences between the two cohorts, warranting avoidance of comparison. Early elective VAD placement in this cohort of patients should be sought to avoid interim ECMO and high post-VAD mortality.

PB0286 Population Pharmacokinetics and Pharmacodynamics of Bivalirudin in Children on Ventricular Assist Device Support

PB0286 Population Pharmacokinetics and Pharmacodynamics of Bivalirudin in Children on Ventricular Assist Device Support

Transition from temporary to durable right ventricular support after left ventricular assist device implantation.

Transition from temporary to durable right ventricular support after left ventricular assist device implantation.

Аcute renal failure in patients with implanted LVAD in the early postoperative period

AKI is one of the major complications in the cardiac surgery group of patients in the world. In patients with LVAD in the short postoperative period, the situation with such a complication as AKI is associated with the state of hemodynamics and fluctuations in the parameters of the hemostasis system.&#x0D; The purpose of this scientific work is to analyze the state of the blood coagulation system and its response to therapy and complications in the early postoperative period in fifty patients with implanted devices for mechanical support of the left ventricle, left ventricle assist device, LVAD, in the Silesian Heart Disease, Poland. Patients were divided into two groups, a control group receiving classical anticoagulation targeted therapy (ATT), which included the most controlled monotherapy with heparin, after reaching the target values of APTT, the addition and transition to monotherapy with warfarin until reaching the target INR and ASA, and the main, research group, who received an alternative ATT consisting of the previous one with the addition of P2Y12-receptor blockers and Xa-factors.&#x0D; The results showed that the control group of patients with classical anticoagulant targeted therapy had greater mortality associated with AKI than the patients of the study group, and it was also demonstrated that the initially longer duration of surgery and intraoperative polyuria gave a greater percentage of AKI in the postoperative period.&#x0D; The work was carried out within the framework of a bilateral agreement on scientific cooperation between the Department of Anesthesiology &amp; Intensive Care at the National Medical Academy of Post-Graduate Education Named After P.L. Shupyk and the Silesian Center for Heart Diseases (Poland). This article is part of the analysis of the work on the analysis of the blood coagulation system in patients after implantation of the left ventricular mechanical circulatory support system with the analysis of such postoperative complication as acute kidney failure.