left ventricular assist devices: the what and the who
DESCRIPTION
Left Ventricular Assist Devices: The What and the Who. Lance E. Sullenberger MD FACC FACP Capital Cardiology Associates. But Heart Failure Increasing…. US Heart Transplants Stable. Left Ventricular Assist Device Pulsatile Flow. Not a true artificial heart. - PowerPoint PPT PresentationTRANSCRIPT
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Left Ventricular Assist Devices:The What and the Who
Lance E. Sullenberger MD FACC FACPCapital Cardiology Associates
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US Heart Transplants StableBut Heart Failure Increasing…
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Left Ventricular Assist DevicePulsatile Flow
• Not a true artificial heart.
• Assists the left ventricle in passing oxygenated blood through the body.
• Initially was a pulsatile device (similar to native heart…)
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Left Ventricular Assist DeviceContinuous (Axial) Flow
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Pulsatile Flow is OutAxial Flow is In
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The Down Side• Infection• Bleeding• Thrombosis• Embolism• Battery issues• Hemolysis
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Who Gets an LVAD?
• Bridge to Recovery
• Bridge to Transplant
• Destination Therapy
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Bridge to Recovery
• Acute Myocarditis
• Acute Myocardial Infarction
• Peripartum Cardiomyopathy
• Younger• Previously healthy• Few comorbidities
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Bridge to Transplant
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Destination TherapyREMATCH Trial
• 129 patients• Ineligible for cardiac
transplant• Class IV CHF• ½ received LVAD• ½ received medical
therapy alone
• Can’t get a TX– Older– Hepatitis– DM with small vessel
disease• Might not get a TX– Renal issues– PHTN
• Complex surgical
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Warning Signs!!
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Inability to Take CHF Therapy
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Low Sodium
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Cardiorenal Syndrome
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Warning Signs!• Recurrent Admissions• Low Blood Pressure• Hyponatremia• Poor Renal Function• Use of Continuous
Inotropes• Increasing diuretic
dose• Worsening Heart
Failure Class
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Bring It Home….