LVAD

• LVAD


  Left ventricular assist device, mechanical pump used in patients with end stage heart failure refractory to aggressive medical therapy
• LVAD


  • Helps to pump blood from the L ventricle to the rest of the body
• Uses of LVAD


  • Bridge to transplant
  • Bridge to recovery
  • Bridge to decision
  • Destination therapy
• Pulsatile LVAD


  Has systolic and diastolic phase
• Nonpulsatile LVAD


  Blood moves via centrifugal force, Patients do not have a pulse
• Nonpulsatile LVAD


  • More durable, less adverse events
  • Improved mortality rates
  • An LVAD wire that people can go home with
  • Do not use BP cuff with them, use MAP instead
• Indications for LVAD placement

  • NYHA level for 60-90 days
  • Max tolerated medical therapy
  • Chronic dependency on inotropic agents
  • LV EF <25%
  • SBP <80-90
• Components of an LVAD

  • Pump
  • Driveline
  • Inflow/outflow cannulas
  • Control system
  • Power source
• LVAD Placement


  1. Implanted in thoracic cavity beneath the heart

  2. Driveline exits through the abdominal wall

  3. Inflow cannula enters the apex of the L ventricle

  4. Outflow cannula is attached to the ascending aorta
• Non-Pulsatile LVAD


  • No pulse
  • BP taken by Doppler unless an arterial line, want MAP to be 70-90
  • Patients need to be connected to battery or AC power at all times
  • If the pump stops for more than 5 minutes, it cannot be restarted
• LVAD alarms


  • Red battery alarm = 5 minutes of power left
  • Yellow alarms = one power lead is disconnected
  • Yellow wrench - fault in driveline and tell RN
• Pulse index


  Measure of flow through the pump and is determined by pump speed and patients native heart function, indicative of preload
• Lower PI


  Less native heart function
• Higher PI


  More native heart function
• Lower pump flow


  Increased dizziness
• Higher MAP


  Increases pump flow
• No chest compression
• Never disconnect 2 power sources at the same time
• Can use defibrillator
• Need lifetime anti-coagulation
• Before leaving room you must have

  • Extra controller
  • 2 extra batteries
  • 2 extra battery clips
• Restrictions


  • No jumping or contact sports
  • No rollercoasters
  • No swimming or bathtub
  • Cannot shower until LVAD team approves
  • No exposure to MRI
  • No pregnancy
  • No driving
• If patient is dizzy

  1. Sit or lie down

  2. Give full glass of water

  3. Alert the nurse

  4. Monitor response to therapy with BORG scale
• Suck down


  Decrease or loss of CO with activity
• Emergency


  1. Sounds like a knocking rather than a hum

  2. Place pt in supine with LE elevated to improve venous return
• Due to dehydration