Long-term assist device patients admitted to ICU: Tips and pitfalls  

作　　者：Michiel Morshuis Hendrik Fox Volker Lauenroth Rene Schramm 

机构地区：[1]Heart and Diabetes Center North Rhine-Westphalia,Bad Oeynhausen 32545,Germany

出　　处：《Journal of Intensive Medicine》2023年第2期81-88,共8页重症医学（英文）

摘　　要：Left ventricular assist device(LVAD)therapy is well-established in the treatment of end-stage cardiac failure.Indications are bridge to transplant(BTT),bridge to candidacy(BTC),bridge to recovery(BTR),and destination therapy(DT).The durability and adverse event(AE)rate of LVADs have improved over the years.However,due to donor shortage,the duration of support in the BTT population has increased tremendously;similarly,DT patients are on the device for a long time.Consequently,the number of readmissions of long-term LVAD patients has increased.In cases of severe AEs,intensive care unit(ICU)treatment can be necessary.Infectious complications are the most common AE.Furthermore,embolic or hemorrhagic strokes can occur due to foreign surfaces,acquired von Willebrand syndrome,and anticoagulation treatment.Another consequence of the coagulative status,in combination with the continuous flow,are gastrointestinal bleeding events.Moreover,in most patients,an isolated LVAD is implanted,and this involves the risk of late right heart failure.Adjustment of pump speed and optimization of the volume status can help solve this issue.Malignant arrhythmias,pre-existing or de novo after LVAD implantation,can be a life-threatening AE.Antiarrhythmic medical therapy or ablation are potential treatment options.As for specific LVADs,the Medtronic HeartWare TM ventricular assist device(HVAD)is not manufactured and distributed currently;however,4000 patients are still on the device.Pump thrombosis can occur,wherein thrombolytic therapy is the first-line treatment option.Additionally,the HVAD can fail to restart after controller exchange due to technical issues,and precautions must be taken.The Momentum 3 trial showed superior survival without pump exchange or disabling stroke in patients treated with the HeartMate 3■(HM3;Abbott,Abbott Park,IL,USA)device in comparison to the HeartMate II(HMII).However,in a few cases,a twisted graft or bio debris formation between the outflow graft and bend relief could be observed,causing outflow graft obs

关 键 词：Heart failure Left ventricular assist device(LVAD)therapy Adverse events 

分 类 号：R541.6[医药卫生—心血管疾病]