Ch. 15 VAD

Question 1

When to try VAD peri and post op

Answer 1

peri- can’t come off CPB, on inotropes, has IABP
post- low CO for 72 hours or dysrthymias and no response to drugs
or LHF?

Question 2

VAD Contraindications

Answer 2

• older than 70 yo
• severe infection
• organ dysfunction

Question 3

VAD Complications

Answer 3

• coagulopathy
• infection
• renal failure

Question 4

Signs of Left Heart Failure

Answer 4

• low contractility, pulm oxygenation

- high LV filling pressures, PCWP

Question 5

2 types of LVAD pumps

Answer 5

1) pulsatile paracorporeal pump- outside body

2) centrifugal pump- change every 72 hours so no clot

Question 6

Signs of Right Heart Failure

Answer 6

• CI <1.8
• aortic pressure < 90
• atrial pressure < 20
• PCWP < 10

Question 7

Flows

Answer 7

full flow = 2.2 L/min/m2 when both VADs working together

• want LAP 5-15 mmHg (prevents air sucking into cannula)
• start RVAD when LAP is at 5 mmHg, and continue increasing until 15 mmHg
• *RVAD is set higher than LVAD cuz LV is still ejecting extra volume

Question 8

VAD Heparin

Answer 8

180-200 ACT

Question 9

VAD Management

Answer 9

pO2 >75 mmHg
SVR 800-1200
no heat exchanger 
antibiotics
fluid management, COP= 25 mmHg (add albumin)

Question 10

Termination

Answer 10

allow heart on VAD to rest for 48 hours

• decrase flows, watch MAP to maintain 2.2 index
• wean 1 liter every hour
• **when low VAD lows- increase ACT 250-350