Mechanical circulatory support devices

Question 1

Hypoxia after LVAD implantation

Answer 1

Optimize ventilator settings –> if refractory, consider intracardiac shunt (PFO)

Question 2

Management of aortic valvulopathy after LVAD implantation

Answer 2

a. If recovery of the LV is not anticipated, i.e., destination therapy, consider suturing AV leaflets close if AI
b. If recovery is likely, then aortic replacement with a tissue valve is probably the best solution.

Question 3

Management of mitral valvulopathy after LVAD implantation

Answer 3

• Mitral valve regurgitation is effectively treated by implanting an LVAD.
• Mitral stenosis needs replacement with bioprosthetic valve

Question 4

Management of tricuspid valvulopathy after LVAD implantation

Answer 4

If preop Tricuspid regurg is severe, limited data suggest improved outcomes after LVAD with concomitant TV repair or replacement with bioprosthetic valve.

Question 5

LVAD pump thrombosis symptoms

Answer 5

Profound heart failure; hematuria, pump alarms, power spikes

Question 6

LVAD pump thrombosis diagnostic test

Answer 6

TTE; LDH; D-dimer; RHC; CT angiography

Question 7

LVAD pump thrombosis treatments

Answer 7

Inotropes, diuresis, o2, Intraventricular thrombolysis, pump exchange.