VAD (Ventricular Assist Devices) Flashcards
What are the 3 indications for LVAD?
- Bridge to Transplantation
- Temporary Support (Improve neurohumoral process and remodeling)
- Destination Therapy
What is the one year survival with end stage heart failure for:
Medical Therapy?
LVAD Therapy?
Cardiac Transplantation?
Medical Therapy = ~20%
LVAD Therapy = 50%
Cardiac Transplantation = 88%
What are the 4 segments of the TEE Exam that need to occur when evaluating LVAD?
- Pre-bypass
- Weaning from Bypass
- Post Bypass
- Post Operative (ICU)
What are the Pre-bypass concerns for LVAD?
- Aortic Valve Function (Assess for AI)
- Intracardiac Shunts (Interatrial Septal Defects)
- Intracardiac Thrombus (LAA and in chambers)
- RV Function (FAC and TAPSE)
- Aortic Atherosclerosis (Epiaortic Exam
- Mitral Valve Exam (Rule out stenosis)
What are your options if you have aortic insufficiency and the patient needs an LVAD?
- Sew valve shut
- Bioprosthetic Valve
What would happen if you had an intraatrial communication during LVAD placement?
- Possible Paradoxical Emboli
- Right to Left shunt to create hypoxia
Rule out PFO and ASD
What degree of TR is recommended to be surgically addressed when placing LVAD?
If moderate –> Repair/Replace
When you wean from bypass, what are the aspects of the LVAD you need to evaluate?
- Evaluate LVAD inflow cannula
- Adequate Flow (Appropriate LV Volume)
- Aortic Valve Function (Ensure no re-entry circuit)
- Intracardiac Shunts (Interatrial Septal Defects)
- De-airing (Anterior located coronary artery)
- RV Function (Milrinone, Epi, Nitric Oxide, Epoprostenol)
What is the treatment if you have the LVAD inflow cannula sucked against the septum?
- Increase Preload
- Increase Afterload
- Decrease flows of Axial Devices (Decrease flow through device)
These will decrease septal obstruction
What is the diameter of pulsatile LVAD inflow cannulas?
16 mm
What is the stroke volume of pulsatile LVAD inflow cannulas?
65 mL
What is the peak velocity of pulsatile LVAD inflow cannulas?
<230 cm/sec
What is the peak velocity of pulsatile LVAD inflow cannulas is consistent with obstruction?
(>230 cm/sec = Obstruction)
When you have a non-pulsatile LVAD, What is the Peak velocity you should obtain when weaning from bypass?
<200 cm/sec
When you have a pulsatile LVAD, What is the Peak velocity you should obtain when weaning from bypass?
<230 cm/sec
What are the 4 most common inflow cannula sites?
- LV Apex
- Trans-Aortic
- Trans-Atrial Septum
- LA
What is the most common inflow cannula site?
LV Apex
What is the major complication with LV inflow cannula placement in the LV apex?
Obstruction with inflow cannula sucking down on septum
What is the complication that can occur with inflow cannula sites in the trans-aortic position?
Possible SAM
Ensure the Aortic Valve isn’t being sucked into the device
What is the Tandem Heart inflow cannula site?
Through Femoral vein and crosses atrial septum into LA
Where is the outflow cannula of the LVAD placed most commonly?
Ascending Aorta
Where is the outflow cannula in the Tandem Heart?
Femoral Artery (Percutaneously)