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I&M for Anesthesia - Fall 2013 > Ventricular Assist Devices > Flashcards

Ventricular Assist Devices Flashcards

0
Q

How many hospital admissions annually for CHF and most commonly diagnosed in patients aged?

A

1 million

65 and older

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1
Q

What percent of the American population have congestive heart failure?

A

2 percent

That’s 4.8 million Americans

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2
Q

How many new cases of CHF each year and what mortality?

A

400,000

50% 5 year mortality

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3
Q

End stage heart failure is defined as

A

Symptoms at rest despite maximal medical therapy

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4
Q

High risk with no symptoms

A

Stage A

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5
Q

Structural heart disease with no symptoms

A

Stage B

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6
Q

Structural disease, previous or current symptoms

A

Stage C

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7
Q

Refractory symptoms requiring special intervention

A

Stage D

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8
Q

The first successful LVAD implant occurred in

A

1966

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9
Q

What became the first device to achieve FDA approval for short term use in 1992?

A

Abiomed BVS 5000

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10
Q

The VAD is a mechanical circulatory device used to ______ replace the function of either the left or right ventricle depending on the underlying heart disease

A

Partially or completely

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11
Q

What are the elements of VAD?

A

Inflow - atria or ventricle

Outflow - aorta, pulmonary artery, femoral artery

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12
Q

The bridge to recovery is used when

A

Patients heart failure is temporary

VADs can be implanted for a few weeks or months

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13
Q

The bridge to transplantation is implanted to temporarily support a heart failure patient while

A

Waiting for a heart transplant

VAD is removed when a new heart is implanted

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14
Q

A heart failure patient who is not eligible for a heart transplant will use VAD as

A

Destination therapy

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15
Q

What might disqualify someone for a heart transplant?

A

Advanced age, smoking, cancer, other health reasons

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16
Q

First generation VADs emulated the heart by using a _____, alternately sucking blood from ____ then forced out into

A

Pulsation action
Left ventricle
Aorta

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17
Q

Second generation VADs are ______ flow pumps with greater simplicity resulting in smaller size and reliability

A

Continuous flow

They are centrifugal pumps or axial flow impeller driven pumps

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18
Q

What is a side effect of a second generation pump?

A

The user will not have a pulse or the pulse intensity is greatly reduced

19
Q

Example of first generation VAD?

A

HeartMate IP LVAS

20
Q

Examples of second generation VADs?

A

Jarvik 2000 Pacemaker
Nimbus/Heartmate II
Micromed DeBakey

21
Q

Third generation VADs suspend the impeller in the pump using _____. They remove the need for _____ and reduce the number of moving parts to

A

Hydrodynamic or electromagnetic suspension

Bearings, one

22
Q

What does REMATCH stand for?

A

Randomized evaluation of mechanical assistance for the treatment of congestive heart failure

23
Q

According to REMATCH, how did patients receiving HeartMate XVE compare with patients only receiving optimal medical management?

A

81% improvement in two year survival

24
Q

What are the two major complications of VAD implantation?

A

Infection

Mechanical failure

25
Q

Did REMATCH show that LVAD assist had better results of transplant compared with patients without LVAD?

A

Yes

26
Q

The tandem Heart pVAD is a ______ centrifugal pump driven by a three phase motor capable of delivering up to

A

Extracorporeal

5 L/min

27
Q

The Tandem Heart pVAD withdraws blood from the left atrium via _____ and returns it to

A

Transseptal cannula placement

Femoral artery

28
Q

The goals of the Tandem Heart pVAD are to reduce _____ and ______. Increase

A

Left ventricular workload, myocardial O2 demand

Cardiac output, mean arterial pressure

29
Q

What is an impeller? This is a component is which LVADs?

A

Motor used to increase the pressure and flow of a fluid.

Second and third generation

30
Q

The HeartMate II can generate flows up to ___ and pressures up to

A

10 L/min

100 mmHg

31
Q

Key clinical considerations for noncardiac surgery?

A

What chambers are being supported. Does the patient have LVAD, RVAD, BIVAD, or TAH?
Does the patient have pulsatile or no pulsatile pump?
What type of procedure?

32
Q

What other questions should be considered when asking if a patient has a first or second generation pump?

A

Anticoagulation status
Determination of flow through pump
Electrocautery interference
Intravenous access

33
Q

Four aspects have to be considered in the management of patients with LVADs presenting for non cardiac surgery

A

LVAD specialists
Power supply and electromagnetic interference
Hemodynamics
Anticoagulation

34
Q

Why should a bipolar cautery be used when possible with LVADs?

A

The device is prone to alteration by electromagnetic interference such as electrocautery or a defibrillator.
The grounding pad should be placed to facilitate current dispersion away from device.

35
Q

LVADs have to be connected to the _______ once the patient reaches the OR

A

Mains supply

36
Q

The pumping mechanism of the LVAD depends on both

A

Preload and after load

37
Q

T or F. LVADs obey Starlings law respect to stroke volume.

A

False. They can only pump the delivered volume; inadequate filling leads to inadequate flow. CVP, PAC, or TEE is indicated for procedures that will alter intraday ulnar volume.

38
Q

Which positions can decrease preload? Other factors?

A

Lateral decubitus
Reverse trendelenburg

Drug induced venodilation, dehydration, hemorrhage

39
Q

Elevation in after load ____ LVAD output and promotes ____. This occurs even when the patient is

A

Reduces
Stasis of blood and increase thrombus formation
Anticoagulated

40
Q

What is the primary aim in peri operative management of patients with LVAD?

A

Avoidance of hypertension

Attenuation of systemic responses to laryngoscopy and surgical stimulus

41
Q

What can cause low LVAD output?

A

Increased PVR

Reduced RV output

42
Q

What should be used with caution with LVAD?

A

Negative inotropic drugs - volatiles, beta blockers, calcium channel blockers

43
Q

What would you use to treat low LVAD output with increase in CVP?

A

Positive inodilator - milrinone

Pulmonary vasodilator - inhaled nitric oxide

44
Q

LVAD patients require long term _____. Should it be continued on the day of surgery in patients using LVAD?

A

Warfarin treatment concerted to heparin therapy before elective surgery.
No, heparin treatment should be discontinued

I&M for Anesthesia - Fall 2013 (13 decks)

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