Ventricular Assist Devices

Question 0

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

Answer 0

1 million

65 and older

Question 1

What percent of the American population have congestive heart failure?

Answer 1

2 percent

That’s 4.8 million Americans

Question 2

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

Answer 2

400,000

50% 5 year mortality

Question 3

End stage heart failure is defined as

Answer 3

Symptoms at rest despite maximal medical therapy

Question 4

High risk with no symptoms

Answer 4

Stage A

Question 5

Structural heart disease with no symptoms

Answer 5

Stage B

Question 6

Structural disease, previous or current symptoms

Answer 6

Stage C

Question 7

Refractory symptoms requiring special intervention

Answer 7

Stage D

Question 8

The first successful LVAD implant occurred in

Answer 8

1966

Question 9

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

Answer 9

Abiomed BVS 5000

Question 10

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

Answer 10

Partially or completely

Question 11

What are the elements of VAD?

Answer 11

Inflow - atria or ventricle

Outflow - aorta, pulmonary artery, femoral artery

Question 12

The bridge to recovery is used when

Answer 12

Patients heart failure is temporary

VADs can be implanted for a few weeks or months

Question 13

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

Answer 13

Waiting for a heart transplant

VAD is removed when a new heart is implanted

Question 14

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

Answer 14

Destination therapy

Question 15

What might disqualify someone for a heart transplant?

Answer 15

Advanced age, smoking, cancer, other health reasons

Question 16

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

Answer 16

Pulsation action
Left ventricle
Aorta

Question 17

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

Answer 17

Continuous flow

They are centrifugal pumps or axial flow impeller driven pumps

Question 18

What is a side effect of a second generation pump?

Answer 18

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

Question 19

Example of first generation VAD?

Answer 19

HeartMate IP LVAS

Question 20

Examples of second generation VADs?

Answer 20

Jarvik 2000 Pacemaker
Nimbus/Heartmate II
Micromed DeBakey

Question 21

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

Answer 21

Hydrodynamic or electromagnetic suspension

Bearings, one

Question 22

What does REMATCH stand for?

Answer 22

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

Question 23

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

Answer 23

81% improvement in two year survival

Question 24

What are the two major complications of VAD implantation?

Answer 24

Infection | Mechanical failure

Question 25

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

Answer 25

Yes

Question 26

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

Answer 26

Extracorporeal | 5 L/min

Question 27

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

Answer 27

Transseptal cannula placement | Femoral artery

Question 28

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

Answer 28

Left ventricular workload, myocardial O2 demand | Cardiac output, mean arterial pressure

Question 29

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

Answer 29

Motor used to increase the pressure and flow of a fluid. | Second and third generation

Question 30

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

Answer 30

10 L/min | 100 mmHg

Question 31

Key clinical considerations for noncardiac surgery?

Answer 31

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?

Question 32

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

Answer 32

Anticoagulation status Determination of flow through pump Electrocautery interference Intravenous access

Question 33

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

Answer 33

LVAD specialists Power supply and electromagnetic interference Hemodynamics Anticoagulation

Question 34

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

Answer 34

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.

Question 35

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

Answer 35

Mains supply

Question 36

The pumping mechanism of the LVAD depends on both

Answer 36

Preload and after load

Question 37

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

Answer 37

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.

Question 38

Which positions can decrease preload? Other factors?

Answer 38

Lateral decubitus Reverse trendelenburg Drug induced venodilation, dehydration, hemorrhage

Question 39

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

Answer 39

Reduces Stasis of blood and increase thrombus formation Anticoagulated

Question 40

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

Answer 40

Avoidance of hypertension | Attenuation of systemic responses to laryngoscopy and surgical stimulus

Question 41

What can cause low LVAD output?

Answer 41

Increased PVR | Reduced RV output

Question 42

What should be used with caution with LVAD?

Answer 42

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

Question 43

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

Answer 43

Positive inodilator - milrinone | Pulmonary vasodilator - inhaled nitric oxide

Question 44

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

Answer 44

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