SCCM Resource Library-LVAD Complications: A 101

Pdf Summary

The document provides an overview of common complications associated with Left Ventricular Assist Devices (LVADs), along with their pathologies and management strategies. Key complications include:

1. <strong>Hemolysis</strong>: Reduced risk with the HeartMate 3 (HM3), related to shear stress. Management involves monitoring LDH levels and treating pump thrombosis if necessary.

2. <strong>Hemorrhage</strong>: Post-operative bleeding can lead to worse outcomes, with gastrointestinal bleeding being common. Management involves monitoring anticoagulation status, platelet transfusions, possible surgical re-exploration, and certain medications like Omega-3 supplements.

3. <strong>Pump Obstruction</strong>: Outflow graft compression and pump thrombosis are diagnosed through imaging and treated with pump replacement or heart transplant, with some risk from anticoagulation therapy.

4. <strong>Right Ventricular (RV) Dysfunction</strong>: Early and late RV dysfunction post-implant is managed with inotropes, mechanical support, and other interventions depending on severity, linked to poor hospital outcomes.

5. <strong>Sepsis</strong>: Infections at the driveline or device site are common, often managed with antibiotics or surgical interventions which also increase thrombosis and stroke risk.

6. <strong>Stroke</strong>: Both ischemic and hemorrhagic strokes are risks in LVAD patients, with ischemic linked to embolic processes and hemorrhagic to anticoagulation. Treatments may include endovascular therapy or INR adjustments.

7. <strong>Suction Events</strong>: Typically from hypovolemia or RV failure, these events risk ventricular arrhythmias and require immediate fluid management.

8. <strong>Tamponade</strong>: This complication necessitates surgical intervention, often linked to post-op issues.

9. <strong>Ventricular Arrhythmias</strong>: Common in LVAD patients due to various factors, manageable with medications or device implantation.

Each complication has specific management strategies often tailored by patient needs and institutional protocols. The document cites various studies reinforcing these practices.

Asset Subtitle

Cardiovascular, 2024, 0:10:00

Asset Caption

With the increase in implantation steadily rising over the past decade, Left Ventricular Assist Devices (LVADs) are expected to be more prevalent in daily medical practice. Providers of all critical care settings should feel comfortable managing these patients, and expecting potential complications that arise secondary to these devices. LVADs create unique pathologic changes including increased propensity for bleeding, physiologic adaptations by the cardiovascular system, and increased risks related to hardware implantation itself. This document aims to give a concise description of common complications and disease states, a succinct physiology of the complication, and management recommendations based on the current literature. Our goal is to have a quick reference sheet and refresher on these disease states that lead to significant morbidity and mortality in this patient population.

First Author: Ella Purington, MD
Second Author/Faculty Advisor: Aaron Surrey, MD

Meta Tag

Content Type Infographic

Knowledge Area Cardiovascular

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Ventricular Function

Year 2024

Keywords

LVAD complications

hemolysis

hemorrhage

pump obstruction

RV dysfunction

sepsis

stroke

suction events

tamponade

ventricular arrhythmias

Infographic

Cardiovascular

Ventricular Function

2024

Associate

Professional

Select

	Society of Critical Care Medicine 500 Midway Drive Mount Prospect, IL 60056 USA Phone: +1 847 827-6888 Fax: +1 847 439-7226 Email: support@sccm.org	Contact Us About SCCM Newsroom Advertising & Sponsorship DONATE	MySCCM LearnICU Patients & Families Surviving Sepsis Campaign Critical Care Societies Collaborative	GET OUR NEWSLETTER
© Society of Critical Care Medicine. All rights reserved. \| Privacy Statement \| Terms & Conditions The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.