Clinical management of continuous-flow left ventricular assist devices in advanced heart failure

Slaughter, Mark S.; Pagani, Francis D.; Rogers, Joseph G.; Miller, Leslie W.; Sun, Benjamin; Russell, Stuart D.; Starling, Randall C.; Chen, Leway; Boyle, Andrew J.; Chillcott, Suzanne; Adamson, Robert M.; Blood, Margaret S.; Camacho, Margarita T.; Idrissi, Katherine A.; Petty, Michael; Sobieski, Michael; Wright, Susan; Myers, Timothy J.; Farrar, David J.; HeartMate II Clinical Investigators,

doi:10.1016/j.healun.2010.01.011

« PreviousThe Journal of Heart and Lung Transplantation
Volume 29, Issue 4, Supplement , Pages S1-S39, April 2010

Clinical management of continuous-flow left ventricular assist devices in advanced heart failure

Mark S. Slaughter, MD
- University of Louisville, Louisville, Kentucky
- Drs. Slaughter, Pagani, Rogers, Miller, Sun, Russell, and Starling contributed equally to this article
Francis D. Pagani, MD
- University of Michigan, Ann Arbor, Michigan
- Drs. Slaughter, Pagani, Rogers, Miller, Sun, Russell, and Starling contributed equally to this article
Joseph G. Rogers, MD
- Duke University, Durham, North Carolina
- Drs. Slaughter, Pagani, Rogers, Miller, Sun, Russell, and Starling contributed equally to this article
Leslie W. Miller, MD
- Georgetown University, Washington Hospital, Washington, District of Columbia
- Drs. Slaughter, Pagani, Rogers, Miller, Sun, Russell, and Starling contributed equally to this article
Benjamin Sun, MD
- Ohio State University, Columbus, Ohio
- Drs. Slaughter, Pagani, Rogers, Miller, Sun, Russell, and Starling contributed equally to this article
Stuart D. Russell, MD
- Johns Hopkins Hospital, Baltimore, Maryland
- Drs. Slaughter, Pagani, Rogers, Miller, Sun, Russell, and Starling contributed equally to this article
Randall C. Starling, MD, M.P.H.
- Cleveland Clinic, Cleveland, Ohio
- Drs. Slaughter, Pagani, Rogers, Miller, Sun, Russell, and Starling contributed equally to this article
Leway Chen, MD
- University of Rochester, Rochester, New York
Andrew J. Boyle, MD
- University of Minnesota, Minneapolis, Minnesota
Suzanne Chillcott, RN
- Sharp Memorial Hospital, San Diego, California
Robert M. Adamson, MD
- Sharp Memorial Hospital, San Diego, California
Margaret S. Blood, RN
- University of Alabama, Birmingham, Alabama
Margarita T. Camacho, MD
- Beth Israel Medical Center, Newark, New Jersey
Katherine A. Idrissi, RN, MSN
- Columbia University, New York, New York
Michael Petty, RN, PhD
- University of Minnesota, Minneapolis, Minnesota
Michael Sobieski, RN, CCP
- University of Louisville, Louisville, Kentucky
Susan Wright, RN, BSN, CCRN
- University of Michigan, Ann Arbor, Michigan
Timothy J. Myers, BS, CRA
- Houston, Texas
David J. Farrar, PhD
- Thoratec Corporation, Pleasanton, California
- Reprint requests: Dr David J. Farrar, Thoratec Corporation, 6035 Stoneridge Dr, Pleasanton, CA 94588. Fax: 925-847-8574
HeartMate II Clinical Investigators

Received 13 January 2010; accepted 17 January 2010. published online 25 February 2010.

Continuous-flow left ventricular assist devices (LVAD) have emerged as the standard of care for advanced heart failure patients requiring long-term mechanical circulatory support. Evidence-based clinical management of LVAD-supported patients is becoming increasingly important for optimizing outcomes. In this state-of-art review, we propose key elements in managing patients supported with the new continuous-flow LVADs. Although most of the presented information is largely based on investigator experience during the 1,300-patient HeartMate II clinical trial, many of the discussed principles can be applied to other emerging devices as well. Patient selection, pre-operative preparation, and the timing of LVAD implant are some of the most important elements critical to successful circulatory support and are principles universal to all devices. In addition, proper nutrition management and avoidance of infectious complications can significantly affect morbidity and mortality during LVAD support. Optimizing intraoperative and peri-operative care, and the monitoring and treatment of other organ system dysfunction as it relates to LVAD support, are discussed. A multidisciplinary heart failure team must be organized and charged with providing comprehensive care from initial referral until support is terminated. Preparing for hospital discharge requires detailed education for the patient and family or friends, with provisions for emergencies and routine care. Implantation techniques, troubleshooting device problems, and algorithms for outpatient management, including the diagnosis and treatment of related problems associated with the HeartMate II, are discussed as an example of a specific continuous-flow LVAD. Ongoing trials with other continuous-flow devices may produce additional information in the future for improving clinical management of patients with these devices.

Key words: patient selection, patient and device management, LVAD, mechanical circulatory support, assisted circulation, bridge to transplantation, destination therapy