1. Left Ventricular Assist Devices:The What and the Who Lance E. Sullenberger MD FACC FACP Capital Cardiology Associates

2. But Heart Failure Increasing… US Heart Transplants Stable

3. Left Ventricular Assist DevicePulsatile Flow • Not a true artificial heart. • Assists the left ventricle in passing oxygenated blood through the body. • Initially was a pulsatile device (similar to native heart…)

4. Left Ventricular Assist DeviceContinuous (Axial) Flow

5. Pulsatile Flow is OutAxial Flow is In

6. The Down Side • Infection • Bleeding • Thrombosis • Embolism • Battery issues • Hemolysis

7. Who Gets an LVAD? • Bridge to Recovery • Bridge to Transplant • Destination Therapy

8. Bridge to Recovery • Acute Myocarditis • Acute Myocardial Infarction • Peripartum Cardiomyopathy • Younger • Previously healthy • Few comorbidities

9. Bridge to Transplant

10. Destination TherapyREMATCH Trial • 129 patients • Ineligible for cardiac transplant • Class IV CHF • ½ received LVAD • ½ received medical therapy alone • Can’t get a TX • Older • Hepatitis • DM with small vessel disease • Might not get a TX • Renal issues • PHTN • Complex surgical

11. Warning Signs!!

13. Inability to Take CHF Therapy

14. Low Sodium

15. Cardiorenal Syndrome

16. Warning Signs! • Recurrent Admissions • Low Blood Pressure • Hyponatremia • Poor Renal Function • Use of Continuous Inotropes • Increasing diuretic dose • Worsening Heart Failure Class

17. Bring It Home….

18. Thank You!!! Lance Sullenberger MDLSULLENBERGER@CAPITALCARDIOLOGY.COM