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Left Ventricular Assist Devices: The What and the Who

Left Ventricular Assist Devices: The What and the Who. Lance E. Sullenberger MD FACC FACP Capital Cardiology Associates. But Heart Failure Increasing…. US Heart Transplants Stable. Left Ventricular Assist Device Pulsatile Flow. Not a true artificial heart.

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Left Ventricular Assist Devices: The What and the Who

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  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!!

  12. Inability to Take CHF Therapy

  13. Low Sodium

  14. Cardiorenal Syndrome

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

  16. Bring It Home….

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

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