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Perioperative Management of LVAD Patients

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Mechanical Circulatory Support for Advanced Heart Failure

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Abstract

A recent INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) annual report on the outcomes of patients who underwent continuous-flow left ventricular assist device (CF-LVAD) or biventricular assist device implantation showed that these patients had a 1-year survival rate of 80% [1]. Most of the mortalities occurred within the first 30 days after device implantation or during the postoperative period of the index hospitalization [1, 2]. The major causes of death during this period were as follows: 60–65% were due to multisystem organ failure (MSOF), which was driven primarily by poor oxygen delivery (DO2) and, often, specifically by right heart failure (RHF) [1, 2]; 15–20% were due to embolic and hemorrhagic stroke [1, 2]; 10–15% were due to bleeding events [1, 2]; 5–10% were sepsis related [3, 4]; and approximately 5% were due to respiratory failure [3]. The remaining deaths were mainly due to device malfunction, arrhythmias, or other less common complications [3, 4]. These data suggest that poor LVAD implantation outcomes can often be prevented or effectively managed. Therefore, diligent perioperative care is paramount to ensure positive outcomes for these patients. This chapter reviews the critical components of effective post operative care, and troubleshooting for the newly implanted CF-LVAD patient.

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Authors and Affiliations

  1. Texas Heart Institute at Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, TX, USA

    Krishna Ayyagari M.D. & William Patrick Mulvoy III M.D., M.B.A

  2. Clinical Pathology, Texas Heart Institute at Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, TX, USA

    Arthur W. Bracey M.D.

  3. Anesthesia Critical Care, Texas Heart Institute at Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, TX, USA

    Cesar A. Castillo M.D.

  4. Critical Care Services, Texas Heart Institute at Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, TX, USA

    James P. Herlihy M.D.

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  1. Krishna Ayyagari M.D.
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  2. William Patrick Mulvoy III M.D., M.B.A
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  3. Arthur W. Bracey M.D.
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  4. Cesar A. Castillo M.D.
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  5. James P. Herlihy M.D.
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Correspondence to James P. Herlihy M.D. .

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Editors and Affiliations

  1. Division of Cardiothoracic Transplantation, Surgical Director, Mechanical Circulatory Support and Cardiac Transplantation, Texas Heart Institute at Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, Texas, USA

    Jeffrey A. Morgan

  2. Medical Director, Heart Transplant Program, Co-Director, Advanced Heart Failure Center, Texas Heart Institute at Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, Texas, USA

    Andrew B. Civitello

  3. Center for Cardiac Support, Texas Heart Institute at Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, Texas, USA

    O.H. Frazier

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Ayyagari, K., Mulvoy, W.P., Bracey, A.W., Castillo, C.A., Herlihy, J.P. (2018). Perioperative Management of LVAD Patients. In: Morgan, J., Civitello, A., Frazier, O. (eds) Mechanical Circulatory Support for Advanced Heart Failure . Springer, Cham. https://doi.org/10.1007/978-3-319-65364-8_8

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