A Comprehensive Review of Risk Factor, Mechanism, and Management of Left Ventricular Assist Device–Associated Stroke

2021 ◽  
Author(s):  
Sung-Min Cho ◽  
Pouya Tahsili-Fahadan ◽  
Ahmet Kilic ◽  
Chun Woo Choi ◽  
Randall C. Starling ◽  
...  
Keyword(s):  
Current Knowledge ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Number Of Patients ◽  
Left Ventricular Assist ◽  
Underlying Mechanisms

AbstractThe use of left ventricular assist devices (LVADs) has been increasing in the last decade, along with the number of patients with advanced heart failure refractory to medical therapy. Ischemic stroke and intracranial hemorrhage remain the leading causes of morbidity and mortality in LVAD patients. Despite the common occurrence and the significant outcome impact, underlying mechanisms and management strategies of stroke in LVAD patients are controversial. In this article, we review our current knowledge on pathophysiology and risk factors of LVAD-associated stroke, outline the diagnostic approach, and discuss treatment strategies.

Aortic Regurgitation in Patients with Left Ventricular Assist Devices

2019 ◽  
pp. 338-344
Author(s):  
Marisa Cevasco ◽  
Koji Takeda ◽  
Masahiko Ando ◽  
Yoshifumi Naka
Keyword(s):  
Surgical Techniques ◽  
Treatment Strategies ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

Aortic insufficiency (AI) occurs as a complication in 25% to 37% of cases that receive left ventricular assist devices (LVAD). The incidence increases after implant by 1% to 6% per month of continued support. Uncertainty remains over the appropriate management of pump speeds to help delay this deterioration (complete emptying versus allowing native ventricular function open the aortic on a regular basis). Significant AI can lead to hemodynamic impairment with adverse outcomes over time. Due to the recirculation of blood, the calculated cardiac output of the LVAD may be markedly skewed. A number of surgical techniques have been proposed for the prevention and management of AI in the setting of LVAD therapy. This chapter details the causes, treatment strategies, and outcomes associated with this complication.

scholarly journals Vascular procedures in patients with left ventricular assist devices: single-center experience

2021 ◽  
Author(s):  
Saad Rustum ◽  
Julia Neuser ◽  
Jan Dieter Schmitto ◽  
Thomas Aper ◽  
Jasmin Sarah Hanke ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Perioperative Complications ◽  
Left Ventricular ◽  
Demographic Variables ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Single Center Experience ◽  
Number Of Patients ◽  
Left Ventricular Assist

Abstract Objective A growing number of patients suffering from heart failure is living with a left ventricular assist device (LVAD) and is in the need for non-cardiac surgery. Vascular procedures due to ischemia, bleeding, or other device-related complications may be required and pose a challenge to the caregivers in terms of monitoring and management of these patients. Therefore, we reviewed our experience with LVAD patients undergoing vascular surgery. Methods From January 2010 until March 2017, a total of 54 vascular procedures were performed on 41 LVAD patients at our institution. Patient records were reviewed retrospectively in terms of incidence of LVAD-related complications, including thrombosis, stroke, bleeding, wound healing, and survival associated with vascular surgery. The type of surgery was recorded, as well as various clinical demographic variables. Results Vascular procedures were performed in 35 men (85.4%) and 6 women (14.6%) with LVADs. There were no perioperative strokes, device thromboses, or device malfunctions. Thirty-day mortality overall was 26.8% (eleven patients), with most patients dying within 30 days after LVAD implantation due to multi-organ failure. In 25 procedures (46.3%), a blood transfusion was necessary. Conclusion Patients on LVAD support are a complex cohort with a high risk for perioperative complications. In a setting where device function and anticoagulation are monitored closely, vascular surgery in these patients is feasible with an acceptable perioperative risk.

scholarly journals Kidney Dysfunction and Left Ventricular Assist Device Support: A Comprehensive Perioperative Review

2015 ◽  
Vol 5 (1) ◽  
pp. 48-60 ◽  
Author(s):  
Samuel T. Coffin ◽  
Dia R. Waguespack ◽  
Nicholas A. Haglund ◽  
Simon Maltais ◽  
Jamie P. Dwyer ◽  
...  
Keyword(s):  
Management Strategies ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Future Research ◽  
Left Ventricular Assist Devices ◽  
Kidney Dysfunction ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Left ventricular assist devices (LVADs) are used increasingly as a bridge to transplantation or as destination therapy in end-stage heart failure patients who do not respond to optimal medical therapy. Many of these patients have end-organ dysfunction, including advanced kidney dysfunction, before and after LVAD implantation. Kidney dysfunction is a marker of adverse outcomes, such as increased morbidity and mortality. This review discusses kidney dysfunction and associated management strategies during the dynamic perioperative time period of LVAD implantation. Furthermore, we suggest potential future research directions to better understand the complex relationship between renal pathophysiology and mechanical circulatory support.

scholarly journals Left Ventricular Assist Devices and the Kidney

2017 ◽  
Vol 13 (2) ◽  
pp. 348-355 ◽  
Author(s):  
Daniel W. Ross ◽  
Gerin R. Stevens ◽  
Rimda Wanchoo ◽  
David T. Majure ◽  
Sandeep Jauhar ◽  
...  
Keyword(s):  
Cardiorenal Syndrome ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Destination Therapy ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Refractory Heart Failure ◽  
Number Of Patients ◽  
Left Ventricular Assist

Left ventricular assist devices (LVADs) are common and implantation carries risk of AKI. LVADs are used as a bridge to heart transplantation or as destination therapy. Patients with refractory heart failure that develop chronic cardiorenal syndrome and CKD often improve after LVAD placement. Nevertheless, reversibility of CKD is hard to predict. After LVAD placement, significant GFR increases may be followed by a late return to near baseline GFR levels, and in some patients, a decline in GFR. In this review, we discuss changes in GFR after LVAD placement, the incidence of AKI and associated mortality after LVAD placement, the management of AKI requiring RRT, and lastly, we review salient features about cardiorenal syndrome learned from the LVAD experience. In light of the growing number of patients using LVADs as a destination therapy, it is important to understand the effect of these devices on the kidney. Additional research and long-term data are required to better understand the relationship between the LVAD and the kidney.

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