Back to Basics: The LVAD Patient

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November 17, 2015 by dailybolusoflr

By: Casey Carr, MD


  • Ventricular assist devices (VADs) are circulatory support pumps that are used in end stage heart failure both as a bridge to transplant and as destination therapy
  • They are implanted in the upper abdomen and connected to an external power supply
  • Blood flows from a tube in the left ventricle, to the VAD, to the aorta
  • Typically patients have no pulse; mean arterial pressures (MAP) need to be measured using Doppler
    • MAPs between 70 to 80 are ideal



  • LVAD patients are commonly anticoagulated
  • Most commonly have bleeding complications following recovery from implantation
  • LVAD patients with continuous flow devices (mostly standard now) are prone to developing acquired von Willebrand disease due to shear stress on cells


    • High risk in patients who are inadequately anticoagulated
    • Pump itself is prone to developing stasis clots
      • Pump can become obstructed
      • Clots can embolize as well
      • Think pump thrombosis if evidence of hemolysis (change in urine color, elevated LDH, decreased renal function, reduced haptoglobin) and poor pump performance (low flow alarm!)
        • Needs immediate pump replacement


      • Common bugs -> Staph aureus and coagulase-negative staph
      • May present on a broad spectrum, from localized skin erythema to sepsis


        • Most patients have an underlying ischemic heart disease, and thus are prone to arrhythmias
        • Sustained VT/VF will quickly lead to RV failure; need immediate cardioversion if unstable 

          Right sided heart failure

          • Major cause of morbidity and mortality after LVAD placement
          • May present with hepatic dysfunction, renal insufficiency, pedal edema, and RV dysfunction on echo


            1. La Franca, E, et al. Heart failure and mechanical circulatory assist devices. Global Journal of Health Science. 2013 May 14;5(5):11-9
            2. Greenwood, JC, et al. Mechanical circulatory support. Emergency Medicine Clinics of North America. 2014 Nov;32(4):851-69

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