Troubleshooting Left Ventricular Assist Devices: Modern Technology and Its Limitations

Springer Science and Business Media LLC - Tập 23 - Trang 1-13 - 2021
Alfredo L. Toll1, Luis Hernandez Mejia2, Amandeep Sidhu3, Andres Carmona-Rubio4
1Universidad Iberoamericana, Santo Domingo, Dominican Republic
2Cleveland Clinic Florida, Weston, USA
3Midwestern University, Glendale, USA
4Cleveland Clinic Foundation, Cleveland, USA

Tóm tắt

As the incidence of heart failure continues to rise, modern generation left ventricular assist devices (LVADs) have become the primary therapeutic modality used as both bridge to transplant (BTT) and destination therapy (DT) in patients with acute and chronic heart failure. This review aims to highlight the progression of LVAD technology, outline LVAD complications and manifestations, and provide evidence-based therapeutic methods to troubleshoot such adverse events. Despite modern innovation, LVAD adverse events continue to hinder the progress of HF paradigms and are associated with a rise in morbidity and mortality. Complications such as bleeding, pump thrombosis, right heart failure, infections, stroke, valvular insufficiency, and arrhythmias are among the most described. While the management of LVAD complications is described, standardized guidelines are needed to properly identify and troubleshoot all the complications faced by this patient population to decrease morbidity and mortality further.

Tài liệu tham khảo

Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139–596. Thiha S, Zaidi ARZ, Robert CA, Abbas MK, Malik BH. A rising hope of an artificial heart: left ventricular assisted device - outcome, convenience, and quality of life. Cureus. 2019;11(9):e5617. Prinzing A, Herold U, Berkefeld A, Krane M, Lange R, Voss B. Left ventricular assist devices-current state and perspectives. J Thorac Dis. 2016;8(8):E660–6. Kilic A, Acker MA, Atluri P. Dealing with surgical left ventricular assist device complications. J Thorac Dis. 2015;7(12):2158–64. Vaidya Y, Riaz S, Dhamoon AS. Left ventricular assist devices. StatPearls. Treasure Island: StatPearls Publishing; 2020. Y Birati E, Jessup M. Left ventricular assist devices in the management of heart failure. Card Fail Rev. 2015;1(1):25–30. Chatterjee A, Feldmann C, Dogan G, Hanke JS, Ricklefs M, Deniz E, et al. Clinical overview of the HVAD: a centrifugal continuous-flow ventricular assist device with magnetic and hydrodynamic bearings including lateral implantation strategies. J Thorac Dis. 2018;10(Suppl 15):S1785–9. Han JJ, Acker MA, Atluri P. Left ventricular assist devices. Circulation. 2018;138(24):2841–51. Milano CA, Rogers JG, Tatooles AJ, Bhat G, Slaughter MS, Birks EJ, et al. HVAD: the ENDURANCE supplemental trial. JACC Heart Fail. 2018;6(9):792–802. Long B, Robertson J, Koyfman A, Brady W. Left ventricular assist devices and their complications: a review for emergency clinicians. Am J Emerg Med. 2019;37(8):1562–70. Grimm JC, Magruder JT, Kemp CD, Shah AS. Late Complications Following Continuous-Flow Left Ventricular Assist Device Implantation. Front Surg. 2015;2:42. Mehra MR, Goldstein DJ, Uriel N, Cleveland JC, Yuzefpolskaya M, Salerno C, et al. Two-year outcomes with a magnetically levitated cardiac pump in heart failure. N Engl J Med. 2018;378(15):1386–95. Hanff TC, Birati EY. Left ventricular assist device as destination therapy: a state of the science and art of long-term mechanical circulatory support. Curr Heart Fail Rep. 2019;16(5):168–79. Imamura T, Nguyen A, Rodgers D, Kim G, Raikhelkar J, Kalantari S, et al. Omega-3 and hemocompatibility-related adverse events. J Card Surg. 2020;35(2):405–12. Teuteberg JJ, Slaughter MS, Rogers JG, McGee EC, Pagani FD, Gordon R, et al. The HVAD left ventricular assist device: risk factors for neurological events and risk mitigation strategies. JACC Heart Fail. 2015;3(10):818–28. Zinoviev R, Lippincott CK, Keller SC, Gilotra NA. In full flow: left ventricular assist device infections in the modern era. Open Forum Infect Dis. 2020;7(5):ofaa124. Trachtenberg BH, Cordero-Reyes A, Elias B, Loebe M. A review of infections in patients with left ventricular assist devices: prevention, diagnosis and management. Methodist Debakey Cardiovasc J. 2015;11(1):28–32. Kyvernitakis A, Pappas O, Farmakiotis D, Horn ET, Benza RL, Bailey SH, et al. Bloodstream infections in continuous flow left ventricular assist device recipients: diagnostic and clinical implications. ASAIO J. 2019;65(8):798–805. Riaz T, Nienaber JJC, Baddour LM, Walker RC, Park SJ, Sohail MR. Cardiovascular implantable electronic device infections in left ventricular assist device recipients. Pacing Clin Electrophysiol. 2014;37(2):225–30. Argiriou M, Kolokotron S-M, Sakellaridis T, Argiriou O, Charitos C, Zarogoulidis P, et al. Right heart failure post left ventricular assist device implantation. J Thorac Dis. 2014;6(Suppl 1):S52–9. Drakos SG, Janicki L, Horne BD, Kfoury AG, Reid BB, Clayson S, et al. Risk factors predictive of right ventricular failure after left ventricular assist device implantation. Am J Cardiol. 2010;105(7):1030–5. Fitzpatrick JR, Frederick JR, Hsu VM, Kozin ED, O’Hara ML, Howell E, et al. Risk score derived from preoperative data analysis predicts the need for biventricular mechanical circulatory support. J Heart Lung Transplant. 2008;27(12):1286–92. Shehab S, Hayward CS. Choosing between left ventricular assist devices and biventricular assist devices. Card Fail Rev. 2019;5(1):19–23. Kang G, Ha R, Banerjee D. Pulmonary artery pulsatility index predicts right ventricular failure after left ventricular assist device implantation. J Heart Lung Transplant. 2016;35(1):67–73. Gopinathannair R, Cornwell WK, Dukes JW, Ellis CR, Hickey KT, Joglar JA, et al. Device therapy and arrhythmia management in left ventricular assist device recipients: a scientific statement from the american heart association. Circulation. 2019;139(20):e967–89. Galand V, Flécher E, Auffret V, Boulé S, Vincentelli A, Dambrin C, et al. Predictors and clinical impact of late ventricular arrhythmias in patients with continuous-flow left ventricular assist devices. JACC Clin Electrophysiol. 2018;4(9):1166–75. Gordon JS, Maynes EJ, Choi JH, Wood CT, Weber MP, Morris RJ, et al. Ventricular arrhythmias following continuous-flow left ventricular assist device implantation: a systematic review. Artif Organs. 2020;44(8):E313–25. Maradey JA, Singleton MJ, O’Neill TJ, Bhave PD. Management of ventricular arrhythmias in patients with LVAD. Curr Opin Cardiol. 2020;35(3):289–94. Bouabdallaoui N, El-Hamamsy I, Pham M, Giraldeau G, Parent M-C, Carrier M, et al. Aortic regurgitation in patients with a left ventricular assist device: a contemporary review. J Heart Lung Transplant. 2018;37(11):1289–97. Yehya A, Rajagopal V, Meduri C, Kauten J, Brown M, Dean L, et al. Short-term results with transcatheter aortic valve replacement for treatment of left ventricular assist device patients with symptomatic aortic insufficiency. J Heart Lung Transplant. 2019;38(9):920–6. Wang TS, Hernandez AF, Felker GM, Milano CA, Rogers JG, Patel CB. Valvular heart disease in patients supported with left ventricular assist devices. Circ Heart Fail. 2014;7(1):215–22. Najjar E, Hallberg Kristensen A, Thorvaldsen T, Hubbert L, Svenarud P, Dalén M, et al. Controller and battery changes due to technical problems related to the HVAD® left ventricular assist device - a single center experience. J Cardiothorac Surg. 2018;13(1):74. Kormos RL, McCall M, Althouse A, Lagazzi L, Schaub R, Kormos MA, et al. Left ventricular assist device malfunctions: it is more than just the pump. Circulation. 2017;136(18):1714–25. Devine A. Troubleshooting the left ventricular assist device. Emerg Med. 2016;48(2):58–63. Trinquero P, Pirotte A, Gallagher LP, Iwaki KM, Beach C, Wilcox JE. Left ventricular assist device management in the emergency department. West J Emerg Med. 2018;19(5):834–41. Horton SC, Khodaverdian R, Powers A, Revenaugh J, Renlund DG, Moore SA, et al. Left ventricular assist device malfunction: a systematic approach to diagnosis. J Am Coll Cardiol. 2004;43(9):1574–83.