Left Ventricular Assist Devices: The What and the Who

Left Ventricular Assist Devices:The What and the Who

Lance E. Sullenberger MD FACC FACPCapital Cardiology Associates

US Heart Transplants StableBut Heart Failure Increasing…

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…)

Left Ventricular Assist DeviceContinuous (Axial) Flow

Pulsatile Flow is OutAxial Flow is In

The Down Side• Infection• Bleeding• Thrombosis• Embolism• Battery issues• Hemolysis

Who Gets an LVAD?

• Bridge to Recovery

• Bridge to Transplant

• Destination Therapy

Bridge to Recovery

• Acute Myocarditis

• Acute Myocardial Infarction

• Peripartum Cardiomyopathy

• Younger• Previously healthy• Few comorbidities

Bridge to Transplant

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

Warning Signs!!

Inability to Take CHF Therapy

Low Sodium

Cardiorenal Syndrome

Warning Signs!• Recurrent Admissions• Low Blood Pressure• Hyponatremia• Poor Renal Function• Use of Continuous

Inotropes• Increasing diuretic

dose• Worsening Heart

Failure Class

Bring It Home….

LANCE SULLENBERGER MDLSULLENBERGER@CAPITALCARDIOLOGY.COM

Thank You!!!