Left Ventricular Assist Devices and their Related Acute Adverse Events: Causes, Outcome, and Management Protocol

Background: The prevalence of patients living with a left ventricular assist device (LVAD) is rapidly increasing due to improvements in pump technology, and expanded device indications. Complications related to the LVAD can be divided into acute adverse events and non-acute adverse events.

We present an overview of the causes, outcomes, and management protocol of LVAD patients presenting with acute adverse events in the hope to decrease mortality and improve long-term results in these patients.

Method: We completed a retrospective cohort study on consecutive LVAD patients, who presented with acute LVAD-related adverse events from June 2011 to March 2018 in our institute. Stable LVAD patients with non-acute adverse events that do not require acute intervention were excluded from our study. Our emergency protocol entails the following: early communication with the VAD team, rapid assessment of LVAD function, bedside ultrasound examination, ECG and blood examination. All patients were transported to intermediate or intensive care unit.

Results: Of the 60 patients who received LVADs during the study period, 30 patients (50%) were initially readmitted through our emergency department (ED), for management of acute LVAD-related adverse events.

The causes were major bleeding in 12 patients (40%), thromboembolic complications in 8 patients (26%), major infection in 3 patients (10%), right heart failure in 3 patients (10%), cardiac arrhythmias in 3 patients (10%), and device malfunction in 1 patient (3%).

Twenty-eight hospitalizations (94%) resulted in survival to discharge. Two patients (6%) died in the hospital: one patient (3%) died from direct consequence of initially massive intracerebral bleeding and the other patient (3%) from hemorrhagic stroke in the setting of complication of the thrombolysis therapy.

Conclusion: In our experience, LVAD bleeding complication is the most common complication and the main cause of mortality in patients presenting with acute adverse events.

Emergency protocol entailing early consultation with the LVAD specialist, rapid assessment of LVAD function, ultrasound examination, and blood examination is recommended to decrease the mortality and to improve the outcomes.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 January 2023