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.
