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Clinical management of continuous-flow left ventricular assist devices in advanced heart failure.

Publication ,  Journal Article
Slaughter, MS; Pagani, FD; Rogers, JG; Miller, LW; Sun, B; Russell, SD; Starling, RC; Chen, L; Boyle, AJ; Chillcott, S; Adamson, RM; Blood, MS ...
Published in: J Heart Lung Transplant
April 2010

Continuous-flow left ventricular assist devices (LVAD) have emerged as the standard of care for advanced heart failure patients requiring long-term mechanical circulatory support. Evidence-based clinical management of LVAD-supported patients is becoming increasingly important for optimizing outcomes. In this state-of-art review, we propose key elements in managing patients supported with the new continuous-flow LVADs. Although most of the presented information is largely based on investigator experience during the 1,300-patient HeartMate II clinical trial, many of the discussed principles can be applied to other emerging devices as well. Patient selection, pre-operative preparation, and the timing of LVAD implant are some of the most important elements critical to successful circulatory support and are principles universal to all devices. In addition, proper nutrition management and avoidance of infectious complications can significantly affect morbidity and mortality during LVAD support. Optimizing intraoperative and peri-operative care, and the monitoring and treatment of other organ system dysfunction as it relates to LVAD support, are discussed. A multidisciplinary heart failure team must be organized and charged with providing comprehensive care from initial referral until support is terminated. Preparing for hospital discharge requires detailed education for the patient and family or friends, with provisions for emergencies and routine care. Implantation techniques, troubleshooting device problems, and algorithms for outpatient management, including the diagnosis and treatment of related problems associated with the HeartMate II, are discussed as an example of a specific continuous-flow LVAD. Ongoing trials with other continuous-flow devices may produce additional information in the future for improving clinical management of patients with these devices.

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Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

April 2010

Volume

29

Issue

4 Suppl

Start / End Page

S1 / 39

Location

United States

Related Subject Headings

  • Surgery
  • Risk Assessment
  • Preoperative Care
  • Patient Selection
  • Humans
  • Heart-Assist Devices
  • Heart Failure
  • Clinical Trials as Topic
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
 

Citation

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Slaughter, M. S., Pagani, F. D., Rogers, J. G., Miller, L. W., Sun, B., Russell, S. D., … HeartMate II Clinical Investigators, . (2010). Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant, 29(4 Suppl), S1-39. https://doi.org/10.1016/j.healun.2010.01.011
Slaughter, Mark S., Francis D. Pagani, Joseph G. Rogers, Leslie W. Miller, Benjamin Sun, Stuart D. Russell, Randall C. Starling, et al. “Clinical management of continuous-flow left ventricular assist devices in advanced heart failure.J Heart Lung Transplant 29, no. 4 Suppl (April 2010): S1-39. https://doi.org/10.1016/j.healun.2010.01.011.
Slaughter MS, Pagani FD, Rogers JG, Miller LW, Sun B, Russell SD, et al. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant. 2010 Apr;29(4 Suppl):S1-39.
Slaughter, Mark S., et al. “Clinical management of continuous-flow left ventricular assist devices in advanced heart failure.J Heart Lung Transplant, vol. 29, no. 4 Suppl, Apr. 2010, pp. S1-39. Pubmed, doi:10.1016/j.healun.2010.01.011.
Slaughter MS, Pagani FD, Rogers JG, Miller LW, Sun B, Russell SD, Starling RC, Chen L, Boyle AJ, Chillcott S, Adamson RM, Blood MS, Camacho MT, Idrissi KA, Petty M, Sobieski M, Wright S, Myers TJ, Farrar DJ, HeartMate II Clinical Investigators. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant. 2010 Apr;29(4 Suppl):S1-39.
Journal cover image

Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

April 2010

Volume

29

Issue

4 Suppl

Start / End Page

S1 / 39

Location

United States

Related Subject Headings

  • Surgery
  • Risk Assessment
  • Preoperative Care
  • Patient Selection
  • Humans
  • Heart-Assist Devices
  • Heart Failure
  • Clinical Trials as Topic
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology