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

被引：676

作者：

Slaughter, Mark S. ^{[2
]}

Pagani, Francis D. ^{[3
]}

Rogers, Joseph G. ^{[4
]}

Miller, Leslie W. ^{[5
]}

Sun, Benjamin ^{[6
]}

Russell, Stuart D. ^{[7
]}

Starling, Randall C. ^{[8
]}

Chen, Leway ^{[9
]}

Boyle, Andrew J. ^{[10
]}

Chillcott, Suzanne ^{[11
]}

Adamson, Robert M. ^{[11
]}

Blood, Margaret S. ^{[12
]}

Camacho, Margarita T. ^{[13
]}

Idrissi, Katherine A. ^{[14
]}

Petty, Michael ^{[10
]}

Sobieski, Michael ^{[2
]}

Wright, Susan ^{[3
]}

Myers, Timothy J.

Farrar, David J. ^{[1
]}

机构：

[1] Thoratec Corp, Pleasanton, CA 94588 USA

[2] Univ Louisville, Louisville, KY 40292 USA

[3] Univ Michigan, Ann Arbor, MI 48109 USA

[4] Duke Univ, Durham, NC USA

[5] Georgetown Univ, Washington Hosp, Washington, DC USA

[6] Ohio State Univ, Columbus, OH 43210 USA

[7] Johns Hopkins Univ, Baltimore, MD USA

[8] Cleveland Clin, Cleveland, OH 44106 USA

[9] Univ Rochester, Rochester, NY USA

[10] Univ Minnesota, Minneapolis, MN USA

[11] Sharp Mem Hosp & Rehabil Ctr, San Diego, CA USA

[12] Univ Alabama Birmingham, Birmingham, AL USA

[13] Beth Israel Deaconess Med Ctr, Newark, NJ USA

[14] Columbia Univ, New York, NY USA

来源：

JOURNAL OF HEART AND LUNG TRANSPLANTATION | 2010年 / 29卷 / 04期

基金：

美国国家卫生研究院;

关键词：

patient selection; patient and device management; LVAD; mechanical circulatory support; assisted circulation; bridge to transplantation; destination therapy; MECHANICAL CIRCULATORY SUPPORT; AORTIC-INSUFFICIENCY; RENAL-FUNCTION; INHALED PROSTAGLANDIN; PULMONARY VASODILATOR; PREDICT SURVIVAL; SCREENING SCALE; ADVERSE EVENTS; RISK-FACTORS; BRIDGE;

D O I：

10.1016/j.healun.2010.01.011

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 It 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 pen-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. J Heart Lung Transplant 2010;29:S1-S39 (C) 2010 Published by Elsevier Inc.

引用

页码：S1 / S39

页数：39

共 116 条

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