The shortage of appropriate donor organs and the expanding pool of patients waiting for heart transplantation have led to growing interest in alternative strategies, particularly in mechanical circulatory support (MCS)
Portland, OR (PRWEB) December 23, 2014
Although studies have clearly shown that Left Ventricular Assist Devices (LVADs) can significantly improve quality of life for patients, there are substantial risks and complications associated with these devices. During a recent AllMed webinar, Dr. Roger Osborn, cardiologist, discussed issues related to LVAD implantation, including risk management and patient safety. According to Dr. Osborn, the shortage of appropriate donor organs and the expanding pool of patients waiting for heart transplantation have led to growing interest in alternative strategies, particularly in mechanical circulatory support (MCS).
Dr. Osborn reviewed the indications for LVAD implantation, and explained that LVADs work with the heart to help it pump blood more efficiently, unlike an artificial heart, which replaces the failing heart completely. While LVADs are placed temporarily for patients who receive the devices as a bridge to transplantation or bridge to recovery, patients with LVADs used as destination therapy undergo permanent LVAD implantation—these are patients with end-stage heart failure and poor predictive survival in their current medical state, who are not eligible for transplantation.
In 2012, the American Heart Association published recommendations for the use of MCS. Dr. Osborn explained that the statement includes general considerations for determining the appropriateness of MCS, and stresses the importance of an experienced multidisciplinary team in the decision-making process. He also discussed the most recent evidence-based guidelines, published by the International Society for Heart and Lung Transplantation, which cover all phases of evaluating, implanting, and managing patients who receive LVADs or related equipment.
Although LVADs improve clinical outcomes in patients with advanced heart failure, the devices are associated with potentially life-threatening complications such as thromboembolism, hemorrhage, right ventricular failure, and infection. Dr. Osborn provided an in-depth look at these potential complications, including factors that contribute to poor outcomes following LVAD implantation. He stressed that thorough preoperative evaluation is necessary to determine whether significant comorbidities exist that pose perioperative risk.
In conclusion, Dr. Osborn noted that LVADs improve patient outcomes and quality of life. However, he cautioned that complications persist due to pre-existing effects of advanced heart failure, the requirement for extensive surgery to implant the device, and the effects of the device in compromised patients. Dr. Osborn stressed the importance of patient selection and thorough evaluation in order to determine the appropriateness of LVAD implantation and to optimize outcomes.
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