LVAD inpatient management

While the evolution of LVAD pump design and management has achieved increased clinical experience and significantly improved 1-year survival rates [1], patients remain at high risk for complications in the immediate perioperative period including thromboembolic events, bleeding, right heart failure, and driveline associated infections. The majority of mortality events occur during the index LVAD implant hospitalization [2] therefore highlights the importance of patient selection and optimal perioperative management. Several factors have the potential to impact the post-operative and long-term course after LVAD implantation. Multidisciplinary teams focusing on education for patients, caregivers, and community health care providers alike as well as modifying risk factors associated with long-term complications pre-discharge are of paramount importance. Moreover, surgical implantation techniques focusing on proper pump pocket creation, optimized positioning of inflow cannula and outflow graft, proper pump position in the body, and fixation were shown to immediately impact post implantation complications, in particular low VAD flows and pump thrombosis. This chapter will provide an introduction to post-operative management for the LVAD patient.