A Critical Care Cardiology Perspective on Managing Acute Emergencies in Patients With Durable Ventricular Assist Devices (JACC July 2026-1)-Article: A Critical Care Cardiology Perspective on Managing Acute Emergencies in Patients With Durable Ventricular Assist Devices

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This JACC state-of-the-art review provides a practical critical care guide for managing acute emergencies in patients with durable left ventricular assist devices (dLVADs), especially the HeartMate 3. As more patients survive longer with dLVAD support, clinicians in emergency, ICU, and cardiac settings increasingly need to recognize device-specific complications and respond quickly.<br /><br />The article explains dLVAD anatomy, physiology, and controller parameters, emphasizing that the most important first step in any unstable patient is to confirm the pump is powered and running. Because dLVAD flow is preload- and afterload-sensitive, changes in volume status, blood pressure, right ventricular function, or device position can cause low flow, suction events, or shock. The review highlights the value of bedside assessment, Doppler blood pressure measurement, echocardiography, device log-file review, invasive hemodynamics, and ramp studies.<br /><br />Major emergency categories include acute heart failure, cardiogenic shock, right heart failure, aortic insufficiency, bleeding, thrombosis, stroke, arrhythmias, device malfunction, driveline or controller failure, outflow graft obstruction, infection, and cardiac arrest. Management is tailored to the cause and may require fluids, diuretics, vasodilators, inotropes, antiarrhythmics, anticoagulation adjustment, endoscopic or surgical interventions, temporary mechanical support, or transplant evaluation.<br /><br />The review notes that hemocompatibility has improved with newer devices, so pump thrombosis is less common, while bleeding—especially gastrointestinal bleeding—remains a major challenge. It also stresses that chest compressions are considered safe once cardiac arrest is confirmed and should not be delayed because of the device.<br /><br />Overall, the paper serves as a rapid-response framework for diagnosing and treating dLVAD emergencies and underscores the need for multidisciplinary care and early contact with the patient’s implant center.

Meta Tag

Concept Left Ventricular Assist Device

Concept Pump Controller

Concept Pump Parameters

Concept Right Heart Failure

Concept Inflow Obstruction

Keywords

durable left ventricular assist device

HeartMate 3

acute emergencies

cardiogenic shock

right heart failure

pump thrombosis

gastrointestinal bleeding

device malfunction

echocardiography

multidisciplinary care

Left Ventricular Assist Device

Pump Controller

Pump Parameters

Right Heart Failure

Inflow Obstruction