Adverse Hemodynamic Consequences of Continuous Left Ventricular Mechanical Support: JACC Review Topic of the Week (JACC July 2023-1)

Description

Left ventricular assist devices (LVAD) provide a life-saving therapy for patients with advanced heart failure. The recognition of pump thrombosis, stroke, and non-surgical bleeding as hemocompatiblity-related adverse events (HRAE) led to pump design improvements and reduced event rates. However, hemodynamic syndromes (HDS) which often clinically manifest as right heart failure (RHF) and aortic insufficiency (AI) persist. The hemodynamic milieu contributes to the development of AI and RHF and thus these comorbidities can be classified as hemodynamic-related events (HDRE). Hemodynamic-driven events are time dependent and often present later than HDRE. Accordingly, heart-failure related events are a major cause of late morbidity and mortality. Here, we examine the emerging strategies to mitigate HDRE, with a focus on best practices for AI and RHF. As we head into the next generation of LVAD technology, it is important to differentiate HDRE from HRAE so that we can improve the true durability of LVAD technology.

Editors
Editor-in-Chief
Valentin Fuster, MD, PhD, MACC

CME Editor
Ragavendra R. Baliga, MD

Authors
Jonathan Grinstein, MD

Important Dates
Date of Release: June 26, 2023
Term of Approval/Date of CME/MOC Expiration: June 25, 2024

Summary


Availability:	Retired


Cost:	FREE


Credit Offered:	No Credit Offered