Clinical dilemmaPresentation and management of left ventricular assist device inflow cannula malposition
Section snippets
Patient 1
A 69-year-old man with non-ischemic cardiomyopathy and progressive heart failure was not considered an optimal candidate for cardiac transplantation because of advanced age and obesity, He underwent elective placement of a HeartMate II LVAD as destination therapy. His early post-operative course was remarkable for pulmonary edema and respiratory failure that prevented extubation. Swan-Ganz catheter evaluation revealed persistent elevation of pulmonary artery pressures despite progressive
Discussion
With continuous-flow LVAD placement, the apical cannula position may be dynamic. Significant obstruction of the apical cannula by the septum or the lateral wall occurred in 4 of 154 implants in this review. Clinical presentations were distinct and included failure to achieve LV unloading, as demonstrated by invasive monitoring, syncope presumably from intermittent obstruction and low output, intractable ventricular arrhythmias, and recurrent severe hemolysis. In one instance, symptoms were
Disclosure statement
Drs Carmelo Milano and Joseph Rogers have served as consultants and have received research grants from Thoratec Inc. None of the other authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
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Left ventricular assist device management and complications
2014, Critical Care ClinicsCitation Excerpt :The second mechanism involves malposition of the inflow cannula, resulting in similar mechanical stimulation of arrhythmias and even VAD thrombosis. This condition may require surgical repositioning of the cannula.42 Although limited data support their use in patients with LVAD, antiarrhythmic drugs (eg, amiodarone, lidocaine) are commonly used in the treatment of ventricular arrhythmias.
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