LVAD

Question 1

How have LVADs been used?

Answer 1

1. as a bridge to transplantation
2. as destination therapy
3. as a bridge to transplant candidacy
4. as a bridge to recovery

Question 2

What are the 2 TYPES of CF LVADS? Where is the impeller located?

Answer 2

1. Heart Mate II: below the diaphragm
2. HVAD: implanted above the diaphragm within pericardial sac

Question 3

List the types of temporary forms of cardiac mechanical support in cardiogenic shock

Answer 3

1. Intra-aortic balloon pump
2. ECMO
3. Impella
4. Tandem

Question 4

What is more COMMON to occur when AV remains CLOSED POSTOPERATIVELY?

Answer 4

1. aortic thrombus
2. new onset “de novo” AI

Question 5

How can you view TERMINAL portion of OUTFLOW CANNULA?

Answer 5

high left parasternal long axis view

Question 6

How can you view MID portion of OUTFLOW CANNULA?

Answer 6

right parasternal view with patient in right lateral decubitus position

Question 7

What is the velocity norm for OUTFLOW grafts?

Answer 7

• normal ≤ 2m/s
• > 2 at any level may represent obstruction

Question 8

What is the velocity norm for INFLOW HEART MATE II?

Answer 8

normal < 1.5 m/s

Question 9

What is the velocity norm for HVAD?

Answer 9

can’t be performed due to color and doppler artifact caused by closeness of the impeller

Question 10

When is BP taken?

Answer 10

Pre exam BP and BP after any pump speed changes.

Question 11

What is being determined when checking the BP?

Answer 11

mean arterial pressure = cuff pressure is gradually reduced until a constant sound is heard

Question 12

What MAP NORM is recommended?

Answer 12

MAP BP < 85 mmHg

Question 13

What MAP NORM indicates hypertension and what does this mean?

Answer 13

• MAP BP > 85 mmHg
• too high speed pump

Question 14

What MAP NORM indicates hypotension and what does this mean?

Answer 14

• MPAP < 60 mmHg
• too low speed pump

Question 15

What are reasons to stop a SPEED CHANGE TEST?

Answer 15

1. completion of test
2. suction event occurs
3. symptoms of hypertension
4. symptoms of hypotension
5. cannula flow reversal

Question 16

Describe a SUCTION EVENT?

Answer 16

when high pump speeds, malplaced cannula or hypovolemia pulls LV segment obstructing flow into the cannula: very critical as dangerous arrhythmia occur and cardiac outflow is impeded

Question 17

What are SIGNS of too LOW of speed?

Answer 17

1. LVIDd increased
2. Right ward shifted IVS
3. More prominent MR
4. Frequent AV opening
5. RA and RVSP increased

Question 18

What are SIGNS of too HIGH of speed?

Answer 18

1. leftward shifted IVS and/or impedes flow into cannula
2. Worsening TR and AR

Question 19

What is an OPTIMAL speed?

Answer 19

1. speed just below the maximum speed that keeps the AV closed or only intermittent opening depending on institution
2. Typically at least 400 and 40 below maximal speedster HMII and HVAD