Professional Documents
Culture Documents
But, in 2008:
term at implant
not true “indication” but
Pulsatile
and
Non Pulsatile
Pulsatile
Ventricle-like pumping sac device.
Blood enters via the inflow cannula and fills a flexible
pumping chamber.
Electric motor or pneumatic (air) pressure collapses the
adjust
Pulsatile VADs are loud and the rate can be
assessed by listening
Output:
The amount of blood ejected from the VAD
rate
Non-Pulsatile
Continuous-flow devices
Impeller (spinning turbine-like rotor blade) propels blood continuously
forward into systemic circulation.
Axial flow: blood leaves impeller blades in the same direction as it enters
(think fan or boat motor propeller).
Are quite and cannot be heard outside of the patient’s body. Assess VAD
status by auscultation over the apex of the LV. The VAD should have a
continuous, smooth humming sound.
The Patient may have a narrow pulse pressure and may not be
measurable with automated blood pressure monitors. This is due to the
continuous forward outflow from the VAD.
↓speed=↓flow)
Dependent on Preload and Afterload
Speed:
How fast the impeller of the internal pump spins
EKG-independent
Afterload-sensitive
Anticoagulated
Prone to:
• infection
• bleeding
• thrombosis/stroke
• mechanical malfunction
Key differences depend on pulsatile vs. non-
pulsatile device
VADs commonly seen in the
community
Thoratec VAD (pVAD/iVAD)
Pneumatic, external(pVAD) or internal (iVAD), pulsatile
pump(s)
right-, left-, or bi-ventricular support
(RVAD/LVAD/BiVAD)
up to ~7.2 lpm flow
Short- to medium-term use (up to ~1-2 years)
bridge to recovery
bridge to transplant
hospital discharge possible
iVAD
pVAD
Thoratec pVAD
HeartMate XVE LVAS
Internally implanted, electric pulsatile pump
left heart support only
up to 10 lpm flow
Medium- to long-term therapy (months to years)
bridge to transplant
destination therapy (only FDA-approved DT device)
HeartMate II LVAS
Internally implanted, axial-flow (non-pulsatile) device
left heart support only
speed: 8000-15000 rpm
• flow: ~3-8 lpm
Medium- to long-term therapy (months to years)
bridge to transplant (FDA-approved)
destination therapy (investigational)
Jarvik 2000 LVAD
Axial-flow (non-pulsatile)
pump
electric, intra-ventricular
left heart support only
Speed: 8000-12000 rpm
flow: ~3-5 lpm
Medium- to long-term therapy
(months to years)
bridge to transplant
(investigational)
Jarvik 2000 LVAD
VAD Issues
Problems/Complications
Major VAD Complications
Bleeding
Thrombosis
Infection
RV dysfunction/failure
Suckdown
LV collapse due to
hypovolemia/hypotension or VAD
overdrive
nonpulsatile devices only
indicators: hypotension, PVCs/VT, low
VAD flows.
Problems/Complications
Treating Suckdown
Initiate a peripheral IV and slowly give
volume to increase preload
If able and instructed by the VAD
Coordinator, reduce the speed of the
VAD
Assess for signs and symptoms of
bleeding and sepsis
Problems/Complications
Device Failure
This is a true emergency requiring immediate
transport to the implanting VAD center
Most common in pulsatile devices
Patients & caregivers are trained to identify
signs and symptoms of device failure
May require the VAD to be replaced
Problems/Complications
Hemolysis