HeartMate 3 LVAD Lecture 9 3

  • candidate: advanced heart failure
  • class 1 for end stage heart failure, NYHA 5

  • use INTERMACS profile to describe severity and clinical projectory
  • sicker person gets temporary device

  • device implantation must have a strategy for later

  • drains blood from LV and pumps to aorta
  • goal to unload LV and improve perfusion
  • RV must function well

HeartMate 3

  • usually on pulse mode, above 4000 rpm. Has pulsatility

Momentum 3

  • increased survival overall:

How to Read Parameters

  • left: old system
  • only set speed

  • allow septum in midline

  • power: measure of energy required by the device
  • look at trend over time

  • if pressure differential increase, flow would decrease

  • when keep same speed, when pressure gradient increase, flow decreases

  • the more LV contracts, more variation in LV size/volume, more variation in PI

  • changes in HR, balloon pump, patient sneezing/coughing
  • suction event: underfilled LV, LV collapse against valve, no flow across pump

  • L normal
  • R: LV collapsed against camera

First 48 Hours

  • majority of mortality in first 30 days

  • low flow may be evidence of tamponade

  • plan for any RV dysfunction

  • camera should be at apex of LV, pointed toward MV, no contact with septum

  • decrease preload, decreased RV size, PCWP: think about bleed or tamponade
  • maintain lower MAP

Complications

Vasoplegia

Bleeding

  • use TEG is very helpful

  • RV failure reasons
  • more venous return to RV from more blood going out of LV
  • A: RV dysfunction and high speed.
  • B: septal in normal position

  • for CPR: turn rpm down to 2000 but not below