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Mechanical circulatory support for advanced systolic heart failure patients has evolved from pulsatile to continuous-flow designs to improve device durability and patient survival. Practice changes in regard to patient selection, surgical techniques, and perioperative medical management have changed over time as registry reports have continued to provide survival and outcomes data. Centrifugal pump with full magnetic levitation (FML) is the only current-generation continuous left ventricular assist device (cfLVAD) approved for implantation in the United States. However, there remain patients who are supported by axial flow pumps (HeartMate II™) and centrifugal pump with hybrid levitation (HeartWare™ HVAD™). Due to changes in the United Network for Organ Sharing (UNOS) allocation system for Heart Transplantation, patients with cfLVAD are expected to be maintained on longer-term support. This chapter will address outpatient medical management of the left ventricular assist device patients with a special focus on optimizing right-heart function, end-organ function, and quality of life.

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Outpatient Management of the Mechanical Circulatory Support Patients

  • 工具书词条

  • 发表日期：

    2025年

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  • Gregory Gibson,
  • J. Eduardo Rame,
  • Indranee Rajapreyar

摘要

Mechanical circulatory support for advanced systolic heart failure patients has evolved from pulsatile to continuous-flow designs to improve device durability and patient survival. Practice changes in regard to patient selection, surgical techniques, and perioperative medical management have changed over time as registry reports have continued to provide survival and outcomes data. Centrifugal pump with full magnetic levitation (FML) is the only current-generation continuous left ventricular assist device (cfLVAD) approved for implantation in the United States. However, there remain patients who are supported by axial flow pumps (HeartMate II™) and centrifugal pump with hybrid levitation (HeartWare™ HVAD™). Due to changes in the United Network for Organ Sharing (UNOS) allocation system for Heart Transplantation, patients with cfLVAD are expected to be maintained on longer-term support. This chapter will address outpatient medical management of the left ventricular assist device patients with a special focus on optimizing right-heart function, end-organ function, and quality of life.