Postoperative Management of Patients Supported by a Left Ventricular Assist Device

The immediate postoperative phase is the most critical period when managing patients with fresh left ventricular assist device implants. The coordinated cooperation of a well versed multi-disciplinary team is needed to make the LVAD implantation a lasting success. The specific modalities unique to implementation of continuous, or at least less-pulsatile blood flow require a new approach to hemodynamic management. Many of the patients going into surgery for LVAD implantation have a longstanding history of low cardiac output with subsequent malperfusion of peripheral organs and backward congestion, potentially leading to compromised lung, liver, and kidney function or intestinal problems. The coagulation system may be altered by mechanics of the heart pump, but also due to long-term anticoagulation before surgery, platelet inhibition, liver dysfunction, and kidney dysfunction. The picture that a fresh post-op patient with a new LVAD will present in the intensive care unit (ICU) can be extremely fluent and quite challenging. Communication to the patients support group and those who can provide emotional help is extremely important. Efforts to secure successful rehabilitation will start as early as possible, and meaningful discharge planning should start in the ICU. The goal of ICU care is to stabilize the patient and lay the foundation for a quick recovery to full functionality, so that the patient can enjoy the maximum benefit of the LVAD procedure.