Postoperative management after implantation of a left ventricular assist device

Background. Due to improved outcomes and lower complication rates of the newer devices in combination with a shortage of available organ donors, left ventricular assist device (LVAD) implantations are increasing - especially as destination therapy. Material and methods. In this state-of-art review, we propose key elements in managing patients supported with the new continuous-flow LVADs. Results. Echocardiography plays a key role in managing patients supported with a VAD including preoperative assessment, postoperative and long-term evaluation. Although complication rates declined in the last years, right heart failure, bleeding and infections are still the main causes of early mortality necessitating prompt recognition and precise therapy. With the growing LVAD population, emergency services have to establish specific algorithms for the assessment of unconscious LVAD patients who lack a peripheral pulse as well as for resuscitation including chest compressions and defibrillation that differ significantly from non-VAD-patients. Conclusion. Perioperative management of VAD patients is very comprehensive and requires a multidisciplinary heart failure team providing sophisticated care from initial referral until support is terminated.