Right Ventricle Dysfunction/Failure
LVADs are very effective at pumping blood from the left ventricle. However an LVAD and left ventricle can only pump as much blood as they receive from the right ventricle. Thus, an LVAD works best when the patient has a stable right ventricle.
Right Ventricle Dysfunction/Failure after LVAD Implant
Following implantation, 10-40% of patients receiving an approved LVAD suffer from right heart dysfunction/failure. In these cases inotropic medications or a temporary right ventricle pump (similar to an LVAD, but designed for the right ventricle) is needed. The use of other support devices with an LVAD increases the risk for further complications.
Once a patient receives an LVAD, there is a slight risk to develop strokes (ischemic or hemorrhagic) with an overall risk of 6-14% incidence per year. This largely depends on which LVAD is being used, the experience of the implanting center and the patient’s own coagulation characteristics. This risk is only slightly increased from that which exists normally in End Stage Heart Failure Patients without LVAD Support at 3-5% per year. However, the improvement of patient quality of life can be very significant. LVAD Patients, in many cases, can lead an almost normal life, a return to work, resume sports activity (except contact sports) and enjoyment of family.
There is also a risk for driveline exit site infection ranging from 3-34% incidence per year. In general, these infections are well treatable and the prevention depends largely on the patient’s meticulous care for the exit site wound. Most LVAD Patients will receive instructions and training on how to properly care for their exit site wounds before they leave the hospital. Strict adherence to these instructions have been found to keep the rate of infections very low.
Bleeding is a broad category of side affect of LVAD Therapy ranging from 16-61% depending on the published study and device used. Typically, most bleeding with LVADs occurs in the early post-operative period and will greatly diminish over time. There is an important blood component known as von Willibrand Factor (vWF) that protects against systemic bleeding which can be affected significantly with certain LVAD Devices.
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