Residency Curriculum Modules: LVADs in Rehabilitation with Leslie Rydberg, MD-LVADs in Rehabilitation

LVADs in Rehabilitation

Pdf Summary

Left Ventricular Assist Devices (LVADs) are mechanical pumps used to support heart function in patients with severe left ventricular failure. They serve as a bridge to heart transplant or as destination therapy for patients ineligible for transplant. The LVAD assumes the pumping function of the left ventricle and comprises a pump, power source, driveline, and control unit, with devices like the Heartmate III commonly utilized.<br /><br />Key operational measures include power consumption (watts), flow rate correlating with cardiac output, preset motor speed (RPM), and pulsatility index indicating the magnitude of flow pulses during the cardiac cycle. LVADs have alarms such as low flow warnings (below 2.5 L/min), which may indicate complications like hypovolemia, orthostasis, over-diuresis, or pump failure requiring urgent attention.<br /><br />Rehabilitation for LVAD patients involves multidisciplinary care, including speech, physical, occupational therapy, and specialized nursing, addressing physical and functional impairments. Common complications observed are driveline infections, stroke, and bleeding, necessitating close monitoring.<br /><br />Patients require vigilant vital and laboratory monitoring, including anticoagulation management with warfarin, blood pressure, peripheral pulses, lactate dehydrogenase (LDH), and urine color (monitoring for dark urine as a possible indicator of hemolysis). Special considerations include transportation only with trained staff, prohibiting showers due to driveline care requirements, strict avoidance of MRIs, and guidance that cardiopulmonary resuscitation (CPR) is recommended in the event of cardiac arrest.<br /><br />In summary, LVADs provide vital circulatory support but require comprehensive rehabilitation and safety measures to manage complications and optimize patient outcomes.

Keywords

Left Ventricular Assist Device

LVAD

Heartmate III

Left ventricular failure

Cardiac output

Pump failure

Driveline infection

Anticoagulation management

Rehabilitation therapy

Vital monitoring