Managing drugs and devices in patients with permanent ventricular assist devices

Martin Cadeiras, Manuel von Bayern, Mario C. Deng

Research output: Contribution to journalReview article

Abstract

Patients will be considered for destination mechanical circulatory support device (MCSD) implantation when all other organ-saving treatment options have failed and they are not eligible for heart transplantation. Current medical evidence suggests that only for those patients who are inotrope-dependent and therefore likely have a 1-year survival probability without MCSD implantation of less than 50%, MCSD intervention: will add to survival and quality-of-life benefit. Suitable candidates for MCSD are those patients who have a high risk of dying from heart failure but acceptable noncardiac risk. Evaluation of patients for MCSD requires a systematic and critical review of all organ systems and of the psychosocial situation. Specifically,, right ventricular function and risk of right ventricular failure should be evaluated before planning destination MCSD implantation. Treatment will focus on prompt recovery from MCSD implantation, maintaining optimal treatment for heart failure, and preventing/treating MCSD complications, including infection, bleeding, coagulopathy, right heart failure, and device dysfunction. MCSD programs should be organized as an advanced heart failure center directed by specialized heart failure cardiologists, surgeons expert at implant and management of MCSD, specialized nurses, social workers, psychologists, financial experts, and physical therapists. MCSD practice is based on a patient-centered theory, with an appropriate understanding of the respective roles of the physician and the patient during their iterative encounters in which the patient is an autonomous person making responsible personal health decisions while the health care team is providing continued expert and empathic counseling about various options, based on systematic outcomes research (eg, by participation in the Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS]-MCSD database, http://www.intermacs.org]).

Original languageEnglish (US)
Pages (from-to)318-331
Number of pages14
JournalCurrent Treatment Options in Cardiovascular Medicine
Volume9
Issue number4
DOIs
StatePublished - Aug 2007
Externally publishedYes

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Heart-Assist Devices
Equipment and Supplies
Pharmaceutical Preparations
Heart Failure
Right Ventricular Function
Physician's Role
Patient Care Team
Survival
Physical Therapists
Heart Transplantation
Treatment Failure
Registries
Counseling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Managing drugs and devices in patients with permanent ventricular assist devices. / Cadeiras, Martin; von Bayern, Manuel; Deng, Mario C.

In: Current Treatment Options in Cardiovascular Medicine, Vol. 9, No. 4, 08.2007, p. 318-331.

Research output: Contribution to journalReview article

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