Keep Your Options Open: Obtain Consent for Both LVAD and TAH Prior to Surgery

Right ventricular failure (RVF) is a serious and common complication in left ventricular assist device (LVAD) recipients that remains difficult to predict. A novel approach to patient consent may enhance your options in the operating room (OR) upon right ventricular (RV) visualization.

RVF is a frequent complication following LVAD implantation, occurring in 10% to 40% of patients1. Patients who develop RVF have reduced survival and progression to transplant and worse outcomes thereafter, including longer ICU stays, more transfusions, use of inotropes and need for right ventricular assist devices (RVADs)2. Adding an RVAD before orthotopic heart transplantation is associated with worse post-transplant outcomes and increased mortality3.

In an effort to reduce the incidence of RVF post-LVAD implant and improve outcomes, numerous approaches to predict RVF in LVAD recipients have been implemented; however, an accurate method of predicting RVF remains elusive.

 

Optimizing Treatment Plans in the OR

Given the challenges of predicting RVF prior to LVAD implant, making the determination whether a patient requires an LVAD or the SynCardia temporary Total Artificial Heart (TAH) may be optimized while in the OR. Once the chest is open, the degree of stress on the right ventricle may be more accurately assessed.

Utilizing this approach would require obtaining patient consent for LVAD and TAH implantation in advance, as well as having both devices on the shelf and ready for use in the OR. Once the chest is open and a more accurate assessment of the patient’s RV is performed, having both options available will enable the implanting surgeon to make the best decision possible for the patient. It will also allow flexibility to change the initial treatment plan, if necessary.

In addition, having the TAH on hand for all major cardiac surgeries, not just LVAD implants, may provide a critical safety net for unexpected emergencies or major complications that may lead to biventricular failure in the OR.

1Lampert B.C., Teuteberg J.J. (2015) Right ventricular failure after left ventricular assist devices. J Heart Lung Transplant 34:1123–1130

2Kalogeropoulos AP, Al-Anbari R, Pekarek A, et al. The Right Ventricular Function After Left Ventricular Assist Device (RVF-LVAD) study: rationale and preliminary results. European Heart Journal – Cardiovascular Imaging. 2015;17(4):429-437. doi:10.1093/ehjci/jev162.

3Taghavi S, Jayarajan SN, Komaroff E, Mangi AA. Right ventricular assist device results in worse post-transplant survival. The Journal of Heart and Lung Transplantation. 2016;35(2):236-241. doi:10.1016/j.healun.2015.10.018.

telephone

CALL OUR HEART FAILURE HOTLINE
1-855-344-1166

Recent Articles
The Importance of a Transition Strategy for ECMO Patients

Short courses of VA ECMO can be lifesaving for patients experiencing acute cardiorespiratory failure; however, prolonged support may lead to increased risk of morbidity and mortality. The new UNOS Adult Heart Allocation Policy heightens the importance of timely transition to a durable mechanical circulatory support device.

How Will the Revised UNOS Adult Heart Allocation System Impact MCS Device Recipients?

Starting in September 2018, the revised UNOS adult heart allocation system goes into effect. This post provides a brief overview of the changes to the medical urgency statuses of mechanical circulatory support (MCS) device recipients and offers additional resources for more information.

Manufacturing the SynCardia TAH_Header | SynCardia
Manufacturing the SynCardia temporary Total Artificial Heart

Curious about how a SynCardia Total Artificial Heart is made? This overview gives you a sneak peek into our manufacturing process.

Treating Malignant Cardiac Tumors with the SynCardia Total Artificial Heart
Use of the SynCardia Total Artificial Heart in Patients with Cardiac Tumors

The SynCardia temporary Total Artificial Heart (TAH) allows for complete resection of the ventricles, including in patients who have cardiac tumors with ventricular involvement, providing long-term support until heart transplantation is possible.

Emerging Use of CardioMEMS™ in SynCardia TAH Patients May Help Improve Transplant Timing and Outcomes
Emerging Use of CardioMEMS™ in SynCardia TAH Patients May Help Improve Transplant Timing and Outcomes

Several case studies suggest that real-time pulmonary artery (PA) pressure readings may provide accurate assessment of pulmonary pressure in patients implanted with the SynCardia temporary Total Artificial Heart (TAH), which may facilitate medical management and assessment of timing for heart transplant — learn more about this emerging approach.