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Update on ventricular assist devices.

C Barden·R Lee
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Abstract

Ventricular assist devices serve as a valuable adjunct to therapy in the setting of profound heart failure. The two largest patient groups--postcardiotomy and those being bridged to transplant--show an average 40-50% survival rate after ventricular assist. Several devices exist including centrifugal, pneumatic, and electrical pumps. Options for ventricular assist include right (RVAD), left (LVAD), and biventricular (BiVAD) support. Knowledge regarding the devices and the pathophysiology of severe heart failure is crucial for the critical care nurse caring for these patients. Critical care nursing interventions for bleeding, renal failure, infection, and other complications will be outlined.

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Cardiac Output, LowEducation, Nursing, ContinuingEquipment DesignHeart-Assist DevicesHumansJournal ArticleReview

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BibTeXRIS

C Barden, R Lee. 1990. Update on ventricular assist devices.. https://doi.org/10.4037/15597768-1990-1003

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PubMed2007

Use of levosimendan, a new inodilator, for postoperative myocardial stunning in a premature neonate.

OBJECTIVE: To first report the successful use of the new inodilator levosimendan in a premature infant with congestive heart failure (CHF) following cardiac surgery. Although the calcium sensitizer levosimendan improves hemodynamics in adults with CHF, no data are available on the use of levosimendan in premature infants with CHF. DESIGN: Single case report. SETTING: Twenty-bed postoperative adult and pediatric cardiac intensive care unit. PATIENT: A 32 wks gestational age, 1525-g premature male twin with transposition of the great arteries. INTERVENTIONS: The patient underwent arterial switch operation. MEASUREMENTS AND MAIN RESULTS: Immediately after operation, the patient developed signs of low cardiac output syndrome. Mixed venous saturation was 56%, serum lactate increased to 14.8 mmol/L, systolic arterial pressure was 40 mm Hg, left atrial pressure was 24 mm Hg, and echocardiography showed reduced left ventricular function with a fractional shortening of 10%. There were no signs of reduced coronary perfusion. Milrinone, dobutamine, and epinephrine did not improve hemodynamics. Levosimendan was initiated at a dose of 0.05 mug.kg.min, increased to 0.1 mug.kg.min, and continuously infused for 24 hrs. Within 6 hrs after starting the levosimendan infusion, left atrial pressure decreased to 7 mm Hg and systolic arterial pressure increased to 60 mm Hg; within 24 hrs after initiation serum lactate level normalized to 1.7 mmol/L and mixed venous saturation increased to 81%. Echocardiography revealed improvement of left ventricular function with a fractional shortening of 25%. No side effects were recognized during administration of levosimendan. CONCLUSIONS: In this premature neonate with postoperative low cardiac output syndrome due to failing myocardial function, levosimendan was a potent inotropic agent.

Cardiac Output, Low↗