Approach to hypotension in the conscious patient with a left ventricular assist device​

MAP: mean arterial pressure; LVAD: left ventricular assist device; JVP: jugular venous pressure; ECG: electrocardiogram; VT: ventricular tachycardia; VF: ventricular fibrillation; RVAD: right ventricular assist device; ECMO: extracorporeal membrane oxygenation.
* Refer to UpToDate content on the echocardiographic ramp test.
¶ Refer to UpToDate content on the diagnosis of sepsis.
Δ A suction event occurs when LV myocardium partially occludes the LVAD inflow cannula and reduces inflow. Suction events are caused by low LV preload relative to the pump speed.
◊ Early pump thrombosis generally requires immediate pump exchange or heart transplantation. Late pump thrombosis can sometimes be successfully treated with intensification of chronic anticoagulation with the addition of intravenous heparin or with thrombolysis; if these measures are not effective, then pump exchange is required.
§ Refer to UpToDate content on the treatment of sepsis.
¥ Signs of inadequate LVAD unloading include increasing LV and left atrial chamber size; increased aortic valve opening duration; increased mitral inflow peak E wave velocity; decreased E wave deceleration time, worsening mitral regurgitation, and elevated pulmonary artery systolic pressure (which may be estimated using the tricuspid regurgitation jet velocity).
‡ Refer to UpToDate content on treatment of causes of right heart failure including pulmonary embolus and other causes of pulmonary hypertension.