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CLINICAL RESEARCH: CARDIAC TRANSPLANT AND ASSIST DEVICES

Left ventricular assist device malfunction: a systematic approach to diagnosis

Steven C. Horton, MD, FACC^,*, Reza Khodaverdian, MD^*, Amanda Powers, BS, James Revenaugh, MD, FACC, Dale G. Renlund, MD, FACC, Stephanie A. Moore, MD, FACC^*, Brad Rasmusson, MD^*, Karl E. Nelson, BS, MBA and James W. Long, MD, PhD^*

^* Division of Utah Artificial Heart ProgramSalt Lake City, Utah, USA
Department of Cardiology, LDS HospitalSalt Lake City, Utah, USA
University of Utah School of Medicine, Salt Lake City, Utah, USA

Manuscript received April 10, 2003; revised manuscript received November 18, 2003, accepted November 24, 2003.

^* Reprint requests and correspondence: Dr. Steven C. Horton, 324 10th Avenue, Suite 206, Salt Lake City, Utah 84103, USA.
SCHorton{at}msn.com

OBJECTIVES: A protocol was designed to diagnose the common malfunctions of a left ventricular assist device (LVAD).

BACKGROUND: Mechanical circulatory support, primarily with an LVAD, is increasingly used for treatment of advanced heart failure (HF). Left ventricular assist device dysfunction is a recognized complication; but heretofore, a systematic method to accurately diagnose LVAD dysfunction has not been thoroughly described.

METHODS: We developed a catheter-based protocol designed to characterize a normally functioning LVAD and diagnose multiple types of dysfunction. A total of 15 studies of 10 patients supported with an LVAD were reviewed. All patients had been evaluated due to concerns regarding LVAD dysfunction.

RESULTS: Of 15 examinations performed, 11 documented severe LVAD inflow valve regurgitation. One of these cases proved to have coexistent severe mitral valve regurgitation. One case was diagnosed with distortion of the LVAD outflow graft. One case of suspected embolization from the pumping chamber excluded the outflow graft as the source of emboli. One study had aortic insufficiency.

CONCLUSIONS: As LVAD use for treatment of end-stage HF becomes widespread and durations of support are extended, dysfunction will be increasingly prevalent. This catheter-based protocol provided a practical method to diagnose multiple causes of LVAD dysfunction.

Abbreviations and Acronyms   HF = heart failure   IVR = inflow valve regurgitation   LV = left ventricle/ventricular   LVAD = left ventricular assist device   PCWP = pulmonary capillary wedge pressure   REMATCH = Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure

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