Table 3 LVAD management (continuous flow, centrifugal pump)

・TEE

Orientation of inflow cannula: perpendicular to mitral valve

PFO: Draws blood flow from the right ventricular system into the lef

t ventricular system after VAD drive

MR: Left ventricular chamber is smaller after VAD drive, MR may be

AR: Aortic valvuloplasty recommended if more than mild (Feldman)

AS: Valve replacement recommended regardless of the stage

TR: Tricuspid valve plasty is recommended in cases of moderate or severe valve ring enlargement

MS: Less frequent, but if present, mitral valvuloplasty is recommended

Air in left ventricular: prevent air emboli

Ventricular septal deviation (see below)

・Blood pressure

Target: 65–75 mmHg

 < 60 mmHg: coronary return pressure decreases and right heart function declines

 > 80 mmHg: greater lift and reduced VAD flow

・Ventricular septum shift

Right shift (possibility of pulmonary congestion)

Increase VAD rpm, check for AR and inflow cannula, blood pressure optimization

Leftward shift (possibility of sucking down event)

Decrease VAD rpm, check for inflow cannula, blood pressure optimization

Correction of hypovolemia, use of inotropic drugs or NO