In previous decades, the therapies for congestive heart failure (CHF) were limited both with respect to options and their ability to modify the underlying disease process. Recent advances in mechanical assist devices and cardiac transplantation have increased the outlook and longevity of patients suffering from CHF. Over 9,000 continuous flow left ventricular assist devices (LVADs) were implanted between 2006 and 2013.1 An unavoidable result of these advances is an increasing incidence of their complications. This review will address the initial approach and management to a patient who presents with a cardiac mechanical assist device in the emergency department.
Patients with refractory advanced heart failure who have failed medical therapy qualify for consideration of a LVAD as a bridging therapy while they undergo evaluation for cardiac transplant. The LVAD acts as a pump that receives blood from an internal cannula in the left ventricle (LV) and ejects the blood via an outflow cannula through the ascending aorta (see Figure 1).2