Perfusionist’s role in long-term ventricular assist device

Abstract

Introduction

Ventricular assist devices (VADs) have emerged as essential tools for stage D heart failure, improving survival and quality of life by serving as a bridge to transplant, destination therapy, or bridge to decision. The successful implantation and management of VADs requires a multidisciplinary team, in which perfusionists have a critical role in ensuring proper oxygen delivery, hemodynamic support, and the smooth transition from extracorporeal support to the implanted device. The objective was to describe the institutional perfusion protocol for LVAD implantation and to characterize intraoperative perfusion parameters at a Latin American referral center.

Methods

A retrospective observational cohort study was conducted including all patients who underwent LVAD implantation at a referral center in northeastern Colombia. Statistical analysis involved the use of descriptive statistics.

Results

A total of 33 patients underwent LVAD implantation, with a median age of 54 years and 51.52% of male. Ischemic cardiomyopathy was the leading etiology (27.27%). The median cardiopulmonary bypass (CPB) time was 153 min (IQR: 128–181). During cardiopulmonary bypass the median lactate levels were 1.8 mmol/L (IQR: 1.5–2.2), and the cardiac index ranged from a minimum CI of 2.3 to a maximum CI of 2.6 L/min/m².

Conclusions

This study highlights the vital role of cardiopulmonary perfusion in the successful implantation of long-term LVADs in advanced heart failure patients. Optimal intraoperative management, including controlled temperature, low lactate levels, and optimal cardiac index, emphasizes the need for standardized strategies and the expertise of perfusionists.