Structural Heart Interventions in Patients with Left Ventricular Assist Devices.

Abstract

Left ventricular assist devices (LVADs) have changed the landscape for patients with advanced heart failure (HF). With advances in pump design and management, patients with LVADs are living longer with improved quality of life despite having more comorbidities and complex structural heart disease. As such, HF cardiologists and surgeons collaborate more frequently with structural heart interventionalists to address the complex problems of patients with LVADs who present at different points of failure in their circuits. Unlike heart transplants and total artificial heart recipients, the native heart and its components must function to maintain successful circulatory support from these assist devices. Multiple points of potential failure of the native heart and the LVAD circuit exist that can result in significant morbidity and mortality. These include regurgitant valve lesions, interatrial shunts, outflow cannula obstruction, and pump thrombosis. Transcatheter interventions can be applied and tailored specifically to the anatomy of the individual in these situations to improve the lives and outcomes of our LVAD patients. This review provides a comprehensive approach for diagnosing and treating structural heart disease associated with patients who have LVADs, focusing on multidisciplinary collaboration and individualized interventional strategies.