ECHO 2013 / Echocardiography in Advanced Heart Failure Mechanical Support

Echo detected changes in right heart hemodynamics are associated with symptomatic status after LVAD implant

Lam et al, JASE 2009;22:1055-1062

•PVR, RVSP, TR reductions within 1 month

•No change in RV size, RV FAC, TAPSE

•Pts with larger reductions in PVR had better clinical status (6MWT, MLHFQ)

•Pts with significant deteriorations in RV function had poorer clinical status

PVR (wood units) = (TR velocity / RVOT TVI) X 10 + 0.16

Wood units X 80 = dyn.s/cm

Normal PVR = 1.25-2.5 WU; 100-200 dyn.s/cm

Abbas et al, JACC 2003:41;1021-7; Lam et al, JASE 2009;22:1055-1062

Potential complications

•Aortic dissection

•Insufficiency of native AV / Ao clot

•Conduit obstruction/kinking

•Worsened RV failure

•Inlet cannula thrombosis

•Overpumping

•Pump failure

•Controller/battery failure

complications

•Device malfunction – loss of circulatory support

–Pump/controller

–Cannulae

–Valves

•obstruction / degeneration - regurgitation

•Infection

•Thrombus formation / embolization

•Surgical bleeding / Leak around cannulae

•other

LVAD complications

Guiding device wean

•Reduce pump rates and observe

–Filling

–Ejection

•LV volumes and function

•Forward flow in LVOT

–Valve function

•AV opening

•Degree of MR / TR

Guiding placement of percutaneous assist devices

•Guiding transeptal puncture (tandem heart)

–In LA away from MV, LA appendage, pulm veins

•Proper positioning of LV cannula (Impella)

–In LV cavity but away from walls

•Assessing filling

–LV/RV volumes

Impella

•Assess AV pre-device placement

•Guide cannula placement

• Monitor cannula position and function

Impella + TTE