Temporary ventricular assist devices
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Temporary ventricular assist devices (or temporary VADs) are temporary percutaneous devices used in supporting a failing heart in cardiogenic shock or perioperatively.
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Temporary VADs consist of an inlet, outlet and impeller pump all housed within a catheter. Temporary VADs are inserted percutaneously usually via the femoral artery. They are advanced retrograde until they overlie the aortic valve and project into the left ventricle. Blood is pumped from the left ventricle through the inlet via the impeller pump and then out into the aorta via the outlet. They usually remain in situ for 4-6 days 1. The most common type is the Impella family of devices.
The tip of a left-sided temporary VAD should be located centrally over the left ventricle 1.
Complications that may arise from temporary VAD insertion and use include 1-3:
- cardiac arrhythmias
- ventricular perforation
- aortic wall injury
- pump thrombosis
- device failure
- device fracture
Impella devices are unsafe with MRI 1.
- 1. Sigakis CJG, Mathai SK, Suby-Long TD, Restauri NL, Ocazionez D, Bang TJ, Restrepo CS, Sachs PB, Vargas D. Radiographic Review of Current Therapeutic and Monitoring Devices in the Chest. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (4): 1027-1045. doi:10.1148/rg.2018170096 - Pubmed
- 2. Brown JL, Estep JD. Temporary Percutaneous Mechanical Circulatory Support in Advanced Heart Failure. (2016) Heart failure clinics. 12 (3): 385-98. doi:10.1016/j.hfc.2016.03.003 - Pubmed
- 3. Saleh QA, Foster M, Abi Rafeh N. First Experience With Successful Percutaneous Retrieval of Retained-Fractured Impella Device. (2017) JACC. Cardiovascular interventions. 10 (2): e15-e16. doi:10.1016/j.jcin.2016.11.012 - Pubmed