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Left Ventricular Assist Device – Special Devices (ICU and Brain Death Determination)

by Brian Warriner, MD
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    00:00 a big plus in their lives. This is a large left-ventricular assist device, a bedside one. These devices actually can be quite small and can actually be basically in the chest with a pack that you carry at your waist and you can go home with them. But, that's not a common situation.

    00:21 The left-ventricular assist device is placed by a cardiac surgeon. It has a balloon that inflates during cardiac diastole. So, when the heart is relaxed, the balloon in the left-ventricular assist device inflates. And we'll see in a subsequent slide that this actually increases diastolic pressure in the aorta, which improves coronary blood flow, and improves oxygenation of the heart, so that's good for the heart muscle.

    00:51 Then, during cardiac systole when the heart contracts, the balloon in the left-ventricular assist device deflates. That unloads the pressure against which the heart has to work, improves cardiac output and produces less work for the myocardium. This kind of device is often used to stabilize patients prior to cardiac surgery. And it can actually be used, as I mentioned earlier, as a bridge to heart transplant. And the smaller devices that can be implanted are used temporary as artificial hearts, and people can use them for up to several months before they, before they start to have problems with them.

    01:33 And this is a diagram of how this device works. You can see that the balloon, which is the gray device in the aorta, comes all the way up almost to the heart, just to where the left subclavian artery comes off. And it inflates during diastole increasing the pressure in the blood close to the heart, forcing it into the coronary arteries and improving myocardial oxygenation. And then during cardiac systole it deflates, so that the pressure against which the heart is working is markedly reduced and the oxygen demands to the heart have reduced. And sometimes this can result in complete recovery of the heart. The ECG is modified and you have to learn how to to utilize this device, and you have to learn how to set the device to inflate and deflate at the right times. If you're off by even just half a second or so, you can cause a lot of problems.

    02:33 So it takes highly skilled people to use this thing. So, Systemic Inflammatory Response


    About the Lecture

    The lecture Left Ventricular Assist Device – Special Devices (ICU and Brain Death Determination) by Brian Warriner, MD is from the course The ICU.


    Author of lecture Left Ventricular Assist Device – Special Devices (ICU and Brain Death Determination)

     Brian Warriner, MD

    Brian Warriner, MD


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