Peter Lesný, Milan Luknár, Eva Goncalvesová
Outpatient management of patients with long-term ventricular assist devices includes several specific aspects in contrast
with the common outpatient care in advanced heart failure. The goal range of mean blood pressure is between 70
and 80 mm Hg. Higher blood pressure reduces pump flow and has to be decreased. ACE inhibitors (or sartans) and beta-
blockers are preferred for blood pressure reduction. Fluid intake should not be reduced, since dehydration may lead
to suction episodes of the inflow cannula to the left ventricle. Patients are anticoagulated with warfarin, prothrombin
time is measured frequently (once a week on average). The outpatient management is targeted at an early detection
of complications: infections, pump thrombosis and hemorrhage. Driveline infections are the most common complication.
Diligent education and driveline fixation are key measures in reduction of driveline infections. Hemolysis is
one of the first signs of pump thrombosis (dark urine, elevated lactate dehydrogenase). Clinical presentation in pump
thrombosis may vary from asymptomatic to cardiogenic shock. The anticoagulation treatment can be interrupted in
case of severe hemorrhage.