LVAD
Left Ventricular Assist Device
26 checklist items
LV size and geometry Critical
LV systolic function (EF) Critical
RV function assessment Critical
Mitral regurgitation severity Critical
Aortic regurgitation Critical
Aortic valve opening
Tricuspid regurgitation
Interatrial septum / PFO / ASD Critical
LV thrombus exclusion Critical
Pericardial effusion baseline
Inflow cannula position Critical
Inflow cannula velocity (PW Doppler) Critical
LV size (unloading assessment) Critical
Interventricular septal position Critical
Aortic valve opening frequency
Aortic regurgitation (post-implant) Critical
Mitral regurgitation (post-implant)
RV function (post-implant) Critical
Pericardial effusion Critical
Pump thrombus assessment Critical
Outflow graft — PLAX view Critical
Outflow graft — High Parasternal Long-Axis view Critical
Ramp study protocol Critical
Optimal speed endpoints Critical
Suction event detection Critical
RVSP monitoring during ramp
Reference Values — LVAD
| Parameter | Value | Clinical Note |
|---|---|---|
| Inflow Cannula Velocity | 1.0–2.0 m/s | >2.0 m/s = obstruction; <1.0 m/s = low flow |
| Inflow Cannula Position | Central, parallel to IVS | 3–4 cm from mitral valve |
| AV Opening Frequency | Every 2–4 beats | Continuous closure = fusion risk |
| Septal Position | Midline | Rightward = over-decompression; Leftward = RV failure |
| TAPSE (post-implant) | ≥10 mm | <10 mm = significant RV dysfunction |
| Outflow Graft Velocity | 1.5–2.5 m/s | >2.5 m/s = obstruction (kink, thrombus, or anastomotic stenosis) |
| Outflow Graft Flow Pattern | Continuous antegrade | Absent or reversed diastolic flow = pump malfunction or severe AR recirculation |
Clinical Pearls — LVAD
- 1Inflow cannula malposition is the most common mechanical complication — always assess position and velocity.
- 2AR progression is nearly universal with continuous-flow LVADs — even mild AR causes significant recirculation.
- 3RV failure post-LVAD is the leading cause of 30-day mortality — pre-implant RV assessment is critical.
- 4Pump thrombus: suspect when LDH rises, power increases, or inflow velocity exceeds 2.5 m/s.
- 5During ramp study, optimal speed = midline septum + intermittent AV opening + no suction events.
- 6PFO/ASD must be excluded pre-implant — LVAD reduces LV pressure, enabling right-to-left shunting.
- 7Outflow graft assessment requires two windows: PLAX (cross-section, Doppler velocity) and High Parasternal Long-Axis (anastomosis, longitudinal graft course).
- 8Outflow graft obstruction (velocity >2.5 m/s) is a surgical emergency — kinking is the most common cause.