Left Ventricular Assist Device Destination Therapy

Le résumé fourni par la source

[Case] Mr H is a 74-year-old man with history of end-stage heart failure (ESHF) secondary to hereditary transthyretin cardiac amyloidosis. Our patient underwent placement of a HeartMate II (Abbott) left ventricular assist device (LVAD) as destination therapy (DT) at an outside hospital and later came to us (Sentara Heart Hospital) for continued management because he resided in the area. Over a 2-year period, the patient experienced multiple hospital admissions for acute heart failure (HF) exacerbations, delirium, and recurrent low-flow alarms. During his last hospitalization, the palliative medicine team was consulted to facilitate goals-of-care discussions with the patient and his family, thereby ensuring appropriate symptom management. Following these discussions, Mr H and his family elected to prioritize comfort and opted for a transition to hospice care at home. The low-flow alarm is a critical tool for detecting, preventing, and addressing underlying disease. This potentially lifesaving alarm cannot be disabled. For patients with HeartMate II LVAD support, patients can silence their own alarms for only 2 minutes on their system controller. These alarms cannot be permanently silenced; the longest suppression period is a 4-hour extended silence, which cannot be performed at home. Additionally, silencing requires connecting the system controller to a power module and system monitor, both of which are costly and unavailable outside of hospital or clinic settings.

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