Care for patients dying with a left ventricular assist device

Abstract

Left ventricular assist devices (LVADs) are increasingly being used to support patients with advanced heart failure, both as a bridge to heart transplantation and as a final or ‘destination’ therapy. Compared with continued medical therapy alone, these devices prolong survival and improve overall patient functional status and quality of life - as such LVADs are not a strictly palliative therapy. However, life with LVAD support is frequently accompanied by device-related complications such as bleeding, ventricular arrhythmias, infection, stroke, renal failure, and right ventricular failure. Management of the LVAD-supported patient who has experienced device-related complications requires both a focus on the underlying pathophysiology and the patient’s overall goals of care. Palliative or supportive care approaches serve an important complementary role in the management of these patients and may also be used to inform decision-making prior to device implantation. We present a review of the complications of LVAD support and their treatment, describe a role for palliative care in the management of these patients, and consider future directions for research to improve the care of LVAD-supported patients.