Abstract
Heart failure is a growing epidemic, which is associated with increased morbidity and mortality alongside increasing healthcare costs. Left ventricular assist devices (LVADs) are increasingly used as an acceptable alternative to heart transplantation. The 2-year survival using the most technologically advanced LVAD design is nearly similar to that of heart transplantation. The pathophysiological basis of heart failure includes compromised central hemodynamics, and impaired organ perfusion and, consequently, microvascular perfusion. Previous studies on microcirculation imaging have shown that alterations in the microcirculation have important prognostic value in patients with advanced heart failure (cardiogenic shock) as well as those receiving mechanical circulatory support. Postoperative care of LVAD patients is typically associated with prolonged ICU stay due to the high surgical risk as well as the high rate of operative and device-related complications. Anticipation and handling of post-LVAD complications require hemodynamic monitoring as well as possibly adjustment of pump settings. A key marker of optimal LVAD settings is improved organ perfusion. Therefore, monitoring of end-organ function to optimize pump settings could improve care of LVAD patients and possibly avoid repeated and lengthy hospitalizations. Microcirculatory imaging is evolving as an important bedside tool for the assessment of hemodynamic coherence and microcirculatory monitoring. Several imaging techniques, such as handheld microscopes based on incident dark-field illumination (IDF), have been introduced for clinical use. In this chapter, we discuss optimal approaches to microcirculatory monitoring from the ICU to the outpatient clinic in patients with an LVAD.
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Acknowledgment
We would like to thank Aysima Şenyürek (medical student from the Erasmus MC of Rotterdam) for her help with the creation of Fig. 18.1.
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Akin, S., Soliman, O.I., Ince, C. (2020). Customized Monitoring of the Microcirculation in Patients with a Left Ventricular Assist Device. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2020. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-37323-8_18
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DOI: https://doi.org/10.1007/978-3-030-37323-8_18
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