Outpatient management of LVAD

Left ventricular assist devices (LVADs) have revolutionized the therapy for advanced heart failure patients by improving the survival and quality of life. Despite all advancement, and improvement in LVAD technology, patients with implanted LVAD will face multiple challenges, including significant lifestyle modifications, complications associated with LVAD, and long-term management. One of the most crucial steps in improving the outcome of LVAD patients is the preparation of the patients and their caregivers before hospital discharge. These steps include adequate education of the patients and their caregivers, assessment of the home safety, referring to rehabilitation centers, and medically optimization of the patients before discharge. After discharge, patients will need close follow-ups. Patients, caregivers, and LVAD teams are responsible for managing blood pressure, driveline exit-site, and equipment. Most of the LVAD patients are on multiple medications, and there are unique pharmacological considerations that the LVAD patients and their caregivers need to be aware of; these include the anticoagulation therapy, antiplatelet therapy, and drug interactions. Caregivers are one of the essential members of the LVAD team. This chapter will review the outpatient challenges and management strategies for LVAD patients and their caregivers.