A Practical Guide to Intensive Care Unit Management after Left Ventricular Assist Device Implantation.

Omar Y Fakhreddine, Seulgi E Kim, Andrew B Civitello

Journal: Cardiology clinics 2026;44(3):459-478

PMID: 42399042

Abstract

Durable left ventricular assist devices (LVADs) have transformed the management of advanced heart failure, but early post-operative management remains a time of heightened vulnerability with disproportionate impact on short-term and long-term outcomes. This article provides a practical, physiology-driven framework for intensive care unit (ICU) management following LVAD implantation, emphasizing early hemostasis and anticoagulation strategies, systematic hemodynamic assessment, and optimization of right ventricular function. Additional sections address respiratory management, dysrhythmia control, nutrition, and early mobilization as essential components of recovery. By synthesizing contemporary evidence with bedside decision-making, this guide aims to support multidisciplinary ICU teams in standardizing care.

Address: Advanced Heart Failure and Transplant Cardiology, Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA; Department of Cardiology, The Texas Heart Institute, Houston, TX, USA. Electronic address: [email protected].; Department of Cardiology, The Texas Heart Institute, Houston, TX, USA; Cardiovascular Disease, Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.; Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA; Heart Transplant Program, Department of Cardiology, The Texas Heart Institute, Houston, TX, USA.

DOI: 10.1016/j.ccl.2026.05.010

MeSH Terms: Humans, Heart-Assist Devices, Heart Failure, Intensive Care Units, Critical Care