Page 8 - VAD Guidelines

Pediatric Ventricular Assist Device (VAD) Guidelines

Device Implantation

OR & Device Considerations
Upon identification of a potential patient for device support and/or completion of VAD selection
committee resulting in planned device placement, availability of implantable and reusable stock must be
confirmed by the OR, Cath Lab manager or designee. Equipment and supply ordering is handled by the
OR, CVICU or Cath Lab manager for their respective areas. Thereafter, the vendor specific to the device
to be implanted should be contacted by the VAD team (usually the APP) with vendor- specific contact
information in the VAD folder on the Children’s SharePoint Drive.

Patient specific information necessary for vendor preparation includes patient’s age, weight, BSA,
abbreviated clinical history, and planned timing of device implantation. The amount of advanced
warning as well as necessary OR equipment is variable and device specific. A general rule of thumb is the
more time available for OR team and vendor preparation the better.

Pre-surgical Device Implant Huddle
Surgical planning should be coordinated prior to initiation of surgery at the time of surgeon presence in
the operating room and should include a minimum of CT surgeon, anesthesiologist, VAD coordinator
and/or VAD attending, perfusionist, and circulating OR staff. Plan should include the following:
• Surgical approach for device position
• Exit site for device driveline or durable cannula
• Position of device controller/monitor
• Plan for transition from bypass to device support

Intraoperative Optimization of Device Settings
Intraoperative VAD settings will be determined using TEE guidance to optimize device flow and cardiac
output while ensuring neutral position of the interventricular septum in patients with biventricular
circulation, minimization of valvar insufficiency, and optimization of systemic ventricular unloading. The
study should be performed with focus on the following elements:
• Inflow cannula position in relation to interventricular septum and mitral valve
• Interventricular septal position (-1=bowing into RV, 0=neutral, +1=bowing into LV)
• Quantification of mitral and tricuspid insufficiency
• Estimate of RV pressure by TR jet and central venous pressure
• Pulmonary vein Doppler tracing
• Frequency of aortic valve opening
• Quantification off aortic insufficiency
• Qualitative assessment of RV and LV function
• Final device settings should be annotated on study

Updated 3/24/2019 page 8