Page 8 - VAD Guidelines
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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
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