Postoperative VAD management: Operating room to discharge and beyond: Surgical and medical considerations

Postoperative management of the left ventricular assist device (LVAD) starts immediately after implantation and separation from cardiopulmonary bypass in the operating room. Initial management considerations include de-airing the heart, assessing right ventricle performance, hemostasis, and choosing whether or not to pack the chest and leave open or close the chest up front before leaving the operating room. Postoperative antibiotics are continued for no longer than 24 hours. Timing of extubation, removal of lines and chest tubes, and starting anticoagulation are all considerations that must be accounted for. Once the patient is extubated and pain is controlled, attention is turned to ambulation and endurance training. It will be during this period of time that the team, along with physical therapy, will determine whether it is safe to discharge the patient home or if he/she must go to short-term rehabilitation first. Final attention prior to discharge must be directed to ensuring that the patient is competent in every aspect of operating his/her LVAD and that the speed has been optimized to best work with the patient’s individual physiology.