Task Force 4: Inpatient Management of Patients with MCSD - The ...

could be actuated with a hand pump or pneumatic driver, there is no way to manually or
externally actuate the continuous pump once it is stopped and cannot be restarted. If
blood remains stagnant in the pump for a period of time, there is a risk of thrombus
formation and embolization should the pump be restarted. For patients who are “pump
dependent” with little residual cardiac function, sudden stoppage may result in death. In
addition, there is backflow of blood through the valveless outflow cannula creating a
situation comparable to free aortic insufficiency, adding a further volume load to the
unsupported ventricle. In cases where there is residual cardiac function, the patient may
survive if able to reach medical attention rapidly. In this scenario, the patient is treated
for cardiogenic shock and may require inotropic and other supportive measures until
they can be transported back to the implanting medical center. In cases where the
patient cannot undergo surgery, the outflow cannula may be percutaneously occluded
as a temporizing measure to stem the backflow through the outflow cannula. 98,99
Ultimately, however, surgical pump exchange is the definitive therapy, as permitted by
the clinical status of the patient and ability to survive re-operation. In less acute
situations where the pump is functioning but there are pump alarms or changes in pump
parameters that cannot be resolved as an outpatient, the patient may need to be
admitted for observation and close monitoring.
Recommendations for Device Failure and Malfunction:
Class I:
1. Pump stoppage of a continuous flow MCSD constitutes a medical emergency, and
the patient should be rapidly transported back to the implanting or other expert
MCSD center for treatment.
Level of Evidence: C.
2. For patients who are unable to undergo surgery, the outflow cannula may be
occluded percutaneously to halt the backflow of blood through the valveless outflow
cannula as a stabilizing maneuver.
Level of Evidence: B.
3. Definitive therapy for pump stoppage is surgical pump exchange if the patient is
stable enough to undergo re-operation.
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