Pumping for Two: Pregnancy in Patients Supported With a Left Ventricular Assist Device.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
07 Nov 2023
07 Nov 2023
Historique:
medline:
7
11
2023
pubmed:
7
11
2023
entrez:
7
11
2023
Statut:
aheadofprint
Résumé
This review discusses the challenges and outcomes associated with pregnancy during left ventricular assist device (LVAD) support. Women account for a third of the heart failure population in the United States. Left ventricular assist devices have emerged as a safe and effective treatment option for patients with advanced heart failure. Pregnancy during LVAD support can occur, and it presents significant risks to both mother and fetus, including hemodynamic stress, thrombotic events, medication-associated teratogenicity, and uterine impingement. This literature review identified 10 cases of confirmed pregnancy during LVAD support, of which eight resulted in successful births. Maternal and fetal mortality occurred in one case, and there was a spontaneous abortion in one case. The review highlights the importance of a multidisciplinary approach, promotion of shared decision-making, thoughtful anticoagulation, adjustment of LVAD speed, and medication optimization to maintain hemodynamic support during pregnancy. Hemodynamic changes during pregnancy include increased cardiac output, heart rate, and plasma volume, as well as decreased systemic vascular resistance, which can impact LVAD support. Despite reduced pulsatility in LVAD-supported patients, ovulation and reproductive capacity might be preserved, and viable pregnancies may be achieved with appropriate management. The review provides insights into the risks and considerations for a viable pregnancy during LVAD support, including the need for ongoing research to inform joined decision-making.
Identifiants
pubmed: 37934714
doi: 10.1097/MAT.0000000000002082
pii: 00002480-990000000-00346
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © ASAIO 2023.
Déclaration de conflit d'intérêts
Disclosure: N.U. is on the medical advisory board for Abbott, Abumed, and Leviticus. G.S. has been a consultant for Abbott, K.J.C. receives NIH grant support K23 HL148528, and V.K.T. receives NIH grant support (HL146964). The other authors have no conflicts of interest to report.
Références
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