Bleeding - most common reason for ED visit, most common in first month after implant (frequency 42%)
GI bleeding is the most common source (15%-30%) followed by epistaxis.
Mechanisms:
Acquired Von Willebrand Disease (vWD) from pump shear forces
supratherapeutic anticoagulation
Lack of pulsatile flow → AV malformations in GI tract
Passive hepatic congestion secondary to biventricular failure, predisoposing to bleeding
Shear forces from<unk>  itself can lead to hemolytic anemia
Immediately consult VAD team/coordinator
Treatment - anticoagulant reversal based on specific agents used
In life-threatening bleeds, consider TXA, PCC, Desmopressin, FFP
Warfarin reversal carries low risk for acute thrombosis 
Infection - driveline and pocket are most common sites
Usually gram positive bacteria, but also need to cover for fungal infection
Pump Thrombosis, estimated at 2-13%, average first thrombosis ~1 year after implant depending on<unk> 
Low output state with falsely elevated pump flow estimates on controller
Diagnose with echo or cardiac CTA
Treatment with heparin and antiplatelet therapy
Consider tPA in life-threatening situations
Causes:
Mechanical - post-surgical<unk>  debris, cardiac emboli, inflow cannula malposition
Inadequate anticoagulation and/or antiplatelet treatment
As optimal dosing and monitoring not well defined due to lack of clinical trials
Will occur despite rigid regimen and compliance of anticoagulation/antiplatelet
Prosthetic material inflammatory reaction with blood
Intrinsic endothelial activation in response to continuous flow-VAD
Arrhythmia - very common
Get labs to evaluate electrolytes and troponin
Treat atrial fibrillation as in any other patient
Treat<unk>  arrhythmias with volume replacement and pharmacological or electrical cardioversion
Place pads anterior/posterior if going to cardiovert/defibrillate
"Suction event"
Pump pulls from an LV that hasn't filled
Causes:
Cannula malposition
Increased peripheral vascular resistance (hypertensive emergency)
Tamponade
GI bleeding is the most common source (15%-30%) followed by epistaxis.
Mechanisms:
Acquired Von Willebrand Disease (vWD) from pump shear forces
supratherapeutic anticoagulation
Lack of pulsatile flow → AV malformations in GI tract
Passive hepatic congestion secondary to biventricular failure, predisoposing to bleeding
Shear forces from<unk>  itself can lead to hemolytic anemia
Immediately consult VAD team/coordinator
Treatment - anticoagulant reversal based on specific agents used
In life-threatening bleeds, consider TXA, PCC, Desmopressin, FFP
Warfarin reversal carries low risk for acute thrombosis 
Acquired Von Willebrand Disease (vWD) from pump shear forces
supratherapeutic anticoagulation
Lack of pulsatile flow → AV malformations in GI tract
Passive hepatic congestion secondary to biventricular failure, predisoposing to bleeding
Shear forces from<unk>  itself can lead to hemolytic anemia
In life-threatening bleeds, consider TXA, PCC, Desmopressin, FFP
Warfarin reversal carries low risk for acute thrombosis 
Usually gram positive bacteria, but also need to cover for fungal infection
Low output state with falsely elevated pump flow estimates on controller
Diagnose with echo or cardiac CTA
Treatment with heparin and antiplatelet therapy
Consider tPA in life-threatening situations
Causes:
Mechanical - post-surgical<unk>  debris, cardiac emboli, inflow cannula malposition
Inadequate anticoagulation and/or antiplatelet treatment
As optimal dosing and monitoring not well defined due to lack of clinical trials
Will occur despite rigid regimen and compliance of anticoagulation/antiplatelet
Prosthetic material inflammatory reaction with blood
Intrinsic endothelial activation in response to continuous flow-VAD
Mechanical - post-surgical<unk>  debris, cardiac emboli, inflow cannula malposition
Inadequate anticoagulation and/or antiplatelet treatment
As optimal dosing and monitoring not well defined due to lack of clinical trials
Will occur despite rigid regimen and compliance of anticoagulation/antiplatelet
Prosthetic material inflammatory reaction with blood
Intrinsic endothelial activation in response to continuous flow-VAD
As optimal dosing and monitoring not well defined due to lack of clinical trials
Will occur despite rigid regimen and compliance of anticoagulation/antiplatelet
Get labs to evaluate electrolytes and troponin
Treat atrial fibrillation as in any other patient
Treat<unk>  arrhythmias with volume replacement and pharmacological or electrical cardioversion
Place pads anterior/posterior if going to cardiovert/defibrillate
Place pads anterior/posterior if going to cardiovert/defibrillate
Pump pulls from an LV that hasn't filled
Causes:
Cannula malposition
Increased peripheral vascular resistance (hypertensive emergency)
Tamponade
Cannula malposition
Increased peripheral vascular resistance (hypertensive emergency)
Tamponade
Left ventricular assist device complications
Bleeding - most common reason for ED visit, most common in first month after implant 
Heart transplant complications
GI bleeding is the most common source 
Aortic endograft complications
Mechanisms:
Cardiac ablation complications
Acquired Von Willebrand Disease 