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The field of mechanical circulatory support is evolving rapidly and new data are published at a rate which can be overwhelming. For the last three years, we published annual reviews of the current literature entitled “What Did We Learn about VADs?” in the past year (1-3). All three papers were well received as the full texts were downloaded 704, 676 and 413 times, respectively, by the readers around the globe. Continuing the tradition, we have written the present review and as with all previous reviews, we summarized some publications from 2017 that we think are of particular importance and interest. There may be some slight overlap with the end of 2016 due to some papers having been published online first.

Unresponsive patient with left ventricular assist device (LVAD) is always a challenge. While LVAD by itself is a relatively novel technology, mere presence of which often puzzles providers not dealing with it on a daily basis, unresponsiveness in such patient adds another level of complexity. Two papers recently published in the Journal (1, 2) describe the course of the events in several patients with LVAD who coded, only one of which was discharged from the hospital alive (1).

The field of mechanical circulatory support is evolving rapidly and new data are published at a rate that can be overwhelming. The last two years, we published reviews entitled “What Did We Learn about VADs in 2014?”(1) and “What Did We Learn about VADs in 2015?”(2). Both papers were well received – the full texts were downloaded 570 and 440 times, respectively, by readers around the globe. Encouraged by this, we wrote the present review, where, like before, we summarized some of the publications from 2016 that we think are particularly important. There may be slight overlap with the end of 2015, because some papers are being published online first.

Immediate post-operative evaluation of patients who have received a left ventricular assist device (LVAD) can be a daunting task. We present a case of a 51-year-old female who developed ventricular tachycardia soon after returning from the operating theatre and describe the role transesophageal echocardiogram played in helping prompt urgent and definitive treatment.

Pump thrombosis is a serious complication of continuous-flow left ventricular assist devices (LVAD). Treatment options include medical thrombolysis, surgical pump exchange or urgent heart transplantation. We are reporting a case of pump thrombosis with active hemolysis and acute renal failure managed surgically by isolating the LVAD while awaiting renal recovery and donor heart availability.

Left ventricular assist device (LVAD) pump thrombosis is a well-known complication of LVAD placement. Elevated lactate dehydrogenase (LDH) has classically been the first objective marker of pump thrombosis. In this case, we present a patient found to have normal serum LDH values but was ultimately found to have significant pump thrombosis.

Background Use of veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) has become increasingly common as a means of providing hemodynamic support for patients in cardiogenic shock. Data regarding the efficacy of VA-ECMO are provided almost exclusively by single-center, retrospective analyses. These retrospective analyses vary significantly with regards to documentation of the underlying pathophysiologic process resulting in cardiogenic shock. Methods Relevant published studies were identified by using a comprehensive search of English-language MEDLINE from 1966 to November 2015. Relevant references found cited in these studies were also analyzed. These studies were analyzed with regard to the indications the authors used for initiation of ECMO, as well as the outcomes for each indication in each individual study. Results Analysis of multiple relevant studies regarding the indications for ECMO support demonstrated that there is a great deal of variability with regard to the use of different indications for initiation of ECMO support. Conclusions Data regarding the efficacy of VA-ECMO is derived largely from single-center, retrospective analyses. In order to gain a better understanding of the efficacy of VA-ECMO in different patient populations, a more standardized format of documenting the indication for VA-ECMO should be used in centers that provide VA-ECMO. In general, all patients supported with VA-ECMO are in cardiogenic shock. In our experience, the underlying processes leading to cardiogenic shock can be classified as: cardiac arrest, acute decompensated congestive heart failure, acute on chronic congestive heart failure, myocardial infarction, acute pulmonary embolism, right ventricular failure not secondary to acute pulmonary embolism, and post-cardiotomy syndrome.

We are presenting the image of the bubbles in the descending aorta in a patient on VA ECMO.