Liver Dysfunction in a Patient with Ventricular Assist Device

Patients with severe or chronic heart failure (CHF) are at risk for hepatic ischemia due to poor global perfusion from left heart failure or for passive congestion from right heart failure, both of which can lead to significant liver dysfunction. In patients with left heart failure, perfusion of the liver tends to improve with ventricular assist device (VAD) implantation; a few patients, however, develop worse liver function post-VAD due to right heart failure, which can threaten patient survival. Identification of patients who need optimization of liver function prior to VAD and consideration of alternative strategies to improve liver function beyond standard of care before and after VAD placement are critical in optimizing patient outcome.