The Journal of ExtraCorporeal Technology No 57-1 | Page 33

A . Calhoun et al .: J Extra Corpor Technol 2025 , 57 , 24 – 31 27

Thresholds for defining LVD and indications and triggers for LV mechanical unloading were tabulated according to categories of clinical ( or radiographic ), hemodynamic , and ECHO findings or parameters . Clinical and radiologic criteria for LVD were placed within the same category for simplicity and to be succinct . Hemodynamic manifestations of LVD were defined as abnormalities with invasive filling pressures and ALPP monitoring . All pressures are reported in mmHg . ECHO criteria for LVD included cardiac ultrasound or pulmonary findings suggestive of pulmonary edema . Several papers stratified their indications and treatments as mild , moderate , and severe . Where applicable this has been included . ALPP : Arterial Line Pulse Pressure ; AV : Aortic Valve ; AS : Atrial Septostomy ; CS : Case Series ; CVP : Central Venous Pressure ; Ed : Editorial ; GD : Guideline Document ; IABP : Intra Aortic Balloon Pump ; IVC : Inferior Vena Cava ; LA : Left Atrium ; LV : Left Ventricle ; LVD : Left Ventricular Distension ; LVOT VTI : Left Ventricular Outflow Tract Velocity Time Integral ; PA : Pulmonary Artery ; PAC : Pulmonary Artery Catheter ; PAD : Pulmonary Artery Diastolic ; PCWP : Pulmonary Capillary Wedge Pressure ; RA : Review Article ; RR : Retrospective Review ; RT : Randomized Trial ; TSLAV : Transeptal Left Atrial Vent .

congestion index were also described . Hemodynamic criteria for LVD and the need for mechanical unloading were described in numerous studies . Of quantifiable criteria , two articles used PCWP above 18 mmHg , one above 20 mmHg , one above 30 mmHg , and three used a graded scale of PCWP . Four articles used a PAD of 25 mmHg . Three articles used an ALPP below 15 mmHg , three below 10 mmHg , and one used a graded scale .

While these criteria are helpful in the diagnosis of LVD and in establishing thresholds for mechanical LV unloading , their advantages and disadvantages must be highlighted . In what follows , we will describe the benefits and limitations of various surveillance methods for LVD .

Review of indicators of LV distension-clinical , radiographic , hemodynamic , and echocardiographic

The most frequently used clinical indicators of LVD are significant pulmonary edema as evidenced by frothy secretions from the endotracheal tube , pulmonary hemorrhage , or ventricular arrhythmias [ 2 , 3 , 40 ]. These signs are often regarded as emergent indications for mechanical LV unloading and may indicate irreversible damage to cardiac muscle [ 1 ]. It is likely that the presence of clinical signs of LVD makes myocardial recovery less likely to occur . Thus , other subclinical indications of LVD should be sought for earlier detection to avoid irreversible heart failure and the subsequent need for durable left ventricular assist device placement or heart transplant .

Radiographic ( chest films or chest computed tomography ) indications of LVD are used to assess for the presence of pulmonary congestion [ 5 ]. These findings usually precede the clinical indicators of LVD and are often easily obtained for patients in a multitude of settings . Though helpful , these findings suggest a parenchymal abnormality and may represent a delayed finding in patients with LVD or could suggest a different pathology such as acute respiratory distress syndrome or aspiration pneumonitis .

Hemodynamic indications of LVD include elevated CVP , elevated PAC pressures ( including pulmonary diastolic pressure ), and PCWP [ 1 , 2 , 5 ]. Additionally , ALPP is an important