15.2 Discharge after ventricular assist device implantation
Successful discharge planning begins preoperatively, with assessment of the cognitive abilities of the patients, their support system and home environment [25, 37, 71, 137, 284, 354–360]. Training of patients, family and other designated caregivers should be performed in the implanting hospital by the LT-MCS team.
A clear algorithm for when and how to seek help, including a synoptic card placed in the pocket and in the room of the patient at home with emergency instructions and contacts, is mandatory [25, 37, 71, 137, 284, 354–360]. The MCS team is responsible for informing the general practitioner, the referring physician and the emergency support personnel of the discharge of the patient with MCS. Those involved with the patient should be provided with basic knowledge of the concepts of MCS.
It is recommended that discharged patients regularly visit the outpatient clinic. During each visit, the following procedures should be considered: physical examination with special attention for the driveline exit site and blood pressure (BP), laboratory testing (including coagulation and markers of haemolysis), technical examination of the device, chest radiogram and echocardiographic scans.