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Sleeping prone with a left ventricular assist device: Dream or reality?

  • Darren C. Tsang
    Affiliations
    Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
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  • Melissa Kellner
    Affiliations
    Division of Non-invasive Cardiology, Department of Cardiovascular and Interventional Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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  • Melanie Thomas
    Affiliations
    Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
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  • Faris G. Araj
    Correspondence
    Corresponding author at: University of Texas Southwestern Medical Center, Professional Office Bldg. 2 Suite 600, 5939 Harry Hines Blvd, Dallas, Texas 75390-9252, United States.
    Affiliations
    Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
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      Highlights

      • Sleep-related quality of life is decreased in people with durable LVADs.
      • No pre- or post-approval data inform manufacturer guidance to avoid prone sleeping positioning.
      • No apparent complications related to prolonged repetitive sleep in the prone position were observed in this case.
      • In select patients with LVADs, prone sleeping position may be safely tolerated.

      Abstract

      Background

      Among many other factors, restrictions on sleeping positions decrease quality of life after durable left ventricular assist device implantation. Specifically, device manufacturers and clinicians typically advise against sleeping in the prone position owing to concerns for driveline disruption, exit site infection, and hemodynamic compromise. Yet, no data exist to inform these recommendations and to the best of our knowledge no studies have examined sleep position in people with left ventricular assist devices. We report the first case of a person with a left ventricular assist device who slept prone, every night, for over one year.

      Case

      This is a 38-year-old man with a HeartWare™ left ventricular assist device who had previously not disclosed that he was sleeping in the prone position for the 16 months following device implantation. The patient did not suffer any episodes of device-related malfunction, infection, neurologic insult, or hemodynamic compromise. We performed a non-invasive assessment in both supine and prone positions to better understand the hemodynamic effects of the prone position.

      Conclusion

      In select recipients of left ventricular assist devices, sleeping in the prone position may be safely tolerated.

      Keywords

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