Zhang YL, Wang WY, Liu ZY. Pharmacological management of major complications following left ventricular assist device implantation in type 2 diabetes mellitus. World J Diabetes 2025; 16(11): 113005 [DOI: 10.4239/wjd.v16.i11.113005]
Corresponding Author of This Article
Zhen-Yu Liu, MD, Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China. liuzhenyu200210@sjtu.edu.cn
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Cardiac & Cardiovascular Systems
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Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 15, 2025 (publication date) through Nov 14, 2025
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World Journal of Diabetes
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1948-9358
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zhang YL, Wang WY, Liu ZY. Pharmacological management of major complications following left ventricular assist device implantation in type 2 diabetes mellitus. World J Diabetes 2025; 16(11): 113005 [DOI: 10.4239/wjd.v16.i11.113005]
World J Diabetes. Nov 15, 2025; 16(11): 113005 Published online Nov 15, 2025. doi: 10.4239/wjd.v16.i11.113005
Pharmacological management of major complications following left ventricular assist device implantation in type 2 diabetes mellitus
Ying-Lu Zhang, Wen-Yan Wang, Zhen-Yu Liu
Ying-Lu Zhang, Wen-Yan Wang, Department of Cardiology, Institute of Cardiovascular Diseases, Heart Failure Center, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan Province, China
Zhen-Yu Liu, Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Co-corresponding authors: Wen-Yan Wang and Zhen-Yu Liu.
Author contributions: Wang WY was responsible for conceptualization; Liu ZY, Zhang YL, Wang WY were responsible for study design, data analysis, and data interpretation; Zhang YL and Liu ZY were responsible for writing - original draft preparation; Wang WY and Liu ZY were responsible for writing - review and editing; Wang WY and Liu ZY were responsible for supervision.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-Yu Liu, MD, Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China. liuzhenyu200210@sjtu.edu.cn
Received: August 13, 2025 Revised: September 7, 2025 Accepted: October 20, 2025 Published online: November 15, 2025 Processing time: 93 Days and 23.9 Hours
Abstract
Left ventricular assist devices (LVADs) represent a cornerstone therapy for advanced heart failure. However, their efficacy in patients with type 2 diabetes mellitus (T2DM) is challenged by diabetes-exacerbated complications. To determine optimal pharmacological strategies to mitigate major LVAD-related complications in patients with T2DM. This review provides evidence for pharmacological strategies to mitigate major LVAD-related complications in T2DM, in which endothelial dysfunction (via impaired PI3K/Akt-NO signaling), chronic inflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding, infection, and right ventricular (RV) failure. For thromboembolism prevention, individualized warfarin management (international normalized ratio: 2.0-3.0) with intensified monitoring is essential, while aspirin omission in magnetically levitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors show promise for thrombosis reduction, but require bleeding risk assessment. Glycemic control necessitates the proactive de-escalation of insulin/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoring SGLT-2 inhibitors/GLP-1 receptor agonists for cardiometabolic benefits. Driveline infection management requires renal-adjusted antimicrobial prophylaxis, culture-directed therapy, and novel approaches for drug-resistant cases. The prevention of RV failure depends on preoperative hemodynamic optimization and post-operative inotropic support. A multidisciplinary approach integrating anticoagulation precision, infection control, glycemic tailoring, and hemodynamic stabilization is critical to counter T2DM-pathophysiology interactions.
Core Tip: Type 2 diabetes mellitus exacerbates left ventricular assist device (LVAD)-related complications via endothelial dysfunction and inflammation. This review highlights tailored strategies, including precision warfarin dosing, aspirin omission from magnetically levitated LVADs, SGLT-2 inhibitors/GLP-1 agonists for glycemic control, and novel infection/right ventricular failure management to optimize outcomes.
