Anesthetic Management of Patients With Continuous-Flow Left Ventricular Assist Devices Undergoing Noncardiac Surgery: An Update for Anesthesiologists

Dalia, Adam A.; Cronin, Brett; Stone, Marc E.; Turner, Katja; Hargrave, Jennifer; Melo, Marcos F. Vidal; Essandoh, Michael

doi:10.1053/j.jvca.2017.11.038

Cited by 22 publications

(65 citation statements)

References 47 publications

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“…For patients with LVAD, the right heart function is frequently marginal; hence, it is important to avoid factors that worsen PVR (e.g., hypoxia, hypercarbia, and light anesthesia) and overfilling the RV with fluid [11][12][13]. However, OLV could lead to higher PVR, induced by possible complications such as hypoxemia and hypercarbia, where the RV encounters sudden changes in afterload, preload, and contractility [14].…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of a patient with a continuous-flow left ventricular assist device for video-assisted thoracoscopic surgery: a case report

Iwata

Yokokawa

et al. 2020

BMC Anesthesiol

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Background: As patients with left ventricular assist device (LVAD) have long expected survival, the incidence of noncardiac surgery in this patient population is increasing. Here, we present the anesthetic management of a patient with a continuous-flow LVAD who underwent video-assisted thoracic surgery (VATS). Case presentation: A 37-year-old man with LVAD was scheduled to undergo VATS because of repeated spontaneous pneumothorax. Generally, patients with these devices have marginal right heart function; therefore, it is important to avoid factors that worsen pulmonary vascular resistance (PVR). However, VATS requires one-lung ventilation (OLV) and it tends to cause increase in PVR, leading to right heart failure. In the present case, when the patient was set in a lateral decubitus position and progressive hypoxia was observed during OLV, transesophageal echocardiography demonstrated a dilated right ventricle and a temporally flattened interventricular septum, and the central venous pressure increased to approximately 20 mmHg. Because we anticipated deterioration of right heart function, dobutamine and milrinone were administered and/or respirator settings were changed to decrease PVR for maintaining LVAD performance. Finally, resection of a bulla was completed, and the patient was discharged in stable condition on postoperative day 37. Conclusions: The anesthetic management of a patient with LVAD during VATS is challenging because the possible hemodynamic changes induced by hypoxia associated with OLV affect LVAD performance and right heart function. In our experience, VATS that requires OLV will be well tolerated in a patient with LVAD with preserved right heart function, and a multidisciplinary approach to maintain right heart function will be needed.

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Section: Discussionmentioning

confidence: 99%

Anesthetic management of a patient with a continuous-flow left ventricular assist device for video-assisted thoracoscopic surgery: a case report

Iwata

Yokokawa

et al. 2020

BMC Anesthesiol

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“…Alpha agonists such as phenylephrine or vasopressin should be available to treat vasodilation induced hypotension as well as inotropic medications. Up to 72% of LVAD adult patients with CF devices required some intra‐operative pharmacological cardiovascular support …”

Section: Perioperative Management For Pediatric Vad Patients Presentimentioning

confidence: 99%

“…Invasive arterial monitoring for longer procedures in patients with CF devices may help avoid unrecognized hypotension or hypertension and associated morbidity. Adult data has shown that a MAP >90 mmHg causes low VAD flows, pump stasis, and cerebrovascular accidents …”

Section: Perioperative Management For Pediatric Vad Patients Presentimentioning

confidence: 99%

“…Up to 72% of LVAD adult patients with CF devices required some intra-operative pharmacological cardiovascular support. 36,39 In addition to standard ASA monitoring there should be a low threshold for invasive arterial monitoring in patients with CF devices since routine non-invasive blood pressure measurements are unreliable in these patients even if a Doppler technique is used.…”

Section: Response To Induction and Maintenance Of General Anesthesiamentioning

confidence: 99%

“…Adult data has shown that a MAP >90 mmHg causes low VAD flows, pump stasis, and cerebrovascular accidents. 39 Adequate venous access should be secured especially for longer cases or surgery involving large fluid shifts and potential blood loss.…”

Section: Response To Induction and Maintenance Of General Anesthesiamentioning

confidence: 99%

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Pediatric ventricular assist devices: Bridge to a new era of perioperative care

Navaratnam

Maeda

Hollander

2019

Pediatric Anesthesia

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Summary Pediatric ventricular assist devices (VADs) are evolving as a standard therapy for end stage heart failure in children. Major recent developments include the increased use of continuous flow (CF) devices in children and increased experience with congenital heart disease (CHD) and outpatient management. In the current and future era anesthesiologists will encounter more children presenting for VAD implantation, subsequent procedures and heart transplantation. Successful perioperative management requires an understanding of the interaction between the patient's physiology and the device and a framework to troubleshoot problems. This review focuses on CF devices, VAD support for CHD and perioperative management of pulsatile and CF devices in the pediatric population.

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Trends, Perioperative Adverse Events, and Survival of Patients With Left Ventricular Assist Devices Undergoing Noncardiac Surgery

et al. 2020

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Key Points Question What are the trends, perioperative adverse events, and mortality associated with noncardiac surgery in patients with left ventricular assist devices (LVADs)? Findings In this cohort study, of 8118 Medicare patients who had an LVAD, 16.3% underwent noncardiac surgery during follow-up. Major adverse cardiovascular events, defined as in-hospital or 30-day all-cause mortality, ischemic stroke, or intracerebral bleeding, occurred in 16.9% of patients who underwent emergent or urgent procedures and in 7.1% of patients who underwent elective procedures. Meaning A substantial proportion of patients with LVADs underwent noncardiac surgery and experienced major perioperative adverse events.

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Anesthetic Management of Patients With Continuous-Flow Left Ventricular Assist Devices Undergoing Noncardiac Surgery: An Update for Anesthesiologists

Cited by 22 publications

References 47 publications

Anesthetic management of a patient with a continuous-flow left ventricular assist device for video-assisted thoracoscopic surgery: a case report

Anesthetic management of a patient with a continuous-flow left ventricular assist device for video-assisted thoracoscopic surgery: a case report

Pediatric ventricular assist devices: Bridge to a new era of perioperative care

Trends, Perioperative Adverse Events, and Survival of Patients With Left Ventricular Assist Devices Undergoing Noncardiac Surgery

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