Cesarean delivery in a parturient with a left ventricular assist device

Gayam, Susheela; Staab, Jared; Shih, Grace; Stoops, Shea

doi:10.1016/j.ijoa.2020.07.007

Cited by 7 publications

(8 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The patient received transverse abdominal plane blocks post operatively for pain control. No complications with the LVAD were noted [28].…”

Section: Case Studies For Lvad Patients and Non Cardiac Surgerymentioning

confidence: 90%

“…Many have an ICD implanted prior to LVAD implantation [4,6,10,14,16]. Ventricular arrhythmias may be caused by so-called "suck down" events: when the left ventricle has a low volume and collapses on itself [4,6,11,16,28].…”

Section: Ventricular Arrhythmiasmentioning

confidence: 99%

“…Causes of RV failure intro can be due to multiple factors including the inflammatory cascade, blood product administration, hypoxia, hypercarbia, and acidosis, among many. Vasopressin is cited as a pressor of choice related to its lack of effect on the pulmonary vasculature [20,28]. Milrinone infusion may also be employed to ensure decreased stress on the right ventricle [3,11].. Lastly, a TEE machine and appropriately trained personnel can provide additional insights if management is difficult or intraoperative adventures are encountered.…”

Section: Induction Maintenance and Emergence Phases Of Anesthesiamentioning

confidence: 99%

See 2 more Smart Citations

Anesthesia for Non-Cardiac Surgery for the LVAD Patient

Kathryn¹,

Silvonek²

2023

Updates in Anesthesia - The Operating Room and Beyond

View full text Add to dashboard Cite

Heart failure is poorly tolerated and end stage heart failure (classified as New York Heart Association (NYHA) class IV) has a two-year survival with medical therapy that approaches 0%. Innovation in this sphere has yielded mechanical therapies, principally the left ventricular assist device (LVAD). In the last decade one-year survival rates of Left ventricular assist device patients have increased from 52–83%. As this therapy is more commonly used to treat advanced heart failure, coupled with the increase in patient survival after implantation, patients are increasingly encountered in the peri-operative arena requiring anesthesia for non-cardiac surgeries. The goal of this chapter is to provide the non-cardiac trained anesthesia provider a primer on what an LVAD is, how it functions, the physiological changes that occur with implantation, and considerations for administering anesthesia to patients with LVADs for non-cardiac surgery. Review of articles from 2018 to 2022 found from a search on PubMed and Google Scholar using the keywords: “Left Ventricular Assist Device”, “LVAD”, “anesthesia”, “non-cardiac surgery”, “Doppler blood pressure measurement”, “VAD coordinator”. Non-cardiac trained anesthesia providers can safely administer the anesthetics to LVAD patients undergoing non-cardiac surgery as long as appropriate considerations are taken.

show abstract

“…The patient received transverse abdominal plane blocks post operatively for pain control. No complications with the LVAD were noted [28].…”

Section: Case Studies For Lvad Patients and Non Cardiac Surgerymentioning

confidence: 90%

Section: Ventricular Arrhythmiasmentioning

confidence: 99%

Section: Induction Maintenance and Emergence Phases Of Anesthesiamentioning

confidence: 99%

See 1 more Smart Citation

Anesthesia for Non-Cardiac Surgery for the LVAD Patient

Kathryn¹,

Silvonek²

2023

Updates in Anesthesia - The Operating Room and Beyond

View full text Add to dashboard Cite

show abstract

“…Pregnancy in an LVAD patient should be considered a contraindication due to hemodynamic alterations that can worsen right or biventricular heart failure, increased prothrombotic risk that can predispose to pump thrombosis, challenges with anticoagulation management and preterm labor [5]. Limited case series on pregnancy outcomes in an LVAD patient have been published [10,[48][49][50][51][52].…”

Section: Left Ventricular Assist Devicesmentioning

confidence: 99%

Management of pregnancy in left ventricular assist device and heart transplant recipients: a concise review

Marek-Iannucci

Uber

Rajapreyar

2023

Current Opinion in Cardiology

View full text Add to dashboard Cite

Purpose of reviewWomen of reproductive age are increasingly undergoing heart transplantation (HT) or left ventricular assist device (LVAD) implantation for advanced heart failure. This review is intended to give an overview of the current state of the art management of pregnancy in patients with LVAD or HT recipients.Recent findingsHeart transplant recipients are at increased risk for graft rejection, renal dysfunction, preeclampsia and worsening of comorbidities (hypertension and diabetes). Patients with LVAD are at higher risk of thromboembolic events, infections, right ventricular failure and require close surveillance during pregnancy. Preconception counseling must be offered to all women of reproductive age group with HT or LVAD to avoid unplanned pregnancies.SummaryA multidisciplinary approach with close antepartum and postpartum surveillance is recommended.

show abstract

“…Although available data on pregnancy outcomes in patients with LVADs are limited to case reports and case series, some recommendations based on expert opinion are possible. 2,12–14 Pregnancy should be managed in a level IV maternity care center with experience in LVAD management by a multidisciplinary team that includes maternal-fetal medicine specialists, LVAD coordinators, cardiology with LVAD experience, anesthesiology, hematology, neonatology, and cardiothoracic surgery. Patients should be extensively counseled about potential life-threatening complications and the option of pregnancy termination should be discussed.…”

Section: Other Aspects Of Pregnancy In Patients With Left Ventricular...mentioning

confidence: 99%

Care and Monitoring of Pregnant Patients With Left Ventricular Assist Devices

Pacheco,

Saad,

Lick

et al. 2023

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

Cardiovascular disease is one of the leading causes of maternal mortality in the United States. Although still rare, pregnancy in patients with left ventricular assist devices (LVADs) is becoming more common. Typical indications for the use of LVADs in reproductive-aged females include ischemic cardiomyopathy, nonischemic (familial) dilated cardiomyopathy, peripartum cardiomyopathy, and some forms of myocarditis. An LVAD drains blood through a cannula placed into the apex of the left ventricle and then returns it to the proximal aorta bypassing the aortic valve allowing hemodynamic support in parallel with the native circulation. The physiologic changes associated with pregnancy, mainly increased blood volume and hypercoagulability, may adversely affect patients with LVADs, leading to many experts recommending against pregnancy. Maternal-fetal medicine specialists should have a central role within a multidisciplinary team required to provide optimal care for this high-risk group of patients.

show abstract

Cesarean delivery in a parturient with a left ventricular assist device

Cited by 7 publications

References 7 publications

Anesthesia for Non-Cardiac Surgery for the LVAD Patient

Anesthesia for Non-Cardiac Surgery for the LVAD Patient

Management of pregnancy in left ventricular assist device and heart transplant recipients: a concise review

Care and Monitoring of Pregnant Patients With Left Ventricular Assist Devices

Contact Info

Product

Resources

About