Facilitating noncardiac surgery for the patient with left ventricular assist device: A guide for the anesthesiologist

Abstract

The introduction of left ventricular assist device (LVAD) has improved survival rates for patients with end-stage heart failure. Two categories of VADs exist: one generates pulsatile flow and the other produces nonpulsatile continuous flow. Survival is better for patients with continuous-flow LVADs. With improved survival, more of such patients now present for noncardiac surgery (NCS). This review, written for the general anesthesiologists, addresses the perioperative considerations when the patient undergoes NCS. For best outcomes, a multidisciplinary approach is essential in perioperative management of the patient.

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

“…The experience in performing NCS in patients with LVAD has been accumulating, reflected by the increase in both original research and systematic and narrative reviews of the subject. [36][37][38][39][40][41] In our study, the number of NCS procedures performed for patients with LVAD increased over the years. Recommendations for monitoring, staffing, and management have been provided in the 2013 International Society of Heart and Lung Transplantation guidelines for mechanical circulatory support.…”

Is it Safe for Patients with Left Ventricular Assist Devices to Undergo Non-Cardiac Surgery?

“…International guidelines advise that a cardiovascular surgeon should be informed prior to planned NCS and should be immediately available for consultation [ 16 ]. Similarly, a non-cardiac anesthesiologist can care for stable patients on LVADs undergoing NCS, but a dedicated cardiac anesthesiologist is recommended for those patients displaying hemodynamic variability or with significant additional comorbidities [ 17 ]. Important anesthetic considerations include optimizing right ventricular function and preload, maintaining LVAD pump speed, and management of systemic vascular resistance [ 17 , 18 ].…”

“…Similarly, a non-cardiac anesthesiologist can care for stable patients on LVADs undergoing NCS, but a dedicated cardiac anesthesiologist is recommended for those patients displaying hemodynamic variability or with significant additional comorbidities [ 17 ]. Important anesthetic considerations include optimizing right ventricular function and preload, maintaining LVAD pump speed, and management of systemic vascular resistance [ 17 , 18 ]. In many circumstances, however, intra-operative anesthetic management in patients with an implanted LVAD undergoing NCS is not significantly different to that in patients without an LVAD.…”

Anesthetic Considerations in a Patient With LVAD and COVID-19 Undergoing Video-Assisted Thoracic Surgery

“…The patient can be bridged with heparin while waiting for INR to reach target reach. 7,16 . In our patient, the patient was bridged with heparin, which was stopped on the morning of the procedure, and restarted once the patient was stable postoperatively Thus in summary, we describe the challenges of dealing with patients with LVAD undergoing non-cardiac surgeries, especially during the COVID-19 pandemic.…”

“…Patients with LVAD may present for minor procedures such as endoscopies or major surgeries including general, vascular or thoracic surgeries 6 . They may undergo monitored anesthesia care or general anesthesia with various monitoring modalities ranging from non-invasive to invasive depending on the clinical situation and stability of the patient 7 . We describe a case of a patient with COVID-19 with an LVAD who needed thoracoscopic decortication for recurrent complex pleural effusion.…”