Mechanical circulatory support devices in noncardiac surgery

Abstract

Mechanical circulatory support (MCS) devices are percutaneously or surgically implantable devices that support either the circulatory system, the pulmonary system, or both. Device technology has improved over time, resulting in more patients using MCS, particularly left ventricular assist devices (LVAD). 1 In addition, the COVID-19 pandemic has brought MCS to the forefront due to the utilization of extracorporeal membrane oxygenation (ECMO) to support patients in profound respiratory failure. 2 The increase in MCS patients has led to more patients requiring anesthesia for noncardiac surgery (NCS), which can be secondary to the pathology that required MCS in the first place, a complication of MCS, or an entirely separate pathology. 3 Thus, it is prudent for anesthesiologists to understand the basic principles of how these devices work to provide safe anesthetics. This article focuses on the general principles surrounding the preoperative evaluation of the MCS patient presenting for NCS, focusing on the most likely encountered devices in this scenario: the intra-aortic balloon pump (IABP), ECMO, and the LVAD.