Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery

Abstract

Aim:The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery.Materials and Methods:This is a retrospective review of the population of patients with LVADs at a single institution undergoing noncardiac procedures between 2009 and 2014. Demographic, perioperative, and procedural data collected included the type of procedure performed, anesthetic technique, vasopressor requirements, invasive monitors used, anesthesia provider type, blood product management, need for postoperative intubation, postoperative disposition and length of stay, and perioperative complications including mortality.Statistical Analysis:Descriptive statistics for categorical variables are presented as frequency distributions and percentages. Continuous variables are expressed as mean ± standard deviation and range when applicable.Results:During the study, 31 patients with LVADs underwent a total of 74 procedures. Each patient underwent an average of 2.4 procedures. Of the total number of procedures, 48 (65%) were upper or lower endoscopies. Considering all procedures, 81% were performed under monitored anesthesia care (MAC). Perioperative care was provided by faculty outside of the division of cardiac anesthesia in 62% of procedures. Invasive blood pressure monitoring was used in 27 (36%) procedures, and a central line, peripherally inserted central catheter or midline was in place preoperatively and used intraoperatively for 38 (51%) procedures. Vasopressors were not required in the majority (65; 88%) of procedures. There was one inhospital mortality secondary to multiorgan failure; 97% of patients survived to discharge after their procedure.Conclusion:At our institution, LVAD patients undergoing noncardiac procedures most frequently require endoscopy. These procedures can frequently be done safely under MAC, with or without consultation by a cardiac anesthesiologist.

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

“…Nearly half of the patients with LVAD require endoscopy and these procedures can frequently be done safely under MAC. [ 81 ] If GA with endotracheal intubation is required for the surgical procedure, rapid sequence induction is recommended in patients with early models of LVADs which had preperitoneal placement. [ 70 ]…”

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

“…These NCS may be needed for managing complications arising from LVAD or otherwise. With studies showing that a trained non-cardiac anesthesiologist can safely manage these patients when they present for NCS, it is vital that all anesthesiologists understand the LVAD physiology and its implications in various surgeries 3 , 4 , 5 . This is even more relevant during the current pandemic where these complex cardiopulmonary interactions may be even more challenging in patients with COVID-19.…”

Vascular procedures in patients with left ventricular assist devices: single-center experience

“…Left ventricular assist devices (LVADs) have become a viable therapeutic strategy for bridge to transplant (BTT) and destination therapy (DT) in the failing heart [1][2][3][4]. With increase in LVAD use and technical progress [5,6], more patients require non-cardiac surgery or develop complications that are leading to surgical interventions [7][8][9][10][11][12]. These complications are often related to bleeding, infection, or ischemia and may require a vascular surgical procedure [13,14].…”