Perioperative Considerations in Left Ventricular Assist Device Placement

Mechanical circulatory support of end-stage heart failure is widely practiced and has improved the management of patients with progressive heart failure. Left ventricular assist device placement for end-stage heart failure is a complex operative procedure. Understanding the complex nature of the pathophysiology of heart failure and effects of anesthetic techniques on heart failure biomechanics of available devices and managing the patient hemodynamics during device implantation are key to deliver appropriate anesthetic care. Adequate preoperative preparation, patient selection, and managing various postoperative concerns are described below. Troubleshooting hemodynamics by using an algorithmic, multifaceted approach while separating from CPB is important. Managing patients in the immediate postoperative period requires a good understanding of the physiological integration of the native circulation with these devices. Early detection of complications secondary to device or patient factors is essential for optimal outcome after LVAD implantation.