Perioperative Management of a Patient With a Nonpulsatile Left Ventricular–Assist Device Presenting for Noncardiac Surgery

doi:10.1053/j.jvca.2009.06.004

Journal of Cardiothoracic and Vascular Anesthesia

Volume 24, Issue 5, October 2010, Pages 820-823

https://doi.org/10.1053/j.jvca.2009.06.004 Get rights and content

Section snippets

Case Presentation

A 55-year-old man supported by a VentrAssist LVAD (Ventracor Limited, Chatswood, Australia) presented for debridement and myocutaneous flap closure of a stage IV sacral decubitus ulcer in the prone position. The device had been implanted as a bridge to transplantation approximately 2 months previously, and the patient was hemodynamically stable. Additional procedures at the time of VAD implantation had included mitral valve replacement, aortic valve replacement, and coronary artery bypass graft

Discussion

VADs are pumps that collect blood returning to the failed side of the heart and eject it downstream of the failing ventricle. Typically, for left ventricular support, blood is drained from the left atrium or left ventricular apex to the pump and returned to the ascending aorta. The goal is either to decompress an acutely ischemic and failing ventricle (thereby reducing its oxygen demand) so it can recover or to provide long-term support for a chronically failing ventricle as either a bridge to

Conclusions

Because VADs are increasingly being placed in patients as a bridge to transplantation or destination therapy, it is increasingly likely that noncardiac anesthesiologists will be called on to anesthetize these patients for noncardiac surgeries. Although intraoperative anesthetic techniques and agents may not actually differ substantially from those for nonsupported patients or for those supported by pulsatile devices, there are new considerations that have arisen specifically because of the lack