Left Ventricular Assist Device Implantation and Management
This chapter studies left ventricular assist device (LVAD) implantation. A thorough preoperative evaluation of a patient undergoing LVAD implantation is of utmost importance because of the confluence of associated medical problems patients can have secondary to heart failure. Knowledge of the indications and contraindications for LVAD implantation is needed to provide proper consultation. Indications for LVAD implantation include bridge to transplantation, destination therapy, bridge to decision, and bridge to recovery. Contraindications to LVAD implantation include neurological changes following implantation, pulmonary dysfunction, renal dysfunction, and hepatic dysfunction. Intraoperative management of LVAD implantation involves monitoring, anesthetic induction/maintenance, and device management. Echocardiography is an invaluable tool in the perioperative monitoring and diagnostic assessment of LVAD implantation. The chapter then looks at early complications such as hypovolemia, vasoplegia, and right ventricular failure.