The LVAD Patient Presenting for Noncardiac Surgery

As the number of end-stage heart failure patients steadily grows, more patients are implanted with long-term left ventricular assist devices (LVAD). Increasingly, noncardiac-trained anesthesiologists are caring for LVAD patients presenting for noncardiac surgery. While continuous-flow LVAD physiology creates unique physiologic and management challenges, patients can be safely anesthetized with appropriate education and training. A multidisciplinary team approach is recommended to review potential perioperative issues for each LVAD patient, including cardiovascular status, LVAD function, anticoagulation, and antibiotic prophylaxis. The anesthesiology team should be comfortable managing hemodynamic instability, arrhythmias, and cardiac arrest in LVAD patients. This chapter uses a case study of an LVAD patient presenting for noncardiac surgery as an example.