[Mechanical circulation assistance. Changes in techniques and concepts. Implication of anesthesia/resuscitation on...

Since the first case in 1987, 159 patients underwent heart mechanical assist device as a bridge to transplantation or as potential post transplanted recovery (right ventricular failure or graft failure) or in case of unsuccessful weaning of cardiopulmonary bypass. Survival rate of patients under assist device waiting either for heart transplantation or for functional recovery was 75.4%. 67.7% of them were transplanted (1 year survival rate 63%). Improvement of cardiac assist device technology and new method of intensive care allowed the observation of 6 myocardial recovery without transplantation 4 after more than 3 weeks of cardiac support. The increase in cardiac assist duration (mean duration = 103 days in 2001) because of organ shortage, led to a change in patients medical care. Unexpected interactions between cardiac treatments and anaesthetic drugs should lead anaesthetists to a better understanding of the failing heart pathophysiology. Consequently, anaesthetists well conduct appropriately anaesthesia and perioperative monitoring. Technical and conceptual evolution should allow some patient, to come back home and to fully recover without the need of transplantation.