Anesthetic management for the placement of a fully implantable artificial replacement heart: a case report

Of the patients with end-stage cardiomyopathy on a heart transplant list, 95% do not receive a donor heart. Due to this severe shortage of donor organs, an artificial replacement heart has been pursued for several decades. To date, 10 patients have received an Abiocor artificial replacement heart (Abiomed, Inc, Danvers, Mass), the latest artificial heart device available. Anesthetic management often is complicated by the preoperative multisystem organ failure arising from the patient's advanced cardiomyopathy. Hemodynamic stabilization before cardiopulmonary bypass is extremely challenging, and the postbypass period creates a unique situation in which the only control the anesthesia provider has on the hemodynamics is management of the systemic vascular resistance. This article describes the anesthetic management of the recipient of the Abiocor artificial heart with the longest survival time.