Anesthesia for left ventricular assist device insertion: a case series and review

Area of Science:

• Cardiology
• Anesthesiology
• Medical Devices

Background:

• Left ventricular assist devices (LVADs) like the HeartMate II are crucial for end-stage heart failure.
• Perioperative anesthetic management is complex in LVAD patients due to comorbidities.
• Understanding anesthetic practices and outcomes is vital for improving patient care.

Purpose of the Study:

• To analyze perioperative anesthetic care elements in patients undergoing HeartMate II LVAD implantation.
• To review general anesthetic techniques, echocardiographic considerations, and blood product utilization.
• To identify patterns in anesthetic management for LVAD surgery.

Main Methods:

• Retrospective electronic health record review of 42 patients who received the HeartMate II LVAD.
• Analysis of anesthetic induction agents, intraoperative medications, and extubation times.
• Evaluation of echocardiographic findings, including right-heart dysfunction and patent foramen ovale, and blood product transfusion data.

Main Results:

• Etomidate was the primary induction agent (81% of patients).
• Average intraoperative fentanyl dose was 1,318 µg; patients were extubated 91 hours post-ICU admission.
• Significant blood product usage: 3 units FFP intraoperatively, 10 units postoperatively; 1.1 units RBCs intraoperatively, 9.3 units in the first 48 hours postoperatively.

Conclusions:

• The study highlights specific anesthetic practices, including common induction agents and substantial blood product requirements, in HeartMate II LVAD recipients.
• Perioperative management involved addressing pre-existing conditions like severe right-heart dysfunction and patent foramen ovale.
• Findings provide insights into the anesthetic care of LVAD patients, informing future clinical practice and research.