[How to manage the anesthesia of a patient bearing a left heart assisting device?]

Left ventricular assist devices have revolutionized the treatment of end-stage cardiac failure. Only indicated as a bridge to transplant in the early beginning, technological evolution opened new horizons and nowadays these devices are also used as bridge for recovery or even as definitive therapy. With the increasing number of devices, a growing number of patients with left ventricular assistance is being presented for non-cardiac surgery. Although ideally managed in device-experienced centres, the unpredictable nature of emergent surgical pathology makes it possible for any anesthesiologist to have to deal with the managing these patients perioperative care. Due to the topic complexity and lack of literature, the purpose of this paper is to make a comprehensive and concise review of these devices basic operating principles, fundamental perioperative care for patients with ventricular assistance and the most common critical events to be aware of.