A case of laparotomic cholecystectomy in a patient with biventricular assist devices

We describe a patient with biventricular assist devices who had systemic inflammation because of cholecystitis that required open cholecystectomy, and we discuss the anesthetics and monitors that should be used in unstable patients with ventricular assist devices (VADs) who are undergoing major surgery. The patient was a 40-year-old man in the dilated phase of hypertrophic obstructive cardiomyopathy, who was implanted with an internal left VAD and external right VAD. We anesthetized the patient with a combination of a low dose of sevoflurane and ketamine to minimize vasodilation. We chose ketamine because we expected it to have a postoperative analgesic effect. An INVOS™ (Medtronic) monitor was beneficial, especially since the pulse oximeter did not work because of a pulse deficit. The FloTrach™ (Edwards Lifesciences) failed to measure the stroke volume and its variability. The left VAD, the Jarvik2000, did not show its flow rate. However, we were able to estimate that the flow was stabilized, because the flow rate of the right VAD was stable, and there was no significant change in both ventricles and septa, as shown on transesophageal echocardiography.