Anesthesia and Intraoperative Echocardiography for End-Stage Heart Failure Surgery

End-stage heart failure remains without a definitive solution other than transplantation, despite significant medical and technological advancements. This chapter delves into the preoperative evaluation of this complex patient group, offering practical and individualized approaches to clinical management. It outlines personalized anesthetic strategies and transesophageal echocardiography (TEE) techniques that have revolutionized intraoperative management and surgical outcomes across various procedures in real time. The chapter integrates best practice recommendations and guidelines from leading medical and scientific societies in heart failure, cardiovascular anesthesia, cardiothoracic surgery, and echocardiography. Topics covered include perioperative evaluation of patients with end-stage heart failure, understanding and managing their clinical condition before undergoing surgery or complex procedures, anesthetic plans, and intraoperative echocardiography protocols tailored to the type of intervention and patient pathophysiology, as well as alternative procedures for managing end-stage heart failure. This review is particularly valuable for cardiovascular anesthesiologists and surgeons working in resource-limited settings, where access to advanced techniques, procedures, and technologies is not always available to address the medical and surgical challenges of these patients.