Left ventricular assist device management during surgery for a ruptured abdominal aortic aneurysm

This case report discusses the anaesthetic management of a patient reliant on a left ventricular assist device who presented with a contained ruptured aortic aneurysm. The placement and removal of the aortic clamp, as well as the blood loss and replacement, constituted a challenge for maintaining cardiac output, optimal pump flow, left ventricular off-loading and avoiding right ventricular failure. Continuous monitoring with transoesophageal echocardiography was a cornerstone for managing the different stages of surgery and for adapting pump revolutions to preload and afterload fluctuations and right ventricular function. Inodilators and vasoconstrictors were used to stabilise sudden fluctuations in haemodynamic parameters. It is important to develop clinical protocols and guidelines for the use of ventricular assist devices to address the complex haemodynamic changes resulting from their use.