Perioperative Management: HeartMate 3 Left Ventricular Assist Devices in Non-Cardiac Surgery

The HeartMate 3 (HM3) left ventricular assist device is currently the most widely used left ventricular assist device worldwide. Advances in technology have enabled its use both as a bridge to transplant and as destination therapy. The HM3's fully magnetically levitated rotor, wider blood flow pathways, and artificial pulse technology have significantly improved hemocompatibility and reduced the incidence of pump thrombosis, stroke, and gastrointestinal bleeding. As a result, the HM3 offers greater durability and fewer complications than its predecessors. With the growing disparity between organ availability and transplant demand, anesthesiologists are increasingly likely to encounter patients supported by HM3 devices in both cardiac and non-cardiac surgical settings. A thorough understanding of the HM3's function, physiological implications, and potential perioperative complications is essential for safe anesthetic management. This narrative review explores the underlying physical principles of the HM3, key technical parameters necessary for monitoring device function, and perioperative management strategies. Topics include multidisciplinary team coordination, anesthetic approach and monitoring, relevant cardiac physiology, and the management of common emergencies. Although cardiac anesthesiologists are ideally suited to manage these complex cases, this may not always be possible. Therefore, it is imperative that all anesthesiologists, particularly those practicing in mechanical circulatory support centers-develop a comprehensive understanding of the HM3 system.