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[Anesthesiology problems for implant and explant of left ventricular Novacor systems]
E Domenegati1, P Ceriana, M G Chiaudani
1I Servizio di Anestesia e Rianimazione, IRCCS Policlinico S. Matteo, Pavia.
Objectives:
To review experience with anaesthetic management in patients undergoing a left ventricular assist system (LVAS) Novacor implant as a bridge to cardiac transplantation.
Design:
Retrospective clinical study.
Setting:
Cardiothoracic operating room in a university hospital.
Patients:
Nine, aged 37-62 years, suffering from 8 dilated and 1 postischemic cardiomyopathy at end stage heart failure. INTERVENTIONS OR METHODS: Under general anaesthesia and cardio-pulmonary bypass the LVAS pump is placed in the abdomen and connected to the left ventricle through an inflow cannula and to the aorta through an outflow cannula. The pump has an output of 5-7 l/min and works in synchronous counterpulsation with the left ventricle.
Results:
The mean Novacor support has been 75.56 days (DS +/- 85.95). Five out of 9 patients have been transplanted, while 3 are still waiting at home. Pretransplant CI was on average 1.66 l/min/m2 (DS +/- 0.27) and REF 11.44% (DS +/- 5.29); after the Novacor implant CI was 3.44 (DS +/- 0.49) and REF 22.22% (DS +/- 4.49).
Conclusions:
A LVAS can bridge patients to heart transplantation while improving or preserving their health conditions. Some factors are to be taken into account for the anaesthesiological management of the implant/explant of a LVAS: the patients' poor clinical conditions; the knowledge of the components and functioning of the LVAS that conditions the choice of the anaesthesiological drugs and volemia; the unassisted right ventricle function that has to be pharmacologically supported; the bleeding problem because of the adherences during the explant surgery.