Anesthetic Considerations in the LVAD Candidate

Patients requiring mechanical circulatory support bring a unique challenge to the cardiac anesthesiologist. Preoperative evaluation will classify patients as either having an ischemic or nonischemic etiology to their heart failure. However, there appears to be no difference in survival at 30 days, 6 months, or even 1 year following left ventricular assist device (LVAD) placement. Anemia and thrombocytopenia are frequent preoperative findings related to chronic disease. Many drugs may have to be dose-adjusted during the perioperative period. Tranexamic acid is commonly used for antifibrinolysis. In addition to the airway exam, the preoperative physical exam should focus on an assessment of any preoperative physical findings of neurological disease, especially prior stroke. Right heart catheterization is part of the basic preoperative assessment prior to LVAD placement. Right ventricle dysfunction can range from mild all the way to frank failure and is common after LVAD placement.