The Patient with an LVAD Presenting for Non-cardiac Surgery: Perioperative Considerations

Heart failure refractory to medical therapy may be treated by heart transplantation. Given that the need for organs outpaces supply, ventricular assist devices (VADs) were developed to support hemodynamics in the patient with end-stage heart failure. Initially approved only in those patients awaiting transplantation, VADs are now implanted for long-term therapy in patients ineligible for transplantation. Many of these patients may subsequently present for non-cardiac surgery, possibly in a non-transplant center. General anesthesiologists may therefore be expected to care for these patients, especially in an emergency. This review presents an overview of current VADs as well as their unique preoperative and intraoperative anesthetic considerations. © 2015, Springer Science + Business Media New York.