Thoracic transplantationAnesthesia for Ventricular Assist Device Placement: Experience From a Single Center
Section snippets
Methods
Between April 2007 and August 2012, VAD implantation was performed in 84 patients with acute or chronic end-stage heart failure. The cohort included 75 male and 9 female subjects of mean overall age of 47.6 ± 13.4 years. Before VAD implantation, all patients were in refractory heart failure with evolving or full multisystem involvement despite medical therapy. An intra-aortic balloon pump had been placed in 16 patients. Assist device implantations were performed by the surgical team with the
Results
The indications for VAD implantation were either dilated (n = 59; 70%) or ischemic cardiomyopathy (n = 25; 30%). Twenty-nine patients (34%) were INTERMACS Grade 1; 25 (30%) INTERMACS Grade 2 and 30 (36%) INTERMACS grade 3 at the time of VAD implantation. Patient demographic features and preoperative data are summarized in Table 1.
Review of intraoperative anesthesia records showed the following practices as an institutional protocol for all patients: In the operating room, we inserted one 16
Discussion
As the number of patients with heart failure is increasing and the donor shortage is continuing, VAD applications have become an important treatment option for patients with end-stage heart failure.6, 7 The classifications of VAD are based on the characteristics of device location (extra-, intra-, or paracorporeal), type of blood flow (pulsatile or nonpulsatile/axial); driving power (pneumatic or electric); and required level of anticoagulation (low or full).4 In this series, 45 patients were
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Anesthetic Management for Left Ventricular Assist Device Implantation Without Using Cardiopulmonary Bypass: Case Series
2015, Transplantation ProceedingsCitation Excerpt :Therefore, inotropic support is important for the purpose of improving right ventricular function and pulmonary vascular resistance. Kocabas et al [12] used dopamine (n = 74; 88%), epinephrine (n = 60; 71%), and norepinephrine (n = 14; 16%) in their series of 84 patients undergoing VAD implantation. The investigators also used inhaled nitric oxide (n = 38; 45%) and dobutamine infusion (n = 79; 94%).
Hemodynamic instability in patients undergoing pulmonary embolectomy: Institutional experience
2015, Journal of Clinical AnesthesiaCitation Excerpt :Regardless of the mechanism, these periods of instability indicate that the anesthesiologist needs to remain acutely vigilant with judicious fluid administration, regular assessment of RV function on TEE and evaluation of filling pressures, and maintenance of coronary perfusion pressures to reduce RV ischemia. Use of inotropic support may be indicated to support these goals as has been previously reported [18-20], although we did not see any benefit in our review. Our institution continues to perform pulmonary embolectomy on a semiroutine basis, when thrombolytics or other therapies are not considered beneficial (~ 10 surgeries per year).
Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective
2021, Seminars in Cardiothoracic and Vascular Anesthesia2019 EACTS Expert Consensus on long-term mechanical circulatory support
2019, European Journal of Cardio-thoracic SurgeryFacilitating noncardiac surgery for the patient with left ventricular assist device: A guide for the anesthesiologist
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