Left ventricular assist devices (LVAD) support a failing left ventricle in acute or chronic end-stage heart failure. More than 20,000 mechanical support devices, principally LVADs, have been implanted in the United States, with an 80 percent survival at one year and 70 percent at two years. This overview will focus on modern generation continuous flow intracorporeal LVADs that anesthesiologists are most likely to encounter when tasked with caring for this patient population.
With a continued increase in LVAD implantations, most anesthesiologists will encounter LVAD patients in clinical practice for non-cardiac procedures. Specifics of anesthetic management depend more on the clinical experience and preference of the anesthesiologist rather than the presence of an LVAD. More important than formal cardiac anesthesia or critical care medicine training is an understanding of LVAD physiology.
Considering that some LVAD patients have preperitoneal implanted devices, most authors agree that use of rapid-sequence induction with cricoid pressure...
