[Anesthesia in patients with left ventricular assist devices : Anesthesiological management of patients with permanent left ventricular assist devices during noncardiac surgery].

For patients with end-stage heart failure durable left ventricular assist devices (LVADs) are increasingly being used as an alternative to heart transplantation. Treatment with LVADs significantly improves both the survival rate and quality of life. The increasing prevalence of heart failure, particularly in older patients, combined with improved survival under LVAD therapy, has led to a growing population of LVAD recipients. As a result, anesthesiologists are increasingly faced with the challenge of providing specialized care for LVAD recipients. While elective procedures are mostly performed in specialized centers, emergency surgery can be required in any hospital. This article highlights the unique aspects in anesthesiological and perioperative management for LVAD patients undergoing noncardiac surgical procedures and interventions. Pathophysiological changes due to LVAD support as well as the obligatory anticoagulation, contribute to an increased risk of (spontaneous) bleeding complications in LVAD patients. Based on the only currently approved LVAD in Germany, the HeartMate 3, this article explains key LVAD operating parameters and discusses typical complications. Perioperative management must address the frequently impaired right ventricular function and ensure an appropriate hemodynamic monitoring. This article provides an overview of the perioperative care of LVAD patients to enhance their safety throughout the perioperative course.