Burcar Kimberly H, Korenke Mark M, Ebadi-Tehrani Mehran M, Mathis Michael R, Toton Monika P
Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Curr Opin Anaesthesiol. 2026 Mar 11. doi: 10.1097/ACO.0000000000001645.
In an era of improved outcomes and expanding use of left ventricular assist devices (LVADs) among patients with end-stage heart failure, anesthesiologists increasingly encounter such patients presenting for noncardiac surgery. This review synthesizes current advances in the perioperative and anesthetic management of patients with LVADs in the noncardiac surgical setting, providing actionable, evidence-based recommendations.
Although a range of durable mechanical circulatory support options currently exist for patients, third-generation continuous-flow LVADs are now the predominant devices, demonstrating improved survival but posing unique perioperative challenges. A multidisciplinary approach - including heart failure and device specialists - is essential for preoperative assessment, medical management, and optimal care coordination in anticipation of the surgical admission. Intraoperative care requires nuanced monitoring strategies and vigilance for complications such as suction events or right ventricular failure; the anesthetic plan should carefully consider preload/afterload dependency and anticoagulation. Postoperative management includes tailored hemodynamic, device, and anticoagulation strategies to minimize complications.
Optimal outcomes for LVAD patients undergoing noncardiac surgery require multidisciplinary planning, device-specific knowledge, and meticulous management of anticoagulation, hemodynamics, and right ventricular function. Future research should standardize protocols for perioperative LVAD management in nonspecialist centers.
在终末期心力衰竭患者预后改善且左心室辅助装置（LVAD）使用日益广泛的时代，麻醉医生越来越多地遇到此类患者接受非心脏手术。本综述总结了非心脏手术环境下LVAD患者围手术期及麻醉管理的当前进展，提供了可操作的、基于证据的建议。
尽管目前为患者提供了一系列持久的机械循环支持选择，但第三代连续流LVAD现在是主要装置，显示出存活率提高，但带来了独特的围手术期挑战。多学科方法——包括心力衰竭和装置专家——对于术前评估、医疗管理以及在预期手术入院时进行最佳护理协调至关重要。术中护理需要细致的监测策略以及对诸如抽吸事件或右心室衰竭等并发症保持警惕；麻醉计划应仔细考虑前负荷/后负荷依赖性和抗凝问题。术后管理包括定制的血流动力学、装置和抗凝策略，以尽量减少并发症。
LVAD患者接受非心脏手术的最佳预后需要多学科规划、特定装置知识以及对抗凝、血流动力学和右心室功能的精心管理。未来的研究应规范非专科中心围手术期LVAD管理的方案。
