Patients with left ventricle assist devices presenting for thoracic surgery and lung resection: tips, tricks and evidence

This article will review the relevant literature and guidelines for patients with LVADs undergoing thoracic surgery, including lung resection. Recent findings The International Society for Heart and Lung Transplant Mechanically Assisted Circulatory Support Registry has received data on more than 16 000 patients with LVADs. Four-year survival is more than 60% for centrifugal devices. There are increasing case reports, summaries and recommendations for patients with LVADs undergoing noncardiac surgery. However, data on thoracic surgery is restricted to case reports. Summary Successful thoracic surgery requires understanding of the LVAD physiology. Modern devices are preload dependent and afterload sensitive. The effects of one-lung ventilation, including hypoxia and hypercapnia, may increase pulmonary vascular resistance and impair the right ventricle. Successful surgery necessitates a multidisciplinary approach, including thorough preoperative assessment; optimization and planning of intraoperative management strategies; and approaches to anticoagulation, right ventricular failure and LVAD flow optimization. This article discusses recent evidence on these topics.
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Albert C. Perrino, Jr Source Type: research