Anesthesia Practices for Implantation of Mechanical Circulatory Support Devices

Recent technological advancements have significantly increased the utilization of mechanical circulatory support (MCS) in patients presenting with advanced heart failure. MCS encompasses a range of temporary percutaneous devices, including intra-aortic balloon pumps (IABPs) and Impella devices, as well as durable left ventricular assist devices (LVADs) and extracorporeal membrane oxygenators (ECMOs). Various MCS options are implanted based on individual patient characteristics, necessitating a comprehensive preoperative evaluation. Understanding the hemodynamic changes during various steps of MCS implantation is paramount for the optimal medical management of these patients during their perioperative period. Individuals undergoing LVAD implantation are particularly susceptible to perioperative right ventricular (RV) failure. Managing RV failure remains one of the most complex clinical scenarios encountered in this patient population. Postoperative management of LVAD patients necessitates a multidisciplinary approach involving cardiothoracic surgeons, cardiologists, anesthesiologists, and nurses. When evaluating LVAD patients presenting for non-cardiac surgery, preoperative assessments should include identifying the specific type of LVAD utilized along with baseline parameters (flow rate, speed, power), determining when the device was initially implanted and if any recent complications. It is also vital to ascertain their current anticoagulation status. Due to the critical illness and presence of various comorbidities in these patients, delivering anesthesia requires a high level of professional education and expertise.