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Anesthetic Management for Patients With Left Ventricular Assist Devices Undergoing Noncardiac Surgery

The incidence and prevalence of chronic heart failure is increasing in the United States, and end-stage heart failure is associated with high mortality. While medical management is often the first-line treatment of heart failure, mechanical circulatory support and ventricular assist device therapies are being increasingly employed to improve symptoms and end-organ dysfunction from heart failure. Patients with left ventricular assist devices (LVADs) are not only surviving with their disease, but also thriving as a result of LVAD support, and many return to normal activities of daily life. Thus, these patients present to hospitals for noncardiac surgeries, both elective and urgent, with increasing frequency. This chapter explores some commonly used ventricular assist devices, the altered physiology that accompanies LVAD therapy with continuous flow devices, as well as some of the anesthetic considerations that are vital for patients presenting for both elective and urgent surgeries.