Updates to perioperative and anesthetic management of the left ventricular assist device patient presenting for noncardiac surgery.

PURPOSE OF REVIEW: 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.

RECENT FINDINGS: 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.

SUMMARY: 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.