Perioperative Management of Patients With Durable and Temporary Left Ventricular Assist Devices Undergoing Non-Cardiac Surgery: A Comprehensive Review.

The number of patients supported by mechanical left ventricular assist devices (LVADs), both durable and temporary, continues to rise. As survival improves, more of these patients are presenting for non-cardiac surgery (NCS), creating distinct perioperative challenges for anesthesiologists. Durable and temporary LVADs differ in flow mechanics, dependence on loading conditions, and anticoagulation requirements, all of which have direct implications for anesthetic management. Successful care hinges on a multidisciplinary approach involving anesthesiology, cardiology, surgery, perfusion, and dedicated LVAD teams. Preoperative assessment should include device interrogation, evaluation of right ventricular function, optimization of volume status, and a carefully individualized anticoagulation plan. Intraoperatively, invasive arterial pressure monitoring, transesophageal echocardiography when feasible, and meticulous attention to preload, afterload, and pump flow are crucial, and the degree of surveillance depends on patient status and the extent of the planned procedure. Key goals include maintaining adequate mean arterial pressure, preventing right-heart failure, avoiding suction events, and routine assessment of proper device function. Postoperatively, patients undergoing major surgery are best managed in an intensive care environment familiar with mechanical circulatory support devices, with early resumption of anticoagulation and close monitoring for bleeding, thrombosis, right-heart failure, and organ dysfunction such as acute kidney injury. When care is delivered in specialized centers with standardized protocols, advanced monitoring, and structured education for perioperative teams, NCS can be performed safely in this complex and growing patient population. This review summarizes current evidence on the perioperative management of patients with LVADs undergoing NCS, with an emphasis on preoperative evaluation, intraoperative hemodynamic management, and postoperative care.