Episode 204: Management of Patients with LVADs for Non-cardiac Surgery with Kia Sedghi

Perioperative management of patients with Left Ventricular Assist Devices (LVADs) undergoing non-cardiac surgery requires a nuanced understanding of mechanical circulatory support and its physiological impact. Because LVADs rely on adequate right ventricular (RV) function to deliver volume to the left ventricle, maintaining RV stability is paramount. Clinicians must prioritize preoperative assessment of RV function, coagulation profiles—specifically addressing acquired von Willebrand deficiency—and the potential for device-related infections. Intraoperative care demands invasive blood pressure monitoring and judicious use of vasopressors, as traditional pulse-based metrics are often unreliable. Real-time monitoring via transesophageal echocardiography proves essential for diagnosing hemodynamic fluctuations, such as the "suck down" phenomenon, where LV collapse against the inflow cannula occurs. Successful outcomes depend on a multidisciplinary approach, balancing anticoagulation needs with bleeding risks while ensuring the device’s power source and mechanical integrity remain secure throughout the procedure.