title: Our experience with implantation of VentrAssist left ventricular assist device.
abstract: Perioperative anaesthetic management of the VentrAssist™ left ventricular assist device (LVAD) is a challenge for anaesthesiologists because patients presenting for this operation have long-standing cardiac failure and often have associated hepatic and renal impairment, which may significantly alter the pharmacokinetics of administered drugs and render the patients coagulopathic. The VentrAssist is implanted by midline sternotomy. A brief period of cardiopulmonary bypass (CPB) for apical cannulation of left ventricle is needed. The centrifugal pump, which produces non-pulsatile, continuous flow, is positioned in the left sub-diaphragmatic pocket. This LVAD is preload dependent and afterload sensitive. Transoesophageal echocardiography is an essential tool to rule out contraindications and to ensure proper inflow cannula position, and following the implantation of LVAD, to ensure right ventricular (RV) function. The anaesthesiologist should be prepared to manage cardiac decompensation and acute desaturation before initiation of CPB, as well as RV failure and severe coagulopathic bleeding after CPB. Three patients had undergone implantation of VentrAssist in our hospital. This pump provides flow of 5 l/min depending on preload, afterload and pump speed. All the patients were discharged after an average of 30 days. There was no perioperative mortality.
authors.affiliation: Department of Anaesthesiology, Narayana Hrudayalaya Institute of Medical Sciences, Bommasandra Industrial Area, Anekal Taluk, Bangalore, Karnataka, India.
authors.forename: Hiriyur Shivalingappa
authors.initials: HS
authors.lastname: Jayanthkumar
authors.forename: Chinnamuthu
authors.initials: C
authors.lastname: Murugesan
authors.forename: John
authors.initials: J
authors.lastname: Rajkumar
authors.forename: Bandlapally Ramanjaneya Gupta
authors.initials: BR
authors.lastname: Harish
authors.forename: Kanchi
authors.initials: K
authors.lastname: Muralidhar
keywords: Cardiac failure; VentrAssist™; left ventricular assist device