title: Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery.
abstract: OBJECTIVE
  The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery.
  
  
  METHODS
  This is a retrospective review of the population of patients with LVADs at a single institution undergoing noncardiac procedures between 2009 and 2014. Demographic, perioperative, and procedural data collected included the type of procedure performed, anesthetic technique, vasopressor requirements, invasive monitors used, anesthesia provider type, blood product management, need for postoperative intubation, postoperative disposition and length of stay, and perioperative complications including mortality.
  
  
  METHODS
  Descriptive statistics for categorical variables are presented as frequency distributions and percentages. Continuous variables are expressed as mean ± standard deviation and range when applicable.
  
  
  RESULTS
  During the study, 31 patients with LVADs underwent a total of 74 procedures. Each patient underwent an average of 2.4 procedures. Of the total number of procedures, 48 (65%) were upper or lower endoscopies. Considering all procedures, 81% were performed under monitored anesthesia care (MAC). Perioperative care was provided by faculty outside of the division of cardiac anesthesia in 62% of procedures. Invasive blood pressure monitoring was used in 27 (36%) procedures, and a central line, peripherally inserted central catheter or midline was in place preoperatively and used intraoperatively for 38 (51%) procedures. Vasopressors were not required in the majority (65; 88%) of procedures. There was one inhospital mortality secondary to multiorgan failure; 97% of patients survived to discharge after their procedure.
  
  
  CONCLUSIONS
  At our institution, LVAD patients undergoing noncardiac procedures most frequently require endoscopy. These procedures can frequently be done safely under MAC, with or without consultation by a cardiac anesthesiologist.
authors.affiliation: Department of Anesthesiology, University of Miami, Miami, FL, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Degnan
authors.affiliation: Department of Anesthesiology, Stanford School of Medicine, Stanford, CA, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Brodt
authors.affiliation: Department of Anesthesiology, University of Miami, Miami, FL, USA.
authors.forename: Yiliam
authors.initials: Y
authors.lastname: Rodriguez-Blanco
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000379:methods*; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative