Anesthetic Management for Left Ventricular Assist Device Implantation Through Left Thoracotomy: Evaluation of On-Pump Versus Off-Pump.
BACKGROUND
Ventricular assist devices (VADs) are alternative approaches to medical treatment in patients with acute or chronic heart failure. The goal of this study was to compare an anesthetic approach in patients undergoing implantation of a VAD with (on-pump) or without (off-pump) cardiopulmonary bypass (CPB) through left thoracotomy.


METHODS
A total of 32 patients were divided into 2 groups: on-pump (group 1) and off-pump (group 2). A standard anesthesia protocol was used in all patients. Baseline characteristics of the patients, intraoperative hemodynamic and respiratory variables, anesthetic agents and vasoactive drugs administered, the amount of blood products, extubation, length of hospital stay and intensive care unit stay, and postoperative complications were recorded.


RESULTS
Patients' mean age was 54.7 ± 13.3 years (range, 18-74 years). Eighteen patients underwent surgery with CPB. Demographic data of the patients, preoperative characteristics, intraoperative use of blood products, intraoperative complications, and anesthetic drugs used were similar between groups (P > .05). The duration of surgery (219 ± 23 vs 273 ± 56 minutes) and anesthesia (274 ± 38 vs 323 ± 57 minutes) were shorter in group 2; there was no difference between the 2 groups in terms of mechanical ventilation time, length of stay in the intensive care unit, and length of hospital stay. There was no decrease in postoperative oxygen parameters and an increase in patient lactate levels with the use of CPB. The use of fresh frozen plasma and platelet suspension in the postoperative period was significantly higher in group 1 (P < .05). The rate of complications and mortality rate were comparable between the 2 groups (P > .05).


CONCLUSIONS
Our study results show that the use of CPB during VAD implantation via left thoracotomy increases operation time and use of blood products, while causing no change in the rate of complications.
Department of Anesthesiology and Reanimation, Ege University Medical Faculty, Izmir, Turkey. Electronic address: csahutoglu@yahoo.com.
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Sahutoglu
Department of Anesthesiology and Reanimation, Ege University Medical Faculty, Izmir, Turkey.
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Turksal
Department of Anesthesiology and Reanimation, Ege University Medical Faculty, Izmir, Turkey.
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Bilic
Department of Anesthesiology and Reanimation, Ege University Medical Faculty, Izmir, Turkey.
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Kocabas
Department of Anesthesiology and Reanimation, Ege University Medical Faculty, Izmir, Turkey.
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Zekiye Askar
Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey.
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Ozturk
Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey.
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Ertugay
Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey.
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Engin
Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey.
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Yagdi
Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey.
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Ozbaran
D000293:Adolescent; D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods; D000777:Anesthetics; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003422:Critical Care; D005260:Female; D006333:Heart Failure / Q000601:surgery; D006353:Heart-Assist Devices; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011184:Postoperative Period; D019919:Prosthesis Implantation / Q000379:methods*; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods*; D055815:Young Adult
D000777:Anesthetics