Anesthesia for left ventricular assist device placement

Apropriate anesthesia for LVAD placement needs to incorporate an understanding of the surgical procedure and LVAD physiology, the altered physiology and pharmacology of the cardiac failure patient, and a knowledge of the interaction of anesthesia with the potent cardiac drugs used in end- stage heart failure therapy. The anesthesiologist is faced with a critically ill decompensated patient, often with altered renal and hepatic function, but must ensure adequate anesthesia to avoid intraoperative awareness. Intelligent use of TEE can assist the surgeon to pinpoint potential pitfalls of LVAD placement and can have a significant effect on improving outcome in these challenging patients.