Anesthetic and perioperative considerations in patients undergoing placement of totally implantable replacement hearts

The recent successful implantation of the AbioCor implantable replacement heart at the Rudd H.-L. Institute, Jewish Hospital, Louisville, KY, has renewed clinical interest in the use of the mechanical replacement heart as therapy for intractable heart failure. Although the number of orthotopic heart transplants has plateaued in the past decade, the number of patients requiring transplantation continues to increase. This supply/demand discrepancy continues to be the main catalyst for the research and development of other therapies for the failing heart. This review addresses perioperative considerations, monitoring modalities, and perioperative therapeutic interventions that may help guide the cardiac anesthesiologist through the challenges presented by implantation of total replacement hearts in end-stage cardiac patients.