Table 1.

Perioperative approach to LVAD patients undergoing non-cardiac surgery

• Preoperative

o Multidisciplinary team identified (primary surgical and anesthesia teams, cardiac surgery, heart failure cardiologist, VAD personnel)

o Preoperative medical optimization when possible or necessary

o Physical examination focused on the sequelae of heart failure

o Baseline EKG, echocardiogram, and laboratory values

o Manage pacemaker/AICD settings when indicated

o Hold, bridge, or reverse anticoagulation when indicated

• Intraoperative

o Standard ASA monitors

o Cerebral tissue oxygenation, processed EEG, arterial line with ultrasound guidance, central venous catheter if fluid shifts are expected, PA catheter only if severe pulmonary hypertension, TEE available

o Monitor VAD control console

o External defibrillator pads in place

o Optimize preload, support RV function, avoid increased in afterload

o Gradual peritoneal insufflations and position changes

• Postoperative

o Standard PACU care unless ICU is otherwise indicated

o Extubation criteria are unchanged

o Avoid hypoventilation, optimize oxygenation

o Resume heparin infusion when post-op bleeding risk is acceptable