My Laparoscopic Appendectomy Patient has a LVAD, Now What?

Background: Heart failure affects over 5.7 million adult Americans; at least 800,000 new cases diagnosed annually. Heart transplant is the gold standard therapy of advanced heart failure but donor hearts are in short supply. Annual transplant rate remains stable at approximately 2500.²

Mechanical circulatory support (MCS) shows survivor benefit and improves quality of life. Significant advances have occurred from the first air-powered Left Ventricular Assist Device(LVAD)in 1963 to the current continuous flow 3^rd generation Heartware HVAD.³ There were 15,745 recipients of MCS in the USA.⁴ Initially used as a bridge to transplantation, 46% of LVADs implanted are now considered destination therapy.

Purpose: Long term LVAD therapy has many patients presenting for non-cardiac surgeries, often minor elective procedures where non-cardiac anesthesiologists provide care. To do so safely requires knowledge of the pathophysiology and device management.

Methods: A Clinical Pathway for Management of Patients with LVADs was developed at Stony Brook Medicine`s Pre-Operative Services. The goal was to provide the anesthesia provider with a tool that is both a clinical resource and educational. This pathway is used as a checklist and communication tool across the continuum of care of the LVAD patient in the perioperative period.

Conclusion: We present our pathway in the context of a case presentation. This innovation has enhanced the perioperative assessment and management of LVAD patients at our institution.

References: at time of presentation.