Anesthésie pour patients porteurs de dispositifs d'assistance ventriculaire gauche en chirurgie non cardiaque

Because of the actual shortage of heart transplant, Left ventricular assist devices (LVADs) are one of the main treatments for end-stage heart failure in patients awaiting for transplantation. Life expectancy of the patients implanted with a LVAD is constantly increasing; hence they become potential candidates for noncardiac surgery. Anesthetists not specialized in cardiac surgery may have to care these patients, particularly in emergency situations. The majority of surgical procedures performed in patients awaiting heart transplantation, concerns gastrointestinal endoscopy and digestive tract surgery. The knowledge of the LVADs, as well as the physiopathology of implanted patients, is essential for the practice of general anesthesia. Although these devices have similar hemodynamic characteristics with a normal left ventricle, they have several specificities notably regarding the right ventricle function, the haemostasis and the infection risk. The perioperative strategy should be discussed before surgery with the cardiac center. The main points includes the use of regional anaesthesia whenever possible, adapted haemodynamic monitoring in case of general anaesthesia and clinical pathway after discharge from recovering room.