Sedation and anesthetic considerations in ambulatory endoscopy for patients with ventricular assist devices

The number of patients with left ventricular assist devices (LVADs) implanted for heart failure continues to grow each year. Despite the survival and quality-of-life benefit LVADs can afford, adverse events do occur. Gastrointestinal bleeding is a known complication associated with continuous-flow LVADs, and many LVAD patients undergo endoscopic procedures to evaluate for sources of gastrointestinal bleeding. As the number of these patients increases, the approach to caring for them evolves. They present a number of challenges to the endoscopy team, including preprocedural planning, resource and personnel allocation, and postprocedural disposition.