Anesthetic management for abdominal aortic surgery in a patient with a left ventricular assist device: a case report

JA Clinical Reports
Koko AdachiMasanori Yamauchi

Abstract

Left ventricular assist devices (LVAD) are a currently established destination and bridge therapy until cardiac transplantation; hence, this patient population continues to increase. Here, we present the first report of abdominal aortic cross-clamping (ACC) in a LVAD patient undergoing emergency aneurysm repair. Anticoagulation was continued pre-and intra-operatively to avoid pump thrombosis. The pumping function of the LVAD is highly dependent on both preload and afterload. In this case, abdominal ACC, which increases the afterload, did not significantly influence circulatory dynamics. However, when the abdominal ACC was released, mean atrial pressure (MAP) fell to 42 mmHg, because preload reduction due to massive bleeding (3532 g) secondary to anticoagulation and afterload reduction by abdominal ACC release combined to cause critical hypotension. Maintenance of MAP required rapid infusion and use of an alpha-adrenergic agent. Surgical and anesthesia times were 411 and 525 min, respectively. Total blood loss was 5389 g, respectively. The patient was discharged after 25 postoperative days with no major complications. ACC release, with its accompanying decrease in preload and afterload, and massive bleeding due to anticoagulatio...Continue Reading

References

Jan 29, 2003·Anesthesiology·Alfred C Nicolosi, Paul S Pagel
Mar 18, 2008·British Journal of Anaesthesia·V KarthaK Tremper
Mar 20, 2012·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Jeffrey A MorganRobert J Brewer
Jul 14, 2012·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Efrem CiviliniRoberto Chiesa
Jan 22, 2013·Journal of Cardiothoracic and Vascular Anesthesia·Kimberly A SliningerAbeel A Mangi
Oct 1, 2013·The Annals of Thoracic Surgery·Brent C LampertJeffrey J Teuteberg
Jan 11, 2014·Canadian Urological Association Journal = Journal De L'Association Des Urologues Du Canada·Jasmir G NayakThomas McGregor
Apr 5, 2014·Annals of Vascular Surgery·Jean E StarrChittoor B Sai-Sudhakar

❮ Previous
Next ❯

Citations


❮ Previous
Next ❯

Related Concepts

Related Feeds

Artificial Heart & Ventricular Assist Devices

Total artificial hearts (TAH) and ventricular assist devices (VADs) provide cardiac support for patients with end-stage heart disease and have significantly improved the survival of these patients. Discover the latest research on Artificial Heart and Ventricular Assist Devices here.

Aneurysm

Aneurysms are outward distensions or bulges that occurs in a weakened wall of blood vessels. Discover the latest research on aneurysms here.