RT Book, Section
A1 Wasnick, John D.
A1 Hillel, Zak
A1 Kramer, David
A1 Littwin, Sanford
A1 Nicoara, Alina
SR Print(0)
ID 8551121
T1 Chapter 11. Ventricular Assist Devices and Heart Transplantation
T2 Cardiac Anesthesia and Transesophageal Echocardiography
YR 2011
FD 2011
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-171798-4
LK accessanesthesiology.mhmedical.com/content.aspx?aid=8551121
RD 2024/04/18
AB Adult  heart  surgery  patients  are  increasingly  older  with  varying  degrees  of  preoperative  ventricular  failure.  Patients  routinely  present  with  both  systolic  and  diastolic  ventricular  dysfunction,  ventricular  remodeling,  fluid  retention,  and  pulmonary  congestion.  Additionally,  even  those  patients  with  well-preserved  ventricular  function  preoperatively  can  deteriorate  intraoperatively  secondary  to  inadequate  myocardial  preservation,  embolism,  myocardial  ischemia,  protamine  reactions,  and  other  "catastrophic"  events  (eg,  anaphylaxis,  aortic  dissection,  etc).  Of  course,  the  overwhelming  majority  of  patients  experiencing  intra-operative  right  or  left  ventricular  failure  can  be  treated  with  a  combination  of  inotropes  and  nitric  oxide  inhalation.  However,  others  lack  sufficient  ventricular  function  to  provide  adequate  delivery  of  oxygenated  blood  to  the  tissues.  Such  patients  readily  develop  renal  dysfunction,  acidosis,  and  ultimately  die  from  cardiogenic  shock  unless  provided  mechanical  assistance  to  support  or  replace  the  heart's  pump  function.  This  chapter  reviews  the  anesthetic  management  of  patients  in  need  of  intra-aortic  balloon  counterpulsation,  (IABP)  ventricular  assist  devices  (VADs),  and  heart  transplantation  (HT).