• A&A practice · Dec 2020

    Case Reports

    Intraoperative Management of Carotid Endarterectomy in Patients With Left Ventricular Assist Devices-The Challenge of Continuous Flow: A Case Report.

    • Rishi Kumar, Manish K Patel, John F Zaki, Ismael A Salas de Armas, Mehmet H Akay, Biswajit Kar, and Igor D Gregoric.
    • From the Division of Cardiothoracic and Vascular Anesthesiology, Department of Anesthesiology, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas.
    • A A Pract. 2020 Dec 1; 14 (14): e01355.

    AbstractSymptomatic carotid artery disease stenosis warrants open surgical carotid endarterectomy (CEA). However, patients with continuous-flow left ventricular assist devices (CF-LVADs) present unique challenges when vasopressors and volume are used to maintain cerebral perfusion pressure after carotid cross-clamping. This report describes patients with CF-LVADs who underwent CEA. We identify how preload, contractility, afterload, pump speed, mean arterial pressure, and anticoagulation should be addressed to maintain CF-LVAD outflow and cerebral perfusion during the procedure. Anesthesiologists can combine an understanding of continuous-flow physiology with invasive monitors to optimize cardiac output and cerebral blood flow during CEA procedures.

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