• A&A practice · Nov 2021

    Intraoperative Management for Left Ventricular Assist Device Implantation With Concurrent Laparoscopic Sleeve Gastrectomy: A Case Series.

    • Rishi Kumar, Sarah Ellis, Salas De ArmasIsmael AIADepartment of Advanced Cardiopulmonary Therapy and Transplantation, UTHealth and Memorial Hermann Hospital - Texas Medical Center, Houston, Texas., Manish K Patel, Mehmet H Akay, Kulvinder S Bajwa, Yafen Liang, 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. 2021 Nov 5; 15 (11): e01545e01545.

    AbstractThe increasing coincidence of obesity with heart failure may preclude eligibility for orthotopic heart transplantation, requiring continuous-flow left ventricular assist devices (LVADs) as destination therapy. This report describes intraoperative considerations for patients who underwent LVAD implantation with concurrent laparoscopic sleeve gastrectomy (LSG) to promote weight loss. In particular, right ventricular dysfunction associated with acute left ventricular unloading may be compounded by pneumoperitoneum for LSG due to the difficulty in ventilating patients with obesity, hypercarbia-mediated increase in pulmonary vascular resistance, and variable cardiac loading conditions. We identify specific anesthetic challenges and discuss methods of monitoring and management.Copyright © 2021 International Anesthesia Research Society.

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