• Hanin Sheikh, Julia Isabella Klein, Kenneth Elliott Higgins Iii, John W Patton, and Benjamin Chu.
• Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California, USA.
• Reg Anesth Pain Med. 2025 Feb 11.

BackgroundThere is a rising number of patients with left ventricular assist devices (LVADs) undergoing non-cardiac procedures, both emergent and elective. Historically, anesthetic options for these patients have been limited to general anesthesia. Limited data exists for the use of neuraxial anesthesia in patients with LVADs despite its common use in orthopedic procedures for non-LVAD patients. Given the benefits of neuraxial anesthesia and the rising population of LVAD patients undergoing elective procedures, a better understanding of LVAD patients' candidacy for neuraxial anesthesia needs further investigation.Case PresentationWe report the case of a patient with an LVAD who successfully underwent a total knee arthroplasty with neuraxial anesthesia at a tertiary academic center. Preoperative transthoracic echo demonstrated stable cardiac function and an ejection fraction of 10-15% with a HeartMate 3 LVAD. The primary anesthetic was a lumbar epidural that was slowly titrated to a surgical anesthetic level and an adductor canal peripheral nerve catheter was placed preoperatively for postoperative analgesia. The patient remained hemodynamically stable throughout the case, with a perfusionist monitoring the LVAD's function intraoperatively, and tolerated the anesthetic well. His postoperative course was uneventful.ConclusionPatients with LVADs should be considered candidates for neuraxial anesthesia with appropriate preoperative planning and perioperative management.© American Society of Regional Anesthesia & Pain Medicine 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.

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