Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Anesthesiol. Sep 30, 2022; 11(1): 1-7
Published online Sep 30, 2022. doi: 10.5313/wja.v11.i1.1
Anesthesia management of a patient undergoing implantation of a left ventricular assist system: A case report
Shu-Guang Wu, Wei He
Shu-Guang Wu, Wei He, Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 340002, Zhejiang Province, China
Author contributions: Wu SG and He W were jointly involved in completing general anesthesia in the patient with EVAHEART implantation; He W collected the case data; Wu SG compiled the case data and wrote the manuscript; both authors have read and approved the final manuscript.
Informed consent statement: We obtained the patient's written informed consent to disclose his case. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that his name will not be published and due efforts will be made to conceal his identity.
Conflict-of-interest statement: All authors declare no competing financial interests for this article.
CARE Checklist (2016) statement: This case report complies with the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4. 0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4. 0/
Corresponding author: Wei He, MD, PhD, Clinical Assistant Professor (Honorary), Doctor, Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 340002, Zhejiang Province, China. hzstar3047@126.com
Received: May 6, 2022
Peer-review started: May 6, 2022
First decision: August 1, 2022
Revised: August 14, 2022
Accepted: September 13, 2022
Article in press: September 13, 2022
Published online: September 30, 2022
Processing time: 146 Days and 3 Hours
Abstract
BACKGROUND

Heart failure is generally regarded as a progressive and irreversible medical condition. The EVAHEART is an implantable left ventricular assist system.

CASE SUMMARY

We report the anesthesia management of a 56-year-old male patient with dilated cardiomyopathy undergoing an EVAHEART implantation. Transesophageal echocardiography is crucial to ensure the correct positioning of the device and the proper aortic valve outflow. Because the continuous blood flow device functions best under low systemic and pulmonary vascular resistance, milrinone is the preferred drug. Our patient was accompanied by pulmonary hypertension, so during the operation, nitric oxide was used to reduce pulmonary artery pressure.

CONCLUSION

The cardiac output achieved by the patient with the assistance of EVAHEART can reach 4 L/min, which of course depends on the front load, rear load, and pump speed.

Keywords: Heart failure; Anesthesia; Hemodynamics; Left ventricular assist device; Transesophageal echocardiography; Pulmonary hypertension

Core Tip: The EVAHEART is an implantable left ventricular assist system. We report the anesthesia management of a 56-year-old male patient with dilated cardiomyopathy undergoing an EVAHEART implantation. The anesthesia and perioperative management of EVAHEART implantation differ from those for traditional auxiliary devices. The first is the physiological characteristics of the non-pulsating continuous blood flow, for which the device has the best pump function under relatively low average arterial pressure and systemic vascular resistance. Second, transesophageal echocardiogram (TEE) is used to verify the correct position of the EVAHEART and to verify that the native heart has only partial auxiliary functions. Blood flow through the left ventricular outflow tract is sufficient to open the aortic valve. Third, perioperative TEE is used to guide the volume supplement, the adjustment of vasoactive drugs, and the adjustment of pump speed. Due to the continuous shortage of heart donors, EVAHEART implantation is the last hope for patients with end-stage heart failure. In the future, an increasing number of people will receive this kind of surgery, so we hope that this report can help them.