Anesthetic Management of Right Ventricular Assist Device Explantation in a Heart Failure Patient on Biventricular Assist Device Support

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  • SUMIYOSHI Miho
    Department of Anesthesiology, National Cerebral and Cardiovascular Center
  • KAMEI Masataka
    Department of Clinical Anesthesia, Mie University Hospital
  • KUBOTA Yosuke
    Department of Anesthesiology, National Cerebral and Cardiovascular Center
  • INATOMI Yuzuru
    Department of Anesthesiology, National Cerebral and Cardiovascular Center
  • KOBAYASHI Junjiro
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
  • OHNISHI Yoshihiko
    Department of Anesthesiology, National Cerebral and Cardiovascular Center

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  • 体外設置型両心補助人工心臓植込み患者に対する右心補助人工心臓離脱評価を全身麻酔下に実施した症例

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Abstract

<p>Ventricular assist devices（VADs）have become an important therapeutic option for patients with life-threatening heart failure refractory to standard care. However, there is currently no optimal protocol for weaning patients from their VADs because right heart evaluation remains sub-optimal and VAD-off tests can cause systemic thromboembolisms. In particular, patients implanted with a biventricular assist device（BVAD）pose a significant challenge for right VAD（RVAD）explantation since properly monitoring adequate improvement in right heart function, which is needed for device explantation, cannot be established. Here, we discuss the dilemma underlying the evaluation process for RVAD explantation：a paracorporeal BVAD patient with fulminant myocarditis whose paracorporeal LVAD needed to be replaced with an implantable LVAD support as a bridge to heart transplantation. To test the degree of right heart recovery as precisely as possible, an RVAD-off test under general anesthesia may be advisable as it facilitates invasive cardiac monitoring and systemic full heparinization to prevent thromboembolisms. Among BVAD patients undergoing RVAD explantation, further studies are clearly needed to determine the best method for assessing right heart reverse remodeling, optimal timing of device explantation, weaning protocols, and indications for aborting the weaning procedure.</p>

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