Table 1 Perioperative approach to LVAD patients undergoing non-cardiac surgery

• Preoperative

 o Multidisciplinary team identified (primary surgical and anesthesia teams, cardiac surgery, heart failure cardiologist, VAD personnel)

 o Preoperative medical optimization when possible or necessary

 o Physical examination focused on the sequelae of heart failure

 o Baseline EKG, echocardiogram, and laboratory values

 o Manage pacemaker/AICD settings when indicated

 o Hold, bridge, or reverse anticoagulation when indicated

• Intraoperative

 o Standard ASA monitors

 o Cerebral tissue oxygenation, processed EEG, arterial line with ultrasound guidance, central venous catheter if fluid shifts are expected, PA catheter only if severe pulmonary hypertension, TEE available

 o Monitor VAD control console

 o External defibrillator pads in place

 o Optimize preload, support RV function, avoid increased in afterload

 o Gradual peritoneal insufflations and position changes

• Postoperative

 o Standard PACU care unless ICU is otherwise indicated

 o Extubation criteria are unchanged

 o Avoid hypoventilation, optimize oxygenation

 o Resume heparin infusion when post-op bleeding risk is acceptable