Effect of Anesthesia on Cardiac Hemodynamics in patients undergoing durable LVAD Implantation: The EACHLVAD Study

Abstract

Purpose Right ventricular (RV) dysfunction is often unmasked or exacerbated during implantation of a left ventricular assist device (LVAD). Prior to LVAD implantation, the effect of anesthesia induction on RV performance is unknown. We assessed for early hemodynamic changes in the RV after induction, prior to initiation of cardiopulmonary bypass (CPB), in the presence or absence of preoperative temporary mechanical circulatory support (tMCS). Methods We prospectively collected hemodynamic measurements in patients undergoing LVAD implantation at a large academic institution between 9/2017 and 9/2018. Preoperative RV hemodynamics were compared to RV hemodynamics post-induction and intubation but prior to CPB, including central venous pressure (CVP), mean pulmonary artery pressure (mPAP), and pulmonary artery pulsatility index (PAPi). Serial hemodynamics and vasoactive inotropic score (VIS) were analyzed over time using random effects models, adjusting for induction agents and use of pre-operative tMCS. Results There were 41 patients included in this analysis, with 4 intubated prior to induction. There was a significant increase in CVP (3.6 mmHg, p intra-aortic balloon pumps were 14 of 17 tMCS cases and had similar reduction in PAPi at all time points (-2.5, p Conclusion RV hemodynamics acutely worsen after anesthesia induction prior to bypass initiation in LVAD recipients. Patients with preoperative tMCS have worse RV hemodynamics at each timepoint but less significant decline over time.