PERSUADE Survey—PERioperative AnestheSia and Intensive Care Management of Left VentricUlar Assist DevicE Implantation in Europe and the United States

Abstract

ObjectiveTo comprehensively assess relevant institutional variations in anesthesia and intensive care management during left ventricular assist device (LVAD) implantation. DesignProspective data analysis. SettingOnline survey. ParticipantsLVAD-centers in Europe and the United States. InterventionsAfter investigating initial interest, 91 of 202 European and 93 of 195 US centers received a link to the survey targeting institutional organization and experience, perioperative hemodynamic monitoring, medical management, and post-operative intensive care aspects. Measurements and Main ResultsThe survey was completed by 73 (36.1%) European and 60 (30.8%) US centers. Although most LVAD implantations were performed in university hospitals (>5 years’ experience), significant differences were observed in the composition of the preoperative multidisciplinary team and provision of intraoperative care. No significant differences in monitoring or induction agents were observed. Propofol was more often used for maintenance in Europe (p<0.001). Choice for inotropes changed significantly from preoperatively (more levosimendan in Europe) to intraoperatively (more use of epinephrine in both Europe and US). Use of quantitative methods for defining right ventricular function was reported more often from European compared to US centers (p<0.05). Temporary mechanical circulatory support for treatment of right ventricular failure was more often used in Europe. Nitric oxide appears to play a major role only intraoperatively. There were no significant differences in early postoperative complications reported from European vs. US centers. ConclusionsDespite the perioperative practice of care for patients undergoing LVAD implantation differs in several aspects between Europe and the US, there were no perceived differences in early postoperative complications.