Our experience in long term ventricular assist device application

Background Heart failure, despite advances in treatment and new insights are still causing high mortality and morbidity as a public health threat. Limitations on the number of heart donors and because of age or other comorbid factors for who are not suitable for heart transplant patients Ventricular Assist Devices (VADs) has emerged as the need for alternative treatments. Short or long term VADs are widely used today in the treatment of end-stage HF patients. Patients and methods After the Faculty of Medicine Clinical Research Ethics Committee approval, adult patients who underwent elective VAD implantation between May 2012 and May 2015 were evaluated retrospectively. 10 of the 75 patients (13.3%) were women, 65 of them (86.7%) were male. Preoperative, intraoperative and postoperative data were retrospectively analyzed. Statistical analysis of the study was performed by Akdeniz University Faculty of Medicine Department of Biostatistics and Medical Informatics Department with SPSS V.20 (IBM Inc.). Results The average age and mean BMI of our patients was found 54.28±11.47 years 26.36±4.31 kg/m2, respectively. In comparison with the etiologic factors DCM / IKMP ratio of 36/39 respectively. On average 8.07±2.23 mg for the induction of anesthesia was administered iv midazolam. The majority of patients (n = 60) were used in average 196.87±104.56 mg of iv thiopental as hypnotic agent in the induction of anesthesia and in 67 cases, the average dose of opioid analgesics as 158.96±52.89 mg iv fentanyl was used. The muscle relaxation in the majority of patients (n = 70) is provided with an average of 55.43±7.92 mg iv rocuronium. All patients were administered for maintained of anaesthesia with inhaled sevoflurane of %1 MAC concentration. The number of patients who were used in intraoperative levosimendan was 26 (34.7%). The number of patients undergoing treatment of IABP administration in the preoperative or intraoperative period were 14 (18.7%). Total used of red blood cells, fresh frozen plasma and platelet transfusions in the intraoperative period were found 5.29±5.94, 5.04±5.47 and 2.16±1.98 U, respectively. In the early postoperative period, 18 patients (24%) has been applied of inhaled nitric oxide therapy. 108.03±63.34 minutes average CPB time of patients, while the total duration of operation with an average of 5.33±1.43 hours. The mean extubation time was 32.21±37.86 hours. Postoperative monitoring in the intensive care unit and total hospitalization time period was found to be 16.15±17.63 and 29.61±30.82 days, respectively. The two of them patients of optimum donor chance was born to do a heart transplant, and these patients are in outpatient resume their lives. 49.3% of all patients (n = 37) lost their lives due to various reasons. 36 patients (48%) are located in the ongoing life of the implanted LVAD and the outpatient waiting list for heart transplantation. After VAD implantation rate of patients undergoing non-cardiac surgical procedure were 29.3% (n = 22). Conclusions Ventricular assist device implantation in an anesthesia management and evaluated on the basis of a multidisciplinary approach to patients with advanced and detailed hemodynamic and neuro-monitoring methods must be applied routinely for postoperative patient care. Not the early diagnosis and prevention of complications would be overlooked role. As a result, in the installation of the LVAD; a harmonious teamwork, especially in patients leaving from CPB, before and during the surgery, the evaluation with TEE by an anesthesiologist will increase the chances of success