Anesthetic management in heart transplantation for a patient with a pre-existing left ventricular assist device: A case report

Background: Heart transplantation in patients with a pre-existing left ventricular assist device (LVAD) poses significant anesthetic and surgical challenges, especially in centers with limited prior experience. We report the first successful case in Vietnam of anesthetic management for heart transplantation in a patient supported by a LVAD. Case Presentation: A 39-year-old woman with end-stage dilated cardiomyopathy had undergone HeartMate LVAD implantation in 2019. She was admitted multiple times for LVAD-related infections and subsequently listed for heart transplantation. Intervention & Outcome: Anesthesia included fentanyl, ketamine, low-dose propofol, and rocuronium, with advanced monitoring with FloTrac and trans-esophageal echocardiograph (TEE). Prophylactic femoral cannulation was performed prior to sternotomy to mitigate serious complications. Surgery lasted 420 minutes with 321 minutes of cardiopulmonary bypass. Transfusion requirements: 2000 mL of red blood cells, 1500mL of plasma, 400mL of cryoprecipitate, and 3 units of platelets. Inotropes and inhaled nitric oxide were used to support right ventricular function. Postoperatively, the cardiac index improved from 1.4 to 2.8L/min/m², ejection fraction was 51%, and the patient was extubated on postoperative day one without anesthetic complications.