TITLE:
Stroke and Left Ventricular Assist Device (LVAD)
AUTHORS:
Robert P. From, David Hasan, Michael T. Froehler, Jennifer L. Goerbig-Campbell
KEYWORDS:
Stroke; Heart Failure; Endovascular; Embolectomy; Neurointerventional; HeartMate II; LVAD
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.1,
January
31,
2013
ABSTRACT: Treatment of ischemic
stroke for a patient on left ventricular assist device (LVAD) by
neurointerventional means is rare and many anesthesia providers are unfamiliar
with both LVAD and neurointerventional protocols. Examples of this include: 1)
filling for continuous-flow LVAD depend on preload and the flow is inversely
related to afterload; as mean arterial pressure (MAP) increases above 80 to90 mmHg, flow decreases; 2) there may be no
palpable pulse in patients with continuous flow LVADs; 3) pulse oximetry may
not work when pump flow is high and native myocardial function is minimal; 4)
increasing MAP above80 mmHg potentially will maintain ischemic brain tissue—the penumbra—until flow is
restored. This latter example creates a paradoxical management goal: increasing
the mean arterial pressure (MAP) above80 mmHg while maintaining ischemic brain tissue, may
decrease flow to the LVAD. Finally, there is controversy regarding which type
of anesthesia is most efficacious for neuro interventional procedures. We
describe three patients on LVAD suffering ischemic stroke requiring anesthesia
for embolectomy and angioplasty during neruointeventioal radiology procedures.