Benefits of Ultra-Fast-Track Anesthesia in Left Ventricular Assist Device Implantation: Propensity Score Matched Analysis

Objectives: The use of left ventricular assist devices (LVADs) has gained significant importance for treatment of end-stage heart failure. Fast-track procedures are well established in cardiac surgery, whereas knowledge of their benefits after LVAD implantation is sparse. We hypothesized that ultra-fast-track anesthesia (UFTA) with in-theater extubation or at a maximum of 4 hour after surgery is feasible in INTERMACS level 3 and 4 patients and might prevent postoperative complications.

Methods: From March, 2010 to March, 2012, 53 LVADs (50 Heart Mate II and 3 Heart Ware) were implanted in patients in our department. UFTA was successfully performed (LVAD _ultra ) in 13 patients. After propensity score matching, we compared the LVAD _ultra group with a matched group (LVAD _match ) receiving conventional anesthesia management.

Results: Patients in the LVAD _ultra group had significantly lower incidences of pneumonia (p = 0.035), sepsis (p = 0.007), delirium (p = 0.049) and right ventricular failure (p = 0.007). They showed a significantly higher cardiac index in the first 24 hour (p = 0.023); a significantly lower central venous pressure (p = 0.014) and a significantly shorter ICU stay (p = 0.005). Kaplan-Meier analysis after four years of follow-up showed no significant difference in survival.

Conclusion: In this pilot study, we demonstrated the feasibility of ultra-fast-track anesthesia in LVAD implantation in patients with INTERMACS level 3–4. Patients had a lower incidence of postoperative complications, better hemodynamic performance, shorter length of ICU stay and lower incidence of RVF after UFTA. Prospective randomized investigations should examine the preservation of right ventricular function in larger numbers and identify appropriate selection criteria.