A left ventricular assist device (LVAD) serves to support a failing left ventricle in patients with end-stage heart failure until recovery (“bridge to recovery”), transplantation (“bridge to transplantation”) or as lifelong therapy (“destination therapy”) in patients ineligible for transplan-tation. Compared to optimal medical management in end- stage heart failure, LVADs convey a significant survival advantage (80 percent survival at one year and 70 percent at two years) and improved quality of life over optimal medical management.1,2  With improved survival in modern LVADs and greater than 15,000 mechanical support device implantations from 2006-2014 in the United States, it follows that anesthesiologists will be increasingly tasked with caring for LVAD patients presenting for non-cardiac surgery (NCS).

Several recent retrospective series have reported on LVAD patients undergoing NCS.3-9  These patients present for NCS involving nearly...

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