Ventricular assist devices and anesthesia.

Ventricular assist devices (VADs) have revolutionized long-term care for patients with congestive heart failure. These patients represent about 1% of the adults in the United States, considering that heart failure is a contributing factor in more than 250,000 deaths annually. It has been estimated that about 60,000 patients per year in the United States could benefit from heart transplantation or long-term mechanical support. Because of the short supply of donor hearts for transplant, assist devices have become of great value. At least four assist devices are clinically available, and two other devices are being investigated. Because cardiopulmonary by-pass is required for implantation of these devices, anesthetizing these critically compromised patients requires extensive monitoring, skillful anesthetic management, and expert postoperative care.