ABSTRACT
Over the last 20 years, considerable advances have been made in the field of mechanical circulatory support (1,2). The cardinal feature of the patient requiring implantation of a mechanical circulatory device is the presence of decompensated heart failure refractory to medical management (3,4). This population presents significant challenges to the medical team, specifically to the cardiac anesthesiologist in the perioperative setting (5). Several clinical features accompany the placement of a ventricular assist device (VAD) compared with other cardiovascular procedures, including the advanced degree of heart failure, the circulatory change induced by VAD therapy, complications specific to these devices, and the higher incidence of associated right ventricular (RV) failure and bleeding (6). Transesophageal echocardiography (TEE) has played an increasing role in the perioperative care of patients with severe heart failure and VAD placement, both as a diagnostic and a monitoring tool in the operating room (OR) and intensive care unit (ICU) (7). In this chapter, the essential role of TEE for VAD placement and monitoring will be reviewed.
