Objectives: In this study, we aimed to share the intraoperative anesthesia management of left ventricular assist device (LVAD) implantation and our approach to right ventricular failure (RVF) that developed in this process, and our results. Patients and methods: A total of 82 patients (71 males, 11 females; mean age: 49.4±9.4 years; range, 18 to 71 years) who underwent LVAD implantation between February 2013 and June 2020 were included in the retrospective study. Preoperative echocardiography, cardiac catheterization findings, and intraoperative records were reviewed. In light of the preoperative hemodynamic, echocardiographic, and preoperative echocardiographic findings of the patients, RVF levels were preoperatively determined, and a medical and mechanical support therapy algorithm for RVF was created. The postoperative outcomes were evaluated within the framework of this algorithm. Results: The mean preoperative left ventricular ejection fraction was 19.6%, and the mean right ventricular ejection fraction was 37.4%. According to our algorithm, eight (9.7%) patients developed severe, 12 (14.6%) moderate, and 48 (58.5%) mild RVF. No RVF was present in 14 (17.2%) patients. The vasoactive inotrope score was 25.7±1.3 in the advanced RVF group and compatible with the severity of RVF. Extracorporeal membrane oxygenation use was required in three (37.5%) patients who had severe RVF. Right ventricular assist device was implanted in one of the three patients with extracorporeal membrane oxygenation due to advanced RVF in the postoperative period. Mortality was observed in two (25%) patients in the advanced group, one (8.3%) in the moderate, three (6.25%) in the mild, and two (14%) in the normal RVF group. Conclusion: A standardized method for defining the RVF severity and a well-defined treatment protocol according to its degree of severity is lacking. Considering hemodynamic and echocardiographic data, grading of RVF in patients is vital for determining the treatment protocol. Treatment for RVF should be converted into standard universal algorithms.

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Background:The aim of the study was to evaluate the patients who underwent minimally invasive cardiac surgery and percutaneous internal jugular vein catheterization in our center, and to discuss the catheterization results and complications in the literature. Materials and Methods:Between January 2015 and September 2019, 70 female (59.3%) and 48 (40.7%) male patients, who underwent minimally invasive cardiac surgery and percutaneous internal jugular vein cannulation in our center, had a mean age of 37.2±14.5 (19-74 years), data of 118 cases were evaluated retrospectively. It was noted that 17 F jugular venous catheter was placed in patients with body surface area (BSA) <1.87, and 19 F venous catheter was placed in patients with (BSA) >1.87. Cannula positions and echocardiographic findings of the patients during cannulation were evaluated with transesophageal echocardiography (TEE).Results: All surgical interventions were performed minimally invasively by thoracotomy. Since the adequate surgical field of vision could not be achieved in 3 (2.5%) of the patients, the operation was reverted to sternotomy. No mortality due to cannulation was observed in any of the patients. Local hematoma (1.6%) developed due to carotid artery puncture in 2 patients, transient atrial fibrillation (1.6%) in 2 patients, and pneumothorax (0.8%) in one patient. Conclusion:Minimally invasive cardiac surgical interventions have become popular nowadays and their importance has increased due to reasons such as faster recovery of patients, less complications, and smaller surgical incision area. Internal jugular cannulation is required in minimally invasive cardiac surgery procedures. In order to avoid possible complications in the percutaneous cannulation process and therefore to reduce mortality, it is very important that cannulation procedures be performed by an experienced team and evaluated with TEE during this time.