Anesthetic Management for Left Ventricular Assist Device Implantation Through Left Thoracotomy: Evaluation of On-Pump Versus Off-Pump C. Sahutoglu a, *, E. Turksal a , U. Bilic a , S. Kocabas a , F. Zekiye Askar a , P. Ozturk b , S. Ertugay b , C. Engin b , T. Yagdi b , and M. Ozbaran b a Department of Anesthesiology and Reanimation, Ege University Medical Faculty, Izmir, Turkey; and b Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey ABSTRACT Background. Ventricular assist devices (VADs) are alternative approaches to medical treatment in patients with acute or chronic heart failure. The goal of this study was to compare an anesthetic approach in patients undergoing implantation of a VAD with (on- pump) or without (off-pump) cardiopulmonary bypass (CPB) through left thoracotomy. Methods. A total of 32 patients were divided into 2 groups: on-pump (group 1) and off- pump (group 2). A standard anesthesia protocol was used in all patients. Baseline characteristics of the patients, intraoperative hemodynamic and respiratory variables, anesthetic agents and vasoactive drugs administered, the amount of blood products, extubation, length of hospital stay and intensive care unit stay, and postoperative complications were recorded. Results. Patients’ mean age was 54.7  13.3 years (range, 18e74 years). Eighteen patients underwent surgery with CPB. Demographic data of the patients, preoperative character- istics, intraoperative use of blood products, intraoperative complications, and anesthetic drugs used were similar between groups (P > .05). The duration of surgery (219  23 vs 273  56 minutes) and anesthesia (274  38 vs 323  57 minutes) were shorter in group 2; there was no difference between the 2 groups in terms of mechanical ventilation time, length of stay in the intensive care unit, and length of hospital stay. There was no decrease in postoperative oxygen parameters and an increase in patient lactate levels with the use of CPB. The use of fresh frozen plasma and platelet suspension in the postoperative period was significantly higher in group 1 (P < .05). The rate of complications and mortality rate were comparable between the 2 groups (P > .05). Conclusions. Our study results show that the use of CPB during VAD implantation via left thoracotomy increases operation time and use of blood products, while causing no change in the rate of complications. M EDIAN STERNOTOMY REMAINS the optimal technique to access the surgical field in heart surgery. However, re-sternotomy is known to cause injury to the heart and great vessels, increase complications, and decrease lung volumes in patients with previous sternot- omy [1]. In addition, an increased number of sternotomy procedures may pose an obstacle for further heart trans- plantation in these patients after implantation of a left ventricular assist device (LVAD). Therefore, LVAD implantation via left thoracotomy has become popular in high-risk patients, and attempts have been made to *Address correspondence to Cengiz Sahutoglu, MD, Anes- teziyoloji ve Reanimasyon AD, Ege Universitesi Tip Fakultesi, 35100 Bornova, Izmir, Turkey. E-mail: csahutoglu@yahoo.com ª 2017 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169 0041-1345/17 http://dx.doi.org/10.1016/j.transproceed.2017.01.013 Transplantation Proceedings, 49, 587e592 (2017) 587