LAUSR

To the Editor: We read with great interest the intriguing study by Mathis et al.1 involving 702 noncardiac procedures performed in patients with left ventricular assist devices (LVADs). We commend the authors for their work in this important area and share their passion and enthusiasm for caring for LVAD patients perioperatively. Mathis et al. reported that arterial line blood pressure (BP) was utilized in 20% of cases, with the remaining relying on noninvasive BP monitoring modalities. Interestingly, they report that 55% of all anesthetics had a greater than 20-min gap intraoperatively without a documented BP reading. Even more alarming is that 48% of their recorded blood pressures is of particular concern, as duration of intraoperative hypotension has been shown to correlate with acute kidney injury, among other adverse outcomes.3,4 Given the low incidence of complications associated with radial arterial line placement and the high incidence of intraoperative hypotension in this population, we would argue that arterial line placement is underutilized in the perioperative management of these patients.5