9.1 Monitoring
For central venous access, ultrasound guidance is preferred due to the high incidence of thrombosis caused by previous indwelling catheters or transvenous pacemaker leads [217–220]. Although the impact of a pulmonary artery catheter on outcome has not been demonstrated for cardiac surgery [221], in relation to MCS implantation, pulmonary artery catheters provide valuable information including mixed venous oxygen saturation, pulmonary arterial pressure and vascular resistance that can guide intraoperative therapy decisions [222–224]. Neuromonitoring with electroencephalography is aimed at avoiding anaesthesia awareness [225]; cerebral perfusion can be assessed by estimating tissue oxygen saturation using near infrared spectroscopy [226].