Central Surgical AssociationDoes the need for noncardiac surgery during ventricular assist device therapy impact clinical outcome?
Section snippets
Methods
All patients implanted with any type of VAD at a single regional cardiac center between 2000 and 2007 were identified from an administrative database maintained by the division of cardiac surgery. During the study period, VAD systems from various manufacturers were utilized (Table I). Data abstracted from these subjects' medical records included general demographic information, time on VAD support, survival, cause of death, and ultimate outcome of VAD therapy (heart transplant or VAD explant).
Results
There were 142 patients who underwent VAD implant during the study period. The number of NCS procedures as well as the type of VAD system implanted by study year for the NCS group is included in Table II. Of those undergoing NCS, 48% underwent VAD implant for ischemic cardiomyopathy, 30% for acute cardiogenic shock, 19% for nonischemic cardiomyopathy, and 4% for hypertrophic obstructive cardiomyopathy. Twenty five subjects (18%) underwent 27 NCS procedures a mean of 119 ± 181 days after VAD
Discussion
The need to treat surgical problems that arise in VAD patients is growing as the number of implanted devices and length of support increases. In 1994, Votapka et al4 reported their early experience with 7 VAD patients undergoing NCS, with slowly growing published series as this technology progressed.5, 6, 7, 8 We identified 25 VAD patients undergoing NCS, with two thirds occurring in the last 2 years of the study, corresponding to a shift toward durable, long-term devices. To our knowledge,
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Cited by (40)
Total Joint Arthroplasty in Patients With an Implanted Left Ventricular Assist Device
2023, Arthroplasty TodayCitation Excerpt :Arthroplasty has been shown to improve cardiovascular fitness in patients limited by arthritic pain, thus improving candidacy for transplantation [8,9]. A study conducted by Garatti et al. [4] and a review article by Brown et al. [10] found that several noncardiogenic surgeries in LVAD patients are feasible and may be without significant morbidity or mortality. However, there are no studies examining the outcomes of patients undergoing TJAs with a history of an implanted LVAD.
EGS plus: Predicting futility in LVAD patients with emergency surgical disease
2022, American Journal of SurgeryCitation Excerpt :Brown and colleagues also demonstrated that two distinct patient subgroups exist: those who require NCS shortly after LVAD placement and those who have a subsequent admission for NCS. Patients who underwent NCS during the same admission as their device implantation had a 40% survival to discharge compared to 75% survival to discharge in those who returned to the hospital for NCS during a subsequent hospital admission.8 Furthermore, as second-generation devices replaced first generation devices, McKellar and colleagues found the need for NCS in patients with second-generation LVADs decreased in the acute post-implant period but was increased in the outpatient setting.11
75 years of the Central Surgical Association: The last quarter century
2018, Surgery (United States)Citation Excerpt :Colonoscopy provided the diagnosis in most patients and “is now being used more effectively for hemostasis resulting in less operative intervention to control bleeding.” With the expanding role of the ventricular assist device (VAD), Brown et al75 found that noncardiac surgery was not uncommon during VAD therapy and was “feasible and safe” and did not increase mortality in the VAD patient population. Kashuk et al76 reported that primary repair of civilian colon injuries was “safe in the majority of patients after” damage control laparotomy, “although it is associated with a higher leak rate than standard laparotomy, the open abdomen affords careful inspection of abdominal contents at reexploration to identify patients who require subsequent diversion.”
Anesthetic Management of Patients With Continuous-Flow Left Ventricular Assist Devices Undergoing Noncardiac Surgery: An Update for Anesthesiologists
2018, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Current consensus suggests that anesthesiologists, irrespective of subspecialty training, may care for LVAD patients as long as they have a detailed knowledge of LVAD physiology.9,10,20,24–28 The preoperative assessment of patients with LVADs undergoing noncardiac surgery should encompass a thorough history, physical examination, device interrogation, and review of laboratory tests and imaging studies.2–18,29 A complete review of systems assessing the extracardiac effects of chronic heart failure and LVAD therapy is necessary before surgery; currently administered medications may include inotropes, diuretics, anticoagulants, and antihypertensive medication and should be reviewed.
Colo-colonic anastomosis in a continuous-flow left ventricular assist device patient
2017, Asian Journal of SurgeryMechanical circulatory support
2015, Best Practice and Research: Clinical AnaesthesiologyCitation Excerpt :Several series and case reports on VAD patients undergoing NCS have been published [84–87]. Outcomes after NCS in patients with VAD are favorable [88,89]. Anesthesia care should be managed at specialized centers by cardiac anesthesiologists, and patients should recover in the ICU.