Elsevier

Surgery

Volume 146, Issue 4, October 2009, Pages 627-634
Surgery

Central Surgical Association
Does the need for noncardiac surgery during ventricular assist device therapy impact clinical outcome?

https://doi.org/10.1016/j.surg.2009.06.033Get rights and content

Background

The role of the ventricular assist device (VAD) in the management of heart failure is expanding. Despite its success, the clinical course for patients requiring noncardiac surgery (NCS) during VAD support is not well described. The objective of this study was to identify VAD patients requiring NCS (+NCS) and compare outcomes with those not requiring NCS (–NCS).

Methods

Patients undergoing VAD implant from 2000 to 2007 were reviewed. NCS procedures, survival, and complications were collected. Survival at 1 year from implant, overall survival at the study conclusion, survival time from implant, and outcome of VAD therapy were compared between groups.

Results

We enrolled 142 subjects. Demographics did not differ between groups. Twenty-five subjects (18%) underwent 27 NCS procedures. Perioperative survival was 100% and 28-day survival was 64%. Survival to discharge was 56%. Bleeding occurred in 48%. Infection occurred in 33%. Estimated blood loss was 355 mL, and the international normalized ratio at time of NCS was 1.9. Laparoscopy was performed in 3 cases. There was no difference in 1-year survival (59% vs 54%), survival at study conclusion (44% vs 46%) or survival time (517 vs 523 days) between +NCS subjects and –NCS subjects. There were similar causes of death in both groups. The +NCS group was on VAD support longer (245 vs 87 days; P < .01), and less likely to undergo heart transplantation (12% vs 35%; P < .01).

Conclusion

NCS is not uncommon during VAD therapy. Bleeding and infection were common complications. Despite this, NCS seems to be feasible and safe and does not seem to increase mortality in the VAD population.

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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