Abstract 18145: Non-cardiac Surgery in Patients With a Ventricular Assist Device
Introduction As both VAD support duration and patient age increase, there is greater likelihood that some of these patients will develop general surgical problems and require non-cardiac surgery (NCS). The clinical course of patients requiring NCS during VAD support is not well described. Previous studies are limited in the number of patients with VADs and number of operations.
Methods We reviewed the NCS procedures of our 190 patients with ongoing VAD support between 10/2010 and 10/2011. NCS was divided into two groups: VAD-related NCS and non-VAD-related NCS.
Results Fifty of our patients underwent 52 NCS procedures in 1 year. We documented 16 VAD-related NCS and 36 non-VAD-related NCS; 14 of these procedures were urgent and 38 were elective. Median age at time of NCS was 58 years; 92% of these patients were male and 52% had ischemic cardiomyopathy. Different devices were used: HeartWare 52%, HeartMate II 32%, INCOR 12%, Berlin Heart BVAD 2%, HW BVAD 2%. One third of the non-VAD-related NCS were dental procedures, nearly one third pacemaker procedures, 17 % abdominal surgery, 9% vascular surgery, 5% basalioma excisions, 3% thyroidectomy, 3% fixation after traumatologic fracture and 3% gynecological. One third of the VAD-related NCS was vascular operations, one third abdominal operations, and one third others. Eighty-four percent were admitted to our own institution and 65% of all NCS were performed there. There were no deaths directly related to the NCS procedure. The most common complication was bleeding requiring PRBC (in 25% of the non-VAD-related NCS). We saw excellent 30 day survival of the patients with non-VAD-related NCS (97%). The 30 day survival of patients with VAD-related NCS was 73%. One stroke occurred after a pacemaker battery exchange. Infection occurred in 11%. There were no technical VAD problems.
Conclusion NCS is not uncommon during VAD therapy. Four aspects have to be considered: team approach on a 24 h basis, perioperative VAD power supply, and appropriate hemodynamic and anticoagulation management. In our experience, non-cardiac surgery in LVAD recipients is feasible without significant morbidity or mortality.
- © 2012 by American Heart Association, Inc.