Outcome of Noncardiac Surgery in Patients With Ventricular Assist Devices

• Published in: The American journal of cardiology 2009-03, Vol.103 (5), p.709-712
• Main Authors: Stehlik, Josef, MD, MPH, Nelson, Devin M., BS, Kfoury, Abdallah G., MD, Reid, Bruce B., MD, Clayson, Stephen E., MD, Nelson, Karl E., BS, MBA, Christensen, Brent J., MD, Renlund, Dale G., MD, Movsesian, Matthew A., MD, Cowley, Cris G., MD, Smith, Hildegard K., MD, Rasmusson, Brad Y., MD, Long, James W., MD, PhD
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Heart surgery; Heart Transplantation; Heart-Assist Devices - adverse effects; Humans; Intensive care medicine; Intraoperative Care; Male; Medical sciences; Middle Aged; Mortality; Postoperative Complications; Preoperative Care; Studies; Surgical Procedures, Operative - mortality; Transplants & implants; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2008.11.021

An increasing number of patients are living with ventricular assist devices (VADs). Many of these patients will require noncardiac surgery for conditions not directly related to their VADs. The aim of this study was to assess the risks and outcomes of noncardiac surgery in these patients. Perioperative and follow-up data from patients with VADs who underwent noncardiac surgery from 1993 to 2006 were analyzed. In that period, 184 VADs were implanted in 155 patients. Thirty-seven patients (24%) subsequently underwent 59 noncardiac surgeries. The mean duration of VAD support before surgery was 229 days. Bleeding was the most common postsurgical complication (10%), necessitating reexploration in 20% of abdominal surgeries. Thirty-day mortality was 12%. No deaths were caused by direct complications of surgery. Successful transplantation occurred in 72% of bridge to transplantation patients who required noncardiac surgery, compared with 71% of these patients who did not require noncardiac surgery (relative risk 1.0, p = 0.9). The average duration of VAD support after noncardiac surgery for destination therapy patients was 324 days, most of which time was spent at home. In conclusion, outcomes after noncardiac surgery in patients with VADs are favorable, and most patients continue to benefit from the intended purpose of mechanical circulatory support after recovering from noncardiac surgery.