Noncardiac surgery in long-term implantable left ventricular assist-device recipients

Daniel J. Goldstein, Samantha M. Jansson, Ellise S. Delphin, Nabeel El-Amir, Robert C. Ashton, Michael Gardocki, Desmond A. Jordan, Katharine A. Catanese, Howard R. Levin, Eric A. Rose, Mehmet C. Oz

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Objective: The authors describe their experience with left ventricular assist-device (LVAD) recipients undergoing noncardiac surgery and delineate surgical, anesthetic, and logistic factors important in the successful intraoperative management of these patients. Summary Background Data: Left ventricular assist-devices have become part of the armamentarium in the treatment of end-stage heart failure. As the numbers of patients chronically supported with long-term implantable devices grows, general surgical problems that are commonly seen in other hospitalized patients are becoming manifest. Of particular interest is the intraoperative management of patients undergoing elective noncardiac surgical procedures. Methods: The anesthesia records and clinical charts were reviewed for eight ventricular assist-device recipients undergoing general surgical procedures between August 1, 1990 and August 31, 1994. Results: A total of 12 procedures were performed in 6 men and 2 women averaging 52.7 years of age. Mean time elapsed from device implantation to operation was 68 ± 35 days. Conventional inhalational and intravenous anesthetic techniques were well tolerated in these patients undergoing diverse surgical procedures. No perioperative mortality was observed. Five of eight patients went on to successful cardiac transplantation. Conclusions: Hemodynamic recovery after LVAD insertion has defined a new group of patients who develop noncardiac surgical problems often seen in other critically ill patients. Recognition of the unique potential problems that the LVAD recipient may encounter in the perioperative period - in particular patient positioning, device limitations, and fluid and inotropic management - will ensure an optimal surgical outcome for LVAD recipients undergoing noncardiac surgery.

Original languageEnglish (US)
Pages (from-to)203-207
Number of pages5
JournalAnnals of Surgery
Volume222
Issue number2
StatePublished - Aug 1995
Externally publishedYes

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Heart-Assist Devices
Equipment and Supplies
Elective Surgical Procedures
Intravenous Anesthetics
Patient Positioning
Perioperative Period
Heart Transplantation
Critical Illness
Anesthetics
Anesthesia
Heart Failure
Hemodynamics
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Noncardiac surgery in long-term implantable left ventricular assist-device recipients. / Goldstein, Daniel J.; Jansson, Samantha M.; Delphin, Ellise S.; El-Amir, Nabeel; Ashton, Robert C.; Gardocki, Michael; Jordan, Desmond A.; Catanese, Katharine A.; Levin, Howard R.; Rose, Eric A.; Oz, Mehmet C.

In: Annals of Surgery, Vol. 222, No. 2, 08.1995, p. 203-207.

Research output: Contribution to journalArticle

Goldstein, DJ, Jansson, SM, Delphin, ES, El-Amir, N, Ashton, RC, Gardocki, M, Jordan, DA, Catanese, KA, Levin, HR, Rose, EA & Oz, MC 1995, 'Noncardiac surgery in long-term implantable left ventricular assist-device recipients', Annals of Surgery, vol. 222, no. 2, pp. 203-207.
Goldstein, Daniel J. ; Jansson, Samantha M. ; Delphin, Ellise S. ; El-Amir, Nabeel ; Ashton, Robert C. ; Gardocki, Michael ; Jordan, Desmond A. ; Catanese, Katharine A. ; Levin, Howard R. ; Rose, Eric A. ; Oz, Mehmet C. / Noncardiac surgery in long-term implantable left ventricular assist-device recipients. In: Annals of Surgery. 1995 ; Vol. 222, No. 2. pp. 203-207.
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