Is it Safe for Patients with Left Ventricular Assist Devices to Undergo Non-Cardiac Surgery?

Berger, Rafal; Németh, Attila; Salewski, Christoph; Boburg, Rodrigo Sandoval; Acharya, Metesh; Weymann, Alexander; Zhigalov, Konstantin; Schmack, Bastian; Schlensak, Christian; Popov, Aron‐Frederik

doi:10.3390/medicina56090424

Cited by 3 publications

(17 citation statements)

References 22 publications

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“…The HM II was the first device approved for destination therapy (DT) [2,4,15,16,18]. Rates of stroke, bleeding, infection, and device malfunction were less than its predecessors [1,4].…”

Section: Second Generation Devicesmentioning

confidence: 99%

“…Table 2 displays normal values for the three continuous flow LVADs currently in use or available for implantation [3,11,18,24] .Since the LVAD is essentially a conduit bypassing the left ventricle, it is entirely possible that the aortic valve does not routinely open. Any pulsatility that does occur is not the result of ventricular ejection through the aortic valve, per se.…”

Section: External Components Of the Lvadmentioning

confidence: 99%

“…Normal value ranges of LVAD devices for speed (rotations per minute (rpm)), flow, and power [3,10,18,24].…”

Section: Tablementioning

confidence: 99%

“…GI bleeds occur in around 30% of patients with LVADs [2,8,[16][17][18]. Upper GI bleeds are more common than lower GI bleeds [3,11].…”

Section: Gastrointestinal Bleedingmentioning

confidence: 99%

“…As people are living longer with LVADs, other health issues may arise that require surgical intervention and therefore the need for anesthesia [15,20]. 15-20% of LVAD patients present for non-cardiac surgery (NCS), whether elective or urgent/emergent [7,18]. In one study held in Europe from 2012 to 2019, within 60% of LVAD patients who had surgical interventions, 39% of procedures were unplanned and 61% were elective [18].…”

Section: Perioperative Considerations For Lvad Patients Undergoing No...mentioning

confidence: 99%

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Anesthesia for Non-Cardiac Surgery for the LVAD Patient

Kathryn¹,

Silvonek²

2023

Updates in Anesthesia - The Operating Room and Beyond

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Heart failure is poorly tolerated and end stage heart failure (classified as New York Heart Association (NYHA) class IV) has a two-year survival with medical therapy that approaches 0%. Innovation in this sphere has yielded mechanical therapies, principally the left ventricular assist device (LVAD). In the last decade one-year survival rates of Left ventricular assist device patients have increased from 52–83%. As this therapy is more commonly used to treat advanced heart failure, coupled with the increase in patient survival after implantation, patients are increasingly encountered in the peri-operative arena requiring anesthesia for non-cardiac surgeries. The goal of this chapter is to provide the non-cardiac trained anesthesia provider a primer on what an LVAD is, how it functions, the physiological changes that occur with implantation, and considerations for administering anesthesia to patients with LVADs for non-cardiac surgery. Review of articles from 2018 to 2022 found from a search on PubMed and Google Scholar using the keywords: “Left Ventricular Assist Device”, “LVAD”, “anesthesia”, “non-cardiac surgery”, “Doppler blood pressure measurement”, “VAD coordinator”. Non-cardiac trained anesthesia providers can safely administer the anesthetics to LVAD patients undergoing non-cardiac surgery as long as appropriate considerations are taken.

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“…The HM II was the first device approved for destination therapy (DT) [2,4,15,16,18]. Rates of stroke, bleeding, infection, and device malfunction were less than its predecessors [1,4].…”

Section: Second Generation Devicesmentioning

confidence: 99%

Section: External Components Of the Lvadmentioning

confidence: 99%

“…Normal value ranges of LVAD devices for speed (rotations per minute (rpm)), flow, and power [3,10,18,24].…”

Section: Tablementioning

confidence: 99%

“…GI bleeds occur in around 30% of patients with LVADs [2,8,[16][17][18]. Upper GI bleeds are more common than lower GI bleeds [3,11].…”

Section: Gastrointestinal Bleedingmentioning

confidence: 99%

Section: Perioperative Considerations For Lvad Patients Undergoing No...mentioning

confidence: 99%

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Anesthesia for Non-Cardiac Surgery for the LVAD Patient

Kathryn¹,

Silvonek²

2023

Updates in Anesthesia - The Operating Room and Beyond

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Outcomes after noncardiac surgery in patients with left ventricular assist devices: a systematic review

Alamouti-Fard,

Garg,

Yazji

et al. 2024

Front. Cardiovasc. Med.

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BackgroundThe number of patients living with left ventricular assist devices (LVADs) has gradually increased in the past decade. Non-cardiac surgery (NCS) in patients with LVAD poses a unique situation with its inherent challenges.AimWe conducted a comprehensive review to investigate the perioperative complications and mortality associated with emergent or elective NCS in patients with LVAD.MethodA comprehensive literature search for any papers referring to continuous LVAD patients with NCS. All publications with at least five durable LVAD patients who had NCS were eligible for inclusion.ResultTwenty articles matching our criteria were found and included in our study. This systematic review included 6,476 LVAD patients who underwent 6,824 NCS. There were 5–3,216 LVAD patients with NCS in each study. The median age was between 39 and 65 years, and most of the patients (78.8%) were male. Thirty-day postoperative mortality ranged from 0% to 60%. Eight studies reported no death within the 30 days of the operation. Common complications include gastrointestinal (GI) bleeding, intracranial bleeding, infection, acute kidney injury (AKI), urinary tract infection (UTI), stroke, sepsis, pneumonia, and VAD exchange. Emergent abdominal surgery had the highest (up to 60%) mortality rate, and vascular and neurological operations had the highest complication rates. Due to the diverse range of patients in each publication and the combination of outcomes presented in various publications, a meta-analysis was not conducted.ConclusionIn LVAD patients, noncardiac surgery may be performed effectively and safely. LVAD patients who undergo non-cardiac surgery may require more transfusions due to their complex coagulopathies. However, perioperative management of LVAD patients undergoing emergent NCS should be optimized to reduce mortality.Systematic Review Registrationhttps://osf.io/fetsb/.

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Quality Improvement in Anesthetic Management of Patients with Left Ventricular Assist Device Support Presenting for Non-Cardiac Surgery: A Single Center Experience

Yahav-Shafir,

Schmelczer,

Frogel

et al. 2024

JCM

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With the growing number of left ventricular assist device (LVAD) recipients requiring non-cardiac surgery and the limited availability of cardiac anesthesiologists, our study reviewed non-cardiac surgeries in HeartMate III patients with LVAD at our institution. We focused on anesthesiologist roles, detailing patient characteristics, anesthetic management, and outcomes and identifying improvement opportunities in this specialized care setting. A retrospective chart review was conducted of all patients with LVAD who underwent non-cardiac surgery at our institution between 2017 and 2022. Patient demographics, surgical characteristics, anesthetic management, and 30-day mortality rates were also assessed. A total of 23 patients were identified, with 17 (73.9%) males and a median age of 61 [53.5, 67.5] years. Cardiac anesthesiologists were present in nine (39.1%) cases. Elective surgeries were more common (73.9%), with intermediate-risk surgeries accounting for 52.2% of all surgeries. General anesthesia was administered to 18 patients (78.3%), with a median duration of 40 [24, 63.5] min. A single patient required reoperation because of bleeding, and two patients (8.7%) experienced 30-day mortality. Despite guidelines lacking detail, involving non-cardiac anesthesiologists in certain cases is essential. Sharing our experience aims to enhance the evolving discourse on non-cardiac surgeries for patients with LVAD, improving their outcomes and safety.

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Is it Safe for Patients with Left Ventricular Assist Devices to Undergo Non-Cardiac Surgery?

Cited by 3 publications

References 22 publications

Anesthesia for Non-Cardiac Surgery for the LVAD Patient

Anesthesia for Non-Cardiac Surgery for the LVAD Patient

Outcomes after noncardiac surgery in patients with left ventricular assist devices: a systematic review

Quality Improvement in Anesthetic Management of Patients with Left Ventricular Assist Device Support Presenting for Non-Cardiac Surgery: A Single Center Experience

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