Perioperative Management of Patients With Left Ventricular Assist Devices Undergoing Noncardiac Procedures: A Survey of Current Practices

Sheu, Richard; Joshi, Brijen; High, Kane M.; Pham, Duc Thinh; Ferreira, Renata G.; Cobey, Frederick C.

doi:10.1053/j.jvca.2014.07.001

Cited by 29 publications

(26 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…13 Much of this has been attributed to the increase in minor NCS procedures, most notably those in the endoscopy suite. 37,38,56 However, our study offers caution in this regard. As we observed intraoperative blood pressure monitoring gaps >20 minutes in a majority of cases despite anesthesiologist attempts to obtain blood pressure measurements or document vital organ perfusion, opportunities for unrecognized hypotension were common.…”

Section: Discussionmentioning

confidence: 75%

“…As has been investigated in previous similar studies, the involvement of a cardiac anesthesia provider, defined by faculty appointment and practice pattern within the cardiac anesthesia division of our department, was included as a study variable. 13,38 To account for evolving trends in LVAD management over the study period, the year of surgery, type of LVAD, and duration since LVAD placement were also included as study variables. Perioperative complications studied included those known to the ventricular assist device population (Table 2).…”

Section: Methodsmentioning

confidence: 99%

“…Calls for such a study have been made, as identifying perioperative risk factors would provide a valuable evidence basis for clinical decision making in this uniquely high-risk population. 38 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Complications, Risk Factors, and Staffing Patterns for Noncardiac Surgery in Patients with Left Ventricular Assist Devices

et al. 2017

View full text Add to dashboard Cite

Background Patients with left ventricular assist devices presenting for noncardiac surgery are increasingly commonplace; however, little is known about their outcomes. Accordingly, the authors sought to determine the frequency of complications, risk factors, and staffing patterns. Methods The authors performed a retrospective study at their academic tertiary care center, investigating all adult left ventricular assist device patients undergoing noncardiac surgery from 2006 to 2015. The authors described perioperative profiles of noncardiac surgery cases, including patient, left ventricular assist device, surgical case, and anesthetic characteristics, as well as staffing by cardiac/noncardiac anesthesiologists. Through univariate and multivariable analyses, the authors studied acute kidney injury as a primary outcome; secondary outcomes included elevated serum lactate dehydrogenase suggestive of left ventricular assist device thrombosis, intraoperative bleeding complication, and intraoperative hypotension. The authors additionally studied major perioperative complications and mortality. Results Two hundred and forty-six patients underwent 702 procedures. Of 607 index cases, 110 (18%) experienced postoperative acute kidney injury, and 16 (2.6%) had elevated lactate dehydrogenase. Of cases with complete blood pressure data, 176 (27%) experienced intraoperative hypotension. Bleeding complications occurred in 45 cases (6.4%). Thirteen (5.3%) patients died within 30 days of surgery. Independent risk factors associated with acute kidney injury included major surgical procedures (adjusted odds ratio, 4.4; 95% CI, 1.1 to 17.3; P = 0.03) and cases prompting invasive arterial line monitoring (adjusted odds ratio, 3.6; 95% CI, 1.3 to 10.3; P = 0.02) or preoperative fresh frozen plasma transfusion (adjusted odds ratio, 1.7; 95% CI, 1.1 to 2.8; P = 0.02). Conclusions Intraoperative hypotension and acute kidney injury were the most common complications in left ventricular assist device patients presenting for noncardiac surgery; perioperative management remains a challenge.

show abstract

Section: Discussionmentioning

confidence: 75%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Complications, Risk Factors, and Staffing Patterns for Noncardiac Surgery in Patients with Left Ventricular Assist Devices

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Sie sollten möglichst an Zentren versorgt werden, die über ausreichend Erfahrung und ein VAD-Kardiotechnikerteam verfügen. Ein invasives Monitoring ist vielfach notwendig, wobei sich gezeigt hat, dass bei nichtkardiochirurgischen Eingriffen die Verwendung des invasiv-arteriellen (und auch invasiv-zentralvenösen) Monitorings invers mit der Erfahrung des Ärzteteams im Umgang mit LVAD-Patienten korreliert [6,25].…”

Section: Aufnahme Nach Nichtkardiochirurgischen Oder Diagnostischen Eunclassified

Intensivbehandlung von Kranken mit Linksherzersatz

Steinlechner¹,

Zimpfer

Schiferer³

et al. 2015

Med Klin Intensivmed Notfmed

View full text Add to dashboard Cite

Apart from heart transplantation, implantation of a left ventricular assist device (LVAD) is the only established surgical treatment for therapy-refractory terminal left heart failure, The specific intensive care unit (ICU) management of these patients depends on the reason for the ICU admission and requires understanding of the characteristic hemodynamics of non-pulsatile LVADs as well as of the inherent problems. Knowledge about the specific features in hemodynamic monitoring, understanding of pump characteristics, management of anticoagulation and hemostasis and the handling of problems, such as right heart failure, aortic valve insufficiency and infections is essential. The management of unconscious LVAD patients can be challenging. It requires a sophisticated transthoracic and transesophageal echocardiography (TTE/TEE) examination, targeted laboratory diagnostics and consideration of possible alternative diagnoses. Professional interdisciplinary cooperation and exchange of current knowledge is crucial.

show abstract

“…Heart failure, or cardiomyopathy (CMP), is a disease that affects approximately 5.1 million patients in the United States and millions more worldwide 1 . The American Heart Association defines CMP as “a serious disease in which the heart muscle becomes inflamed and weakened.” 2 Cardiomyopathy is further defined as myocardial disease related to mechanical or electrical dysfunction that causes ventricular dilation 3 .…”

mentioning

confidence: 99%

Ventricular Assist Device Implantation: Perioperative Nursing Considerations

Nowotny

Boner

Maltais³

2016

AORN Journal

View full text Add to dashboard Cite

Treatment for patients in end-stage heart failure has been revolutionized by the development of the ventricular assist device (VAD), an implantable heart pump used for long-term mechanical circulatory support. These devices are now small, lightweight, and efficient continuous-flow pumps that have replaced the larger, heavier, fill-to-empty predecessors. Management of the VAD case requires interdisciplinary effort across a diverse continuum of care and an understanding of new implantation techniques. This article describes current advances in VAD technology, indications for use, and perioperative nursing considerations related to patients who have undergone VAD implantation.

show abstract

Perioperative Management of Patients With Left Ventricular Assist Devices Undergoing Noncardiac Procedures: A Survey of Current Practices

Cited by 29 publications

References 22 publications

Complications, Risk Factors, and Staffing Patterns for Noncardiac Surgery in Patients with Left Ventricular Assist Devices

Complications, Risk Factors, and Staffing Patterns for Noncardiac Surgery in Patients with Left Ventricular Assist Devices

Intensivbehandlung von Kranken mit Linksherzersatz

Ventricular Assist Device Implantation: Perioperative Nursing Considerations

Contact Info

Product

Resources

About