Management of LVAD Patients for Noncardiac Surgery: A Single-Institution Study

Nelson, Eric; Heinke, Timothy; Finley, Alan; Guldan, George J.; Gaddy, Parker; O’Toole, John M.; Mims, Ryan; Abernathy, James H.

doi:10.1053/j.jvca.2015.01.027

Cited by 29 publications

(29 citation statements)

References 11 publications

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“…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. Our study suggests a need for improved blood pressure monitoring for detection and treatment of hypotension in LVAD patients, and sheds light on prior conflicting literature either supporting 9,37 or refuting 14,56 this concept.…”

Section: Discussionsupporting

confidence: 52%

“…Our provider-specific findings should be interpreted with caution, as the extent of cardiac anesthesiologist involvement continues to vary widely among institutions, due to a lack of consensus on LVAD patient management as well as intra- and inter-institutional variation in anesthesia provider skills and experience. 13,14,37 …”

Section: Discussionmentioning

confidence: 99%

“…14,56 This may relate to differences in monitor type, patient and surgical characteristics, and anesthetic management. In particular, the use of a Doppler probe with a manual sphygomomanometer, as well as a slow-deflation cuff (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…However, owing to illness and complications, related or unrelated to LVAD therapy, patients have inevitably presented for a wide array of non-cardiac surgeries. 3–14 …”

Section: Introductionmentioning

confidence: 99%

“…3–5,7–14,17,18,22,35–37 Profiles of this patient population have been described in terms of surgical procedure type, admission status, elective versus urgent/emergent status, as well as frequency of complications. Although complications have been described, studies have been limited in sample size, with the largest study to date comprising 271 adult cases, 13 and have been greatly underpowered when investigating adverse event frequency.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…However, owing to illness and complications, related or unrelated to LVAD therapy, patients have inevitably presented for a wide array of non-cardiac surgeries. 3–14 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Trends, Perioperative Adverse Events, and Survival of Patients With Left Ventricular Assist Devices Undergoing Noncardiac Surgery

et al. 2020

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Key Points Question What are the trends, perioperative adverse events, and mortality associated with noncardiac surgery in patients with left ventricular assist devices (LVADs)? Findings In this cohort study, of 8118 Medicare patients who had an LVAD, 16.3% underwent noncardiac surgery during follow-up. Major adverse cardiovascular events, defined as in-hospital or 30-day all-cause mortality, ischemic stroke, or intracerebral bleeding, occurred in 16.9% of patients who underwent emergent or urgent procedures and in 7.1% of patients who underwent elective procedures. Meaning A substantial proportion of patients with LVADs underwent noncardiac surgery and experienced major perioperative adverse events.

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HFA of the ESC position paper on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider Part 3: at the hospital and discharge

et al. 2021

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The growing population of left ventricular assist device (LVAD)‐supported patients increases the probability of an LVAD‐ supported patient hospitalized in the internal or surgical wards with certain expected device related, and patient‐device interaction complication as well as with any other comorbidities requiring hospitalization. In this third part of the trilogy on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider, definitions and structured approach to the hospitalized LVAD‐supported patient are presented including blood pressure assessment, medical therapy of the LVAD supported patient, and challenges related to anaesthesia and non‐cardiac surgical interventions. Finally, important aspects to consider when discharging an LVAD patient home and palliative and end‐of‐life approaches are described.

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Management of LVAD Patients for Noncardiac Surgery: A Single-Institution Study

Cited by 29 publications

References 11 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

Trends, Perioperative Adverse Events, and Survival of Patients With Left Ventricular Assist Devices Undergoing Noncardiac Surgery

HFA of the ESC position paper on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider Part 3: at the hospital and discharge

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