Outcome of Noncardiac Surgery in Patients With Ventricular Assist Devices

Stehlik, Josef; Nelson, Debra L.; Kfoury, Abdallah G.; Reid, B.B.; Clayson, Stephen E.; Nelson, Karl E.; Christensen, Brent J.; Renlund, Dale G.; Movsesian, Matthew A.; Cowley, Cris G.; Smith, H.K.; Rasmusson, B.Y.; Long, James W.

doi:10.1016/j.amjcard.2008.11.021

Cited by 56 publications

(54 citation statements)

References 11 publications

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“…6 Although open partial 9 and open radical nephrectomy 10 have been described, this is the first report of laparoscopic renal surgery in a patient supported with an HMII LVAD. Although there is growing interest in less invasive, nephron-sparing techniques, their efficacy is not established and nephroureterectomy continues to serve as the gold standard for the treatment of upper tract TCC.…”

Section: Discussionmentioning

confidence: 99%

“…5 A substantial proportion of these patients require surgical management of non-cardiac disease. 6 The upper abdominal, pre-peritoneal location of the HeartMate II (HMII) LVAD (Thoratec Corp, Pleasanton, CA) precludes extension of median or paramedian incisions (Fig. 1); 7 however, literature regarding the safety and feasibility of laparoscopic surgery in patients supported with this device is limited (Table 1).…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic nephroureterectomy in a patient with a left ventricular assist device

Nayak

White

Nates

et al. 2013

CUAJ

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Left ventricular assist device (LVAD) therapy is an established treatment option for select patients with advanced heart failure. Advances in technology and patient management have resulted in improved post-implant outcomes. Consequently, more patients with LVADs are presenting for evaluation and care of non-cardiac surgical disease. However, there is a paucity of literature regarding the optimal perioperative and surgical management of such patients. We present the case of a 71-year-old male with a HeartMate II (Thoratec Corporation, Pleasanton, CA) LVAD, who underwent a laparoscopic left nephroureterectomy for an upper urinary tract transitional cell carcinoma. His perioperative course was uneventful due to the multidisciplinary efforts of cardiac surgery, cardiac anesthesia, nephrology and urology. To our knowledge, this is the first reported case of a laparoscopic nephroureterectomy in a patient with a HeartMate II LVAD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Laparoscopic nephroureterectomy in a patient with a left ventricular assist device

Nayak

White

Nates

et al. 2013

CUAJ

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“…A previous study identified major postoperative bleeding as the main problem in smaller procedures, such as cholecystectomy, appendectomy and tracheostomy, where heparin was held perioperatively without clotting complications. 6 Another study claimed that patients with LVADs tolerated smaller procedures with perioperative discontinuation of AC with tolerable thromboembolic risk. 7 Contrary to these cases with favorable outcomes, Ficke et al describe a patient with LVAD, who underwent an uneventful cystoscopy, but, shortly thereafter, went into cardiac arrest with fatal outcome.…”

Section: Discussionmentioning

confidence: 99%

Dangerous surgical scavenger hunt: the complicated course of a patient with left ventricular assist device and end-stage renal disease undergoing reconstructive flap surgery

et al. 2014

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Patients with left ventricular assist devices (LVADs) who develop stage IV sacral pressure sores (SPS) have an increased procedural risk. We present the complications, including severe intra- and postoperative bleeding, diarrhea with metabolic acidosis, volume loss and acute on chronic renal failure, flap dehiscence and late LVAD outflow cannula thrombosis, in a 54-year-old male who underwent diverting ileostomy (DI) and subsequent fasciocutaneous flap (FCF) surgery for stage IV SPS while supported with an LVAD. Our experience suggests that, despite continuous heparinization, life-threatening thrombotic complications, such as device clotting, can occur. Therefore, the benefit of intervention has to outweigh the risk of bleeding, which should be managed with meticulous surgical technique and substitution of red blood cells rather than the reversal of heparinization or the substitution of clotting factors. Continuation of double anti-platelet therapy should also be considered.

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“…Patienten mit einem VAD unterziehen sich in einer steigenden Anzahl von Fällen nichtkardiochirurgischen operativen Eingriffen, 4-42% der VAD-Patienten werden im Verlauf nach der initialen Implantation des VAD mit nichtkardiochirurgischen Operationsindikationen operiert [3,4,5,6,7,8]. Hieraus ergibt sich ein wichtiges und klinisch relevantes Thema für das anästhesiologische Management dieser Patienten.…”

Section: Managementkonzepte In Der Anästhesieunclassified

“…Das anästhesiologische Management für nichtkardiochirurgische operative Eingriffe bei VAD-Patienten stellt eine Herausforderung dar, da diese Patienten einer Hochrisikopatientengruppe angehören und verschiedene VAD-abhängige Komplikationen zu beachten sind, wie ein erhöhtes Blutungs-und Thromboserisiko [13,14], Hypotension [5], Koagulopathie [8], Infektionen [3,8] sowie Limitationen durch das linksventrikuläre Assist-System [5,8] und Rechtsherzversagen [13].…”

Section: Managementkonzepte In Der Anästhesieunclassified

Nichtkardiochirurgische operative Eingriffe bei Patienten nach Implantation eines „ventricular assist device“

Blum

2014

Med Klin Intensivmed Notfmed

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Outcome of Noncardiac Surgery in Patients With Ventricular Assist Devices

Cited by 56 publications

References 11 publications

Laparoscopic nephroureterectomy in a patient with a left ventricular assist device

Laparoscopic nephroureterectomy in a patient with a left ventricular assist device

Dangerous surgical scavenger hunt: the complicated course of a patient with left ventricular assist device and end-stage renal disease undergoing reconstructive flap surgery

Nichtkardiochirurgische operative Eingriffe bei Patienten nach Implantation eines „ventricular assist device“

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