Patients with left ventricle assist devices presenting for thoracic surgery and lung resection: tips, tricks and evidence

Abstract

Purpose of review Over a thousand left ventricular-assist device (LVAD) implants were performed for heart failure destination therapy in 2017. With increasing survival, we are seeing increasing numbers of patients present for noncardiac surgery, including resections for cancer. This article will review the relevant literature and guidelines for patients with LVADs undergoing thoracic surgery, including lung resection. Recent findings The International Society for Heart and Lung Transplant Mechanically Assisted Circulatory Support Registry has received data on more than 16 000 patients with LVADs. Four-year survival is more than 60% for centrifugal devices. There are increasing case reports, summaries and recommendations for patients with LVADs undergoing noncardiac surgery. However, data on thoracic surgery is restricted to case reports. Summary Successful thoracic surgery requires understanding of the LVAD physiology. Modern devices are preload dependent and afterload sensitive. The effects of one-lung ventilation, including hypoxia and hypercapnia, may increase pulmonary vascular resistance and impair the right ventricle. Successful surgery necessitates a multidisciplinary approach, including thorough preoperative assessment; optimization and planning of intraoperative management strategies; and approaches to anticoagulation, right ventricular failure and LVAD flow optimization. This article discusses recent evidence on these topics.

The rise of organ donation after circulatory death: a narrative review

“…3) [8]. Other types of organ failure do not have ready access to a transplant alternative, though progress with cardiac mechanical assist devices is proving to be a lifesaving bridge to transplantation [9]. The impact of improvements in deceased donation can be seen through the change in mortality on the transplant waiting list and time on the waiting list before transplant (Table 1).…”