Perioperative management of a patient with an axial-flow rotary ventricular assist device for laparoscopic ileo-colectomy

Sathishkumar, Subramanian; Kodavatiganti, Ramesh; Plummer, Sandi; High, Kane M.

doi:10.4103/0970-9185.92456

Cited by 17 publications

(34 citation statements)

References 14 publications

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“…The device itself also depends upon several physiologic variables. The output of second- and third-generation devices is directly related to pump speed and inversely related to the pressure gradient across the pump [ 10 , 16 , 20 ]. These devices have continuously rotating impellers which continue to pump at a fixed speed regardless of their environment.…”

Section: Introductionmentioning

confidence: 99%

Ventricular assist devices and non-cardiac surgery

et al. 2015

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The use of ventricular assist devices has expanded significantly since their approval by the Food and Drug Administration in the United States in 1994. In addition to this, the prevalence of heart failure continues to increase. We aim to provide an overview of perioperative considerations and management of these patients for non-cardiac surgery. We performed a Medline search for the words “ventricular assist device,” “Heartmate” and “HeartWare” to gain an overview of the literature surrounding these devices, and chose studies with relevance to the stated aims of this review. Patients with ventricular assist devices are presenting more frequently for surgery not related to their cardiac pathology. As the mechanically supported population grows, general anesthesiologists will be faced with managing these patients, possibly outside of the tertiary care setting. The unique challenges of this patient population can best be addressed by a thorough understanding of ventricular assist device physiology and a multidisciplinary approach to care.

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Section: Introductionmentioning

confidence: 99%

Ventricular assist devices and non-cardiac surgery

et al. 2015

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“…However, OLV could lead to higher PVR, induced by possible complications such as hypoxemia and hypercarbia, where the RV encounters sudden changes in afterload, preload, and contractility [14]. Therefore, based on the findings of previous studies [3][4][5][6][7][8][9][10], the management of LVAD-supported patients for VATS may be more challenging than that of LVAD-supported patients undergoing noncardiac surgeries, as there may be sudden OLVassociated, deteriorative RV function.…”

Section: Discussionmentioning

confidence: 99%

“…Left ventricular assist devices (LVADs) are gaining popularity as a viable treatment, and patients with LVADs survive for many years; consequently, such patients who require noncardiac surgery are becoming increasingly common [1,2]. The management of LVAD-supported patients for noncardiac surgery presents many challenges, and case reports of patients with LVADs who underwent several different types of noncardiac surgeries have been published [3][4][5][6][7][8][9][10]. However, none of these cases reported the perioperative management of video-assisted thoracic surgery (VATS).…”

Section: Introductionmentioning

confidence: 99%

Anesthetic management of a patient with a continuous-flow left ventricular assist device for video-assisted thoracoscopic surgery: a case report

Iwata

Yokokawa

et al. 2020

BMC Anesthesiol

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Background: As patients with left ventricular assist device (LVAD) have long expected survival, the incidence of noncardiac surgery in this patient population is increasing. Here, we present the anesthetic management of a patient with a continuous-flow LVAD who underwent video-assisted thoracic surgery (VATS). Case presentation: A 37-year-old man with LVAD was scheduled to undergo VATS because of repeated spontaneous pneumothorax. Generally, patients with these devices have marginal right heart function; therefore, it is important to avoid factors that worsen pulmonary vascular resistance (PVR). However, VATS requires one-lung ventilation (OLV) and it tends to cause increase in PVR, leading to right heart failure. In the present case, when the patient was set in a lateral decubitus position and progressive hypoxia was observed during OLV, transesophageal echocardiography demonstrated a dilated right ventricle and a temporally flattened interventricular septum, and the central venous pressure increased to approximately 20 mmHg. Because we anticipated deterioration of right heart function, dobutamine and milrinone were administered and/or respirator settings were changed to decrease PVR for maintaining LVAD performance. Finally, resection of a bulla was completed, and the patient was discharged in stable condition on postoperative day 37. Conclusions: The anesthetic management of a patient with LVAD during VATS is challenging because the possible hemodynamic changes induced by hypoxia associated with OLV affect LVAD performance and right heart function. In our experience, VATS that requires OLV will be well tolerated in a patient with LVAD with preserved right heart function, and a multidisciplinary approach to maintain right heart function will be needed.

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“…2 To date there are 25 previously reported cases of laparoscopic surgery successfully performed on patients with VADs, with seven of these procedures being laparoscopic cholecystectomy. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] During abdominal operations, certain precautions can be taken to improve the safety of patients with VADs. The use of imaging, such as fluoroscopy, can help to identify the locations of the VAD and its associated drive wires.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Cholecystectomy in Patients with HeartMate II Left Ventricular Assist Devices

Eck

Belli

Smith

et al. 2014

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Laparoscopic cholecystectomy can be performed safely on patients with ventricular assist devices. Complications due to damage to the device can be avoided with the assistance of fluoroscopy to identify the implanted abdominal portions of the ventricular assist device. Each laparoscopic procedure performed on these patients presents the surgeon with unique obstacles in which careful operative planning and intraoperative monitoring are essential.

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Perioperative management of a patient with an axial-flow rotary ventricular assist device for laparoscopic ileo-colectomy

Cited by 17 publications

References 14 publications

Ventricular assist devices and non-cardiac surgery

Ventricular assist devices and non-cardiac surgery

Anesthetic management of a patient with a continuous-flow left ventricular assist device for video-assisted thoracoscopic surgery: a case report

Laparoscopic Cholecystectomy in Patients with HeartMate II Left Ventricular Assist Devices

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