Safety and Feasibility of Laparoscopic Abdominal Surgery in Patients With Mechanical Circulatory Assist Devices

Abstract

Objectives Increasing number of mechanical circulatory assist devices (MCADs) are being placed in heart failure patients. Morbidity from device placement is high and the outcome of patients who require noncardiac surgery after, is unclear. As laparoscopic interventions are associated with decreased morbidity, we examined the impact of such procedures in these patients. Methods A retrospective review was conducted on 302 patients who underwent MCAD placement from 2005 to 2012. All laparoscopic abdominal surgeries were included and impact on postoperative morbidity and mortality studied. Results Ten out of 16 procedures were laparoscopic with 1 conversion to open. Seven patients had a HeartMate II, 2 had Total Artificial Hearts, and 1 had CentriMag. Four patients had devices for ischemic cardiomyopathy and 6 cases were emergent. Surgeries included 6 laparoscopic cholecystectomies, 2 exploratory laparoscopies, 1 laparoscopic colostomy takedown, and 1 laparoscopic ventral hernia repair with mesh. Median age of the patients was 63 years (range, 29-79 years). Median operative time was 123 minutes (range, 30-380 minutes). Five of 10 patients were on preoperative anticoagulation with average intraoperative blood loss of 150 mL (range, 20-700 mL). There were 3 postoperative complications; acute respiratory failure, acute kidney injury and multisystem organ failure resulting in death not related to the surgical procedure. Conclusion The need for noncardiac surgery in post-MCAD patients is increasing due to limited donors and due to more durable and longer support from newer generation assist devices. While surgery should be approached with caution in this high-risk group, laparoscopic surgery appears to be a safe and successful treatment option.

Laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis in a patient with a left ventricle assist device: A case report and brief review of the literature (with video)

“…However, previous reports suggest that a pneumoperitoneum at 10-15 mmHg is also acceptable (Table 1). 6,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] There are currently nine case reports and seven case series in the literature, including 32 cases that described LC (Table 1). Of the 42 total cases (including the presented case), only one case (2.4%) converted to open surgery.…”

“…However, previous reports suggest that a pneumoperitoneum at 10–15 mmHg is also acceptable (Table 1). 6,10–24 …”

“…However, previous reports suggest that a pneumoperitoneum at 10–15 mmHg is also acceptable (Table 1 ). 6 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 …”

Emergency laparoscopic cholecystectomy for intraabdominal hemorrhage in a patient with a left ventricular assist device: a case report

“…This case further supports the usefulness of laparoscopic approach for avoiding driveline injury in patients with LVADs. There are currently three case reports [3–5] and three case series including four to six cases [6–8] (Table 1) on laparoscopic cholecystectomy (LC) in patients with an LVAD. There were no cases of conversion to open surgery or critical intraoperative complications.…”

Facilitating noncardiac surgery for the patient with left ventricular assist device: A guide for the anesthesiologist

“…When a significant amount of intra-abdominal adhesions from previous abdominal procedures is encountered, the surgeon may still have to convert to laparotomy for easier access. [ 63 ] Whatever the surgical decision, the surgical team must be mindful of the potential precarious intraoperative hemodynamic state of the patient and that duration and manipulation of viscera during surgery will affect intraoperative and postoperative cardiopulmonary function and abdominal organ perfusion.…”