Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery

Meredith Degnan, Jessica Brodt, Yiliam Rodriguez

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Aim: The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery. Materials and Methods: This is a retrospective review of the population of patients with LVADs at a single institution undergoing noncardiac procedures between 2009 and 2014. Demographic, perioperative, and procedural data collected included the type of procedure performed, anesthetic technique, vasopressor requirements, invasive monitors used, anesthesia provider type, blood product management, need for postoperative intubation, postoperative disposition and length of stay, and perioperative complications including mortality. Statistical Analysis: Descriptive statistics for categorical variables are presented as frequency distributions and percentages. Continuous variables are expressed as mean ± standard deviation and range when applicable. Results: During the study, 31 patients with LVADs underwent a total of 74 procedures. Each patient underwent an average of 2.4 procedures. Of the total number of procedures, 48 (65%) were upper or lower endoscopies. Considering all procedures, 81% were performed under monitored anesthesia care (MAC). Perioperative care was provided by faculty outside of the division of cardiac anesthesia in 62% of procedures. Invasive blood pressure monitoring was used in 27 (36%) procedures, and a central line, peripherally inserted central catheter or midline was in place preoperatively and used intraoperatively for 38 (51%) procedures. Vasopressors were not required in the majority (65; 88%) of procedures. There was one inhospital mortality secondary to multiorgan failure; 97% of patients survived to discharge after their procedure. Conclusion: At our institution, LVAD patients undergoing noncardiac procedures most frequently require endoscopy. These procedures can frequently be done safely under MAC, with or without consultation by a cardiac anesthesiologist.

Original languageEnglish (US)
Pages (from-to)676-682
Number of pages7
JournalAnnals of Cardiac Anaesthesia
Volume19
Issue number4
DOIs
StatePublished - Oct 1 2016

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Heart-Assist Devices
Anesthesia
Endoscopy
Perioperative Care
Hospital Mortality
Intubation
Anesthetics

Keywords

  • Cardiac anesthesia
  • Left ventricular assist device
  • Noncardiac surgery
  • Perioperative care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery. / Degnan, Meredith; Brodt, Jessica; Rodriguez, Yiliam.

In: Annals of Cardiac Anaesthesia, Vol. 19, No. 4, 01.10.2016, p. 676-682.

Research output: Contribution to journalArticle

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abstract = "Aim: The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery. Materials and Methods: This is a retrospective review of the population of patients with LVADs at a single institution undergoing noncardiac procedures between 2009 and 2014. Demographic, perioperative, and procedural data collected included the type of procedure performed, anesthetic technique, vasopressor requirements, invasive monitors used, anesthesia provider type, blood product management, need for postoperative intubation, postoperative disposition and length of stay, and perioperative complications including mortality. Statistical Analysis: Descriptive statistics for categorical variables are presented as frequency distributions and percentages. Continuous variables are expressed as mean ± standard deviation and range when applicable. Results: During the study, 31 patients with LVADs underwent a total of 74 procedures. Each patient underwent an average of 2.4 procedures. Of the total number of procedures, 48 (65{\%}) were upper or lower endoscopies. Considering all procedures, 81{\%} were performed under monitored anesthesia care (MAC). Perioperative care was provided by faculty outside of the division of cardiac anesthesia in 62{\%} of procedures. Invasive blood pressure monitoring was used in 27 (36{\%}) procedures, and a central line, peripherally inserted central catheter or midline was in place preoperatively and used intraoperatively for 38 (51{\%}) procedures. Vasopressors were not required in the majority (65; 88{\%}) of procedures. There was one inhospital mortality secondary to multiorgan failure; 97{\%} of patients survived to discharge after their procedure. Conclusion: At our institution, LVAD patients undergoing noncardiac procedures most frequently require endoscopy. These procedures can frequently be done safely under MAC, with or without consultation by a cardiac anesthesiologist.",
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