BACKGROUND: Cardiac left ventricular assist device (LVAD) placement is a common therapy for heart failure. Non-cardiac surgical care of these patients can be complex given the need for anticoagulation, perioperative monitoring, comorbidities, and anatomical considerations due to the device itself. There are no guidelines or significant patient series reported to date for laparoscopic procedures in this population. We herein report the techniques and outcomes for commonly performed laparoscopic procedures in patients with LVADs at a high volume center. METHODS: From our database of patients with ventricular assist devices, we retrospectively identified patients who underwent laparoscopic abdominal surgery. Intraoperative and perioperative data were collected, including anticoagulation management, transfusions and complications. Techniques and preoperative considerations from the surgeons were also compiled and described. RESULTS: Of 374 patients that had placement of LVADs, 17 had an elective laparoscopic procedure: enteral access placement (n = 7), cholecystectomy (n = 6), hernia repair (n = 2), small bowel resection (n = 1) and splenectomy (n = 1). Preoperative evaluation routinely included radiologic imaging to evaluate driveline location. The most common abdominal entry technique was a periumbilical open Hasson technique (11/17). No cases were converted to open. Overall, the average blood loss was 132 ± 64 mL and the average operative time was 1.8 ± 0.3 h. Five of the 17 patients required intraoperative blood transfusion. No patients suffered perioperative thrombotic events or LVAD complications secondary to holding anticoagulation. No patients required interventions or reoperation for bleeding complications. There were no mortalities related to these procedures. CONCLUSIONS: Laparoscopic abdominal procedures are safe and feasible in patients with LVADs. Although special consideration for bleeding and thrombotic risks, placement of ports and perioperative management is required, the presence of a LVAD itself should not be considered a contraindication for laparoscopic surgery and may in fact be the preferred method for access in these patients.
BACKGROUND: Cardiac left ventricular assist device (LVAD) placement is a common therapy for heart failure. Non-cardiac surgical care of these patients can be complex given the need for anticoagulation, perioperative monitoring, comorbidities, and anatomical considerations due to the device itself. There are no guidelines or significant patient series reported to date for laparoscopic procedures in this population. We herein report the techniques and outcomes for commonly performed laparoscopic procedures in patients with LVADs at a high volume center. METHODS: From our database of patients with ventricular assist devices, we retrospectively identified patients who underwent laparoscopic abdominal surgery. Intraoperative and perioperative data were collected, including anticoagulation management, transfusions and complications. Techniques and preoperative considerations from the surgeons were also compiled and described. RESULTS: Of 374 patients that had placement of LVADs, 17 had an elective laparoscopic procedure: enteral access placement (n = 7), cholecystectomy (n = 6), hernia repair (n = 2), small bowel resection (n = 1) and splenectomy (n = 1). Preoperative evaluation routinely included radiologic imaging to evaluate driveline location. The most common abdominal entry technique was a periumbilical open Hasson technique (11/17). No cases were converted to open. Overall, the average blood loss was 132 ± 64 mL and the average operative time was 1.8 ± 0.3 h. Five of the 17 patients required intraoperative blood transfusion. No patients suffered perioperative thrombotic events or LVAD complications secondary to holding anticoagulation. No patients required interventions or reoperation for bleeding complications. There were no mortalities related to these procedures. CONCLUSIONS: Laparoscopic abdominal procedures are safe and feasible in patients with LVADs. Although special consideration for bleeding and thrombotic risks, placement of ports and perioperative management is required, the presence of a LVAD itself should not be considered a contraindication for laparoscopic surgery and may in fact be the preferred method for access in these patients.
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Authors: James K Kirklin; David C Naftel; Francis D Pagani; Robert L Kormos; Lynne W Stevenson; Elizabeth D Blume; Susan L Myers; Marissa A Miller; J Timothy Baldwin; James B Young Journal: J Heart Lung Transplant Date: 2015-10-08 Impact factor: 10.247
Authors: Finn Gustafsson; Binyamin Ben Avraham; Ovidiu Chioncel; Tal Hasin; Avishai Grupper; Aviv Shaul; Sanemn Nalbantgil; Yoav Hammer; Wilfried Mullens; Laurens F Tops; Jeremy Elliston; Steven Tsui; Davor Milicic; Johann Altenberger; Miriam Abuhazira; Stephan Winnik; Jacob Lavee; Massimo Francesco Piepoli; Lorrena Hill; Righab Hamdan; Arjang Ruhparwar; Stefan Anker; Marisa Generosa Crespo-Leiro; Andrew J S Coats; Gerasimos Filippatos; Marco Metra; Giuseppe Rosano; Petar Seferovic; Frank Ruschitzka; Stamatis Adamopoulos; Yaron Barac; Nicolaas De Jonge; Maria Frigerio; Eva Goncalvesova; Israel Gotsman; Osnat Itzhaki Ben Zadok; Piotr Ponikowski; Luciano Potena; Arsen Ristic; Tiny Jaarsma; Tuvia Ben Gal Journal: ESC Heart Fail Date: 2021-09-28