Yalini Vigneswaran, MD, Victoria Wang, Vivek Prachand, MD, John Alverdy, MD, Stephen Wyers, MD, Colleen Juricek, RN, Nir Uriel, MD, Mustafa Hussain, MD. University of Chicago
Purpose: Cardiac ventricular assist devices are becoming more common therapy for heart failure and more frequently encountered in our general surgery patients. Non-cardiac surgical care of these patients can be complex given the need for anticoagulation, perioperative monitoring and anatomical considerations due to the device itself. There are no guidelines or significant patient series reported to date for general surgery procedures in this population. We herein report techniques and outcomes for commonly performed laparoscopic procedures in these patients at our high volume cardiac ventricular assist device placement center.
Methods: All patients with ventricular assist device placement at our institution were retrospectively reviewed to identify patients who underwent laparoscopic abdominal surgery. Intraoperative and perioperative data were collected including transfusions, anticoagulation management and complications. Techniques and preoperative considerations from the surgeons were also compiled and described.
Results: Of the 374 patients who had placement of ventricular assist devices, 17 had a 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 drive line location. Port placement was deliberate with relation to drive line. No extra ports were required in any cases due to positioning of the drive line. Various methods were used to enter the abdomen, but most common was a periumbilical open Hasson technique (11/17). No cases were converted to open. Overall, the average blood loss was 132±64mL and average operative time 1.8±0.3 hours. Five of the 17 patients had intraoperative blood transfusion as per anesthesia discretion.
No patients had perioperative thrombus or LVAD complications secondary to holding anticoagulation. Anticoagulation was held an average of 4.1 days before surgery and restarted 1.8 days after surgery. Average preoperative INR was 1.7±0.1. In the immediate postoperative period seven patients had anemia that resolved with blood transfusions, this included one patient who had groin hematoma after inguinal hernia repair. Preoperative INR and platelet count did not appear predictive for patients with postoperative bleeding. No patients required interventions for bleeding complications. There were no mortalities related to the procedures.
Conclusions: Laparoscopic procedures such as enteral access, cholecystectomy and hernia repairs are safe in patients with ventricular assist devices. Although special consideration for bleeding risks, placement of ports and perioperative management is required, the presence of a ventricular assist device itself should not be a contraindication for laparoscopic surgery and may in fact be preferred for these patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79220
Program Number: P063
Presentation Session: Poster (Non CME)
Presentation Type: Poster