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Outcome of Abdominal and Colorectal Surgery in Patients with Left Ventricular Assistant Devices
Ammar Asban; Maria X Traa; Nelya Melnitchouk
Tufts Medical Center, Boston, MA

Background: Advances in left ventricular assistant device (LVAD) technology have contributed to prolonged life expectancy and an increasing demand for non-cardiac surgery in this population.

Methods: Retrospective review of 13 patients with LVADs who underwent abdominal surgery at a tertiary center between 2003-2013. Data collected include type of device implanted, patientsí comorbidities, coagulation status, intraoperative complications, need for intraoperative blood products transfusion, type of surgery performed, complications, and mortality and LVAD outcome.

Results: The mean duration of LVAD support before surgery was 309 days. 77% patients had an LVAD as a bridge to transplant and 24% as destination therapy. 47% of surgeries were emergencies. The most common intraoperative complication was arrhythmia. The most common post-operative complications were bleeding (18%), venous thromboembolism in (18%), and surgical site infection (12%). Intraoperative blood transfusion was required in 24% operations and FFP in 18% operations. 44% operations required blood transfusion in the first week post-operation. All patients survived the procedures with a 24-hour mortality rate of 12% and thirty-day mortality rate of 18%. 24-hour mortality was higher in emergency cases (25%) versus elective cases (0%).

Conclusion: Surgery is feasible in LVAD patients. Emergency operations have higher 24-hour and 30 day mortality with most causes of death being nonspecific to the abdominal surgery performed. Patients undergo operations on average one year after placement of the LVAD device, and the majority have the device as a bridge to cardiac transplant. Surgeons should consider these outcomes before resolving not to perform abdominal procedures on this higher-risk population.

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