title: Surgical procedures for patients receiving mechanical cardiac support.
abstract: Mechanical cardiac support devices are used for patients with cardiopulmonary failure. We reviewed our institutional experience with noncardiac surgical procedures (NCPs) in patients supported by ventricular assist devices (VADs, n = 198) or extracorporeal membrane oxygenation (ECMO,  n = 165) between July 1998 and June 2010. In total, 64 NCPs were performed in 55 VAD patients and 14 NCPs in 14 ECMO patients. Thirty-day mortality was higher for the VAD compared with the ECMO group (25 vs 86%; P < 0.001) and was greater for emergent compared with nonemergent  procedures (58 vs 19%; P < 0.001). Excluding tracheostomy, no patients died within 30 days of a nonemergent procedure. Kaplan-Meier survival showed a trend toward worse survival after NCP in ECMO patients, but NCP did not alter survival in VAD patients. Fewer VAD patients  were bridged to heart transplantation when NCP was required, and time from device implantation to transplant was significantly longer than for patients without NCP. In summary, this is the largest series of NCPs on VAD support and the only series on ECMO. Mortality is substantial for ECMO  patients. Selected procedures can be performed safely in VAD patients but will delay heart transplantation.
authors: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-6904, USA.
authors: Paul J
authors: PJ
authors: Chestovich
authors: Murray H
authors: MH
authors: Kwon
authors: H Gill
authors: HG
authors: Cryer
authors: Areti
authors: A
authors: Tillou
authors: Jonathan R
authors: JR
authors: Hiatt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D055815:Young Adult