title: Non-cardiac surgery in patients on long-term left ventricular assist device support.
abstract: BACKGROUND
  An increasing number of patients on left ventricular assist device (LVAD) support are requiring non-cardiac surgical (NCS) procedures. We reviewed our experience with the management of patients on continuous flow (CF) LVAD support undergoing NCS.
  
  
  METHODS
  From March 2006 through March 2011, 86 patients with chronic heart failure underwent implantation of a HeartMate II (Thoratec Corp, Pleasanton, CA) LVAD. Clinical records of these patients were reviewed to identify patients who underwent NCS while on LVAD support, with a focus on peri-operative death, bleeding, thrombosis, and device malfunction, as well as management of pre-operative anti-coagulation.
  
  
  RESULTS
  While on CF-LVAD support, 20 patients underwent 25 NCSs, comprising 13 major and 12 minor procedures. Operations were performed electively in 22 and as emergencies in 3. No peri-operative deaths, thromboembolic complications, or device malfunctions occurred. The incidence of bleeding requiring transfusion of packed red blood cells was 36.0%, including 25% of patients undergoing minor NCSs and 46.2% undergoing major NCSs (p = 0.004). All bleeding complications occurred in patients on both warfarin and aspirin pre-operatively. The only significant differences between patients who did and did not require transfusion were pre-operative warfarin use and significantly higher pre-operative international normalized ratio in the transfused group (1.9 ± 0.4 vs 1.4 ± 0.3; p = 0.008).
  
  
  CONCLUSIONS
  Non-cardiac operations can be performed safely in patients with CF-LVADs. It may possible to reduce peri-operative bleeding by lowering pre-operative anti-coagulation goals, especially before major surgery. However, additional analysis is required to determine if this can be performed safely.
authors.affiliation: Division of Cardiothoracic Surgery, Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan 48202, USA. jmorgan2@hfhs.org
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
authors.forename: Hassan W
authors.initials: HW
authors.lastname: Nemeh
authors.forename: Scott E
authors.initials: SE
authors.lastname: Henry
authors.forename: Brent
authors.initials: B
authors.lastname: Gerlach
authors.forename: Celeste T
authors.initials: CT
authors.lastname: Williams
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
authors.forename: Cristina
authors.initials: C
authors.lastname: Tita
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brewer
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D017558:Elective Surgical Procedures / Q000009:adverse effects; D004632:Emergency Medical Services; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants