title: General and acute care surgical procedures in patients with left ventricular assist devices.
abstract: BACKGROUND
  Left ventricular assist devices (LVADs) have become common as a bridge to heart transplant as well as destination therapy. Acute care surgical (ACS) problems in this population are prevalent but remain ill-defined. Therefore, we reviewed our experience with ACS interventions in LVAD patients.
  
  
  METHODS
  A total of 173 patients who received HeartMate(®) XVE or HeartMate(®) II (HMII) LVADs between December 2001 and March 2010 were studied. Patient demographics, presentation of ACS problem, operative intervention, co-morbidities, transplantation, complications, and survival were analyzed.
  
  
  RESULTS
  A total of 47 (27 %) patients underwent 67 ACS procedures at a median of 38 days after device implant (interquartile range 15-110), with a peri-operative mortality rate of 5 % (N = 3). Demographics, device type, and acuity were comparable between the ACS and non-ACS groups. A total of 21 ACS procedures were performed emergently, eight were urgent, and 38 were elective. Of 29 urgent and emergent procedures, 28 were for abdominal pathology. In eight patients, the cause of the ACS problem was related to LVADs or anticoagulation. Cumulative survival estimates revealed no survival differences if patients underwent ACS procedures (p = 0.17). Among HMII patients, transplantation rates were unaffected by an ACS intervention (p = 0.2).
  
  
  CONCLUSIONS
  ACS problems occur frequently in LVAD patients and are not associated with adverse outcomes in HMII patients. The acute care surgeon is an integral member of a comprehensive approach to effective LVAD management.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, 1800 North Orleans Street/Blalock 655, Baltimore, MD, 21287, USA, gja10@jhmi.edu.
authors.forename: George J
authors.initials: GJ
authors.lastname: Arnaoutakis
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Bittle
authors.forename: Jeremiah G
authors.initials: JG
authors.lastname: Allen
authors.forename: Eric S
authors.initials: ES
authors.lastname: Weiss
authors.forename: Jennifer
authors.initials: J
authors.lastname: Alejo
authors.forename: William A
authors.initials: WA
authors.lastname: Baumgartner
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Shah
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
authors.forename: John V
authors.initials: JV
authors.lastname: Conte
mesh_terms: D000328:Adult; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D015996:Survival Rate