title: Noncardiac surgery in patients on mechanical circulatory support.
abstract: This study examined outcomes in patients with left ventricular assist device (LVAD) and extracorporeal membrane oxygenation (ECMO) requiring noncardiac surgical procedures and identified factors that influence outcomes. All patients with mechanical circulatory support (MCS) devices at our institution from 2002 to 2013 undergoing noncardiac surgical procedures were reviewed. There were 148 patients requiring MCS during the study period, with 40 (27.0%) requiring 62 noncardiac surgical procedures. Of these, 29 (72.5%) had implantable LVAD and 11 (27.5%) were supported with ECMO. The two groups were evenly matched with regard to age (53.6 vs. 54.5 years, p = 0.87), male sex (71.4 vs. 45.5%, p = 0.16), and baseline creatinine (1.55 vs. 1.43 mg/dl, p = 0.76). Patients on ECMO had greater demand for postoperative blood products (0.8 vs. 2.8 units of packed red blood cells, p = 0.002) and greater postoperative increase in creatinine (0.07 vs. 0.44 mg/dl, p = 0.047). Median survival was markedly worse in ECMO patients. Factors associated with mortality included ECMO support, history of biventricular assist device, and postoperative blood transfusion. Preoperative aspirin was associated with survival. These findings demonstrate the importance of careful surgical hemostasis and minimizing perioperative blood transfusions in patients on MCS undergoing noncardiac surgical procedures. In addition, low-dose antiplatelet therapy should be continued perioperatively.
authors.affiliation: From the *Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania; †Temple University School of Medicine, Philadelphia, Pennsylvania; and ‡Division of Cardiac Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.forename: Carl
authors.initials: C
authors.lastname: Beyer
authors.forename: Halley
authors.initials: H
authors.lastname: Vora
authors.forename: Senthil N
authors.initials: SN
authors.lastname: Jayarajan
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
authors.forename: Jay
authors.initials: J
authors.lastname: Dujon
authors.forename: Lars O
authors.initials: LO
authors.lastname: Sjoholm
authors.forename: Abhijit
authors.initials: A
authors.lastname: Pathak
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Santora
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Goldberg
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Rappold
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001803:Blood Transfusion; D003404:Creatinine / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000601:surgery* / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D003404:Creatinine