Dangerous surgical scavenger hunt: the complicated course of a patient with left ventricular assist device and end-stage renal disease undergoing reconstructive flap surgery.
Patients with left ventricular assist devices (LVADs) who develop stage IV sacral pressure sores (SPS) have an increased procedural risk. We present the complications, including severe intra- and postoperative bleeding, diarrhea with metabolic acidosis, volume loss and acute on chronic renal failure, flap dehiscence and late LVAD outflow cannula thrombosis, in a 54-year-old male who underwent diverting ileostomy (DI) and subsequent fasciocutaneous flap (FCF) surgery for stage IV SPS while supported with an LVAD. Our experience suggests that, despite continuous heparinization, life-threatening thrombotic complications, such as device clotting, can occur. Therefore, the benefit of intervention has to outweigh the risk of bleeding, which should be managed with meticulous surgical technique and substitution of red blood cells rather than the reversal of heparinization or the substitution of clotting factors. Continuation of double anti-platelet therapy should also be considered.
Dept. Cardiothoracic Surgery, University Hospital Regensburg, Germany Exempla Saint Joseph Hospital, Internal Medicine Residency Program, Denver, CO, USA miriamfreundt@me.com.
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Freundt
Dept. Cardiothoracic Surgery, University Hospital Regensburg, Germany Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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Haneya
Dept. Cardiothoracic Surgery, University Hospital Regensburg, Germany.
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Schmid
Dept. Cardiothoracic Surgery, University Hospital Regensburg, Germany.
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Hirt
D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood / Q000188:drug therapy*; D013524:Surgical Flaps / Q000009:adverse effects*
complication; end-stage renal failure; flap surgery; intra-abdominal surgery; left ventricular assist device