title: Systematic Review of Outcomes After Noncardiac Surgery in Patients with Implanted Left Ventricular Assist Devices.
abstract: The number of patients supported with left ventricular assist devices (LVADs) is rising rapidly, and noncardiac surgery (NCS) in these patients presents unique challenges. Given the controversy regarding the safety and timing of elective NCS, we performed a systematic review examining the perioperative morbidity and mortality of NCS in stable patients with LVADs. The published literature was searched using strategies created by a medical librarian. All reports involving five or more patients with implanted LVAD undergoing NCS were eligible for inclusion. One hundred and sixty one patients who underwent 252 surgeries were included from seven studies. Cohort size ranged from 8 to 47 patients undergoing 12 to 67 NCS. Median age ranged from 50.1 to 68 years and 75 to 100% were male. Thirty day postoperative mortality ranged from 6.4 to 16.7%, although four studies reported no deaths. Due to the small number of included studies with relative few patients and widely heterogeneous reporting of outcomes a formal quantitative meta-analysis was not performed. Noncardiac surgery in patients with LVADs appears to be safe and feasible in select patients. Future studies should use standard study design and reporting parameters to facilitate the systematic examination of safety and outcomes for elective NCS in LVAD patients.
authors.affiliation: From the *Division of Cardiology, Department of Internal Medicine, †Department of Surgery, and ‡Becker Library, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Davis
authors.forename: Dominic
authors.initials: D
authors.lastname: Sanford
authors.forename: Joel
authors.initials: J
authors.lastname: Schilling
authors.forename: Angela
authors.initials: A
authors.lastname: Hardi
authors.forename: Graham
authors.initials: G
authors.lastname: Colditz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D016896:Treatment Outcome