title: Hemodynamic Consequences of Laparoscopy for Patients on Mechanical Circulatory Support.
abstract: BACKGROUND
  Technologic advances and superior survival with mechanical circulatory support (MCS) have led to an expanding population that develops intraabdominal conditions requiring intervention. Whether laparoscopy can be performed without detrimental effects on hemodynamics and device function is not well described.
  
  
  METHODS
  Effects of laparoscopy performed on MCS were retrospectively assessed. Intraoperative hemodynamics and device function were compared with the same time interval 24 hours prior to surgery using intrapatient paired t tests. Outcomes included survival, transfusion, thromboembolic events, and infection.
  
  
  RESULTS
  Twelve patients with ventricular assist devices or total artificial hearts underwent laparoscopy from 2012 to 2014. Median follow-up was 116 days. Operations included cholecystectomy, diagnostic laparoscopy, gastrojejunostomy, and gastrostomy. There were no differences between preoperative and intraoperative mean arterial pressure, heart rate, and inotrope or vasopressor requirements (P > .05). Device fill volume, flow, rate, and power were unchanged (P > .05), whereas pulsatility index decreased by 0.2 (95% confidence interval, 0.03, 0.36) with laparoscopy (P = .03). All intraoperative fluctuations in hemodynamics and device function improved with reduction of pneumoperitoneum, adjusting device speed, or pharmacologic support. There were no operative mortalities. Thirty-day survival and survival to discharge were 75% and 50%, respectively. Despite antiplatelet therapy and preoperative international normalization ratio of 2.2 ± 0.9, there were no re-operations for bleeding, and 50% did not require transfusion. Two patients with recent cardiac surgery had thromboembolic events: one stroke and one device thrombus. None had postoperative bacteremia or driveline infection.
  
  
  CONCLUSIONS
  Laparoscopy can be performed on MCS with low morbidity and mortality and minimal perturbations in hemodynamics and device function.
authors.affiliation: 1 Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center , Los Angeles, California.|2 Department of Surgery, Cedars-Sinai Medical Center , Los Angeles, California.
authors.forename: Heidi
authors.initials: H
authors.lastname: Reich
authors.affiliation: 1 Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center , Los Angeles, California.
authors.forename: Danny
authors.initials: D
authors.lastname: Ramzy
authors.affiliation: 1 Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center , Los Angeles, California.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Czer
authors.affiliation: 1 Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center , Los Angeles, California.
authors.forename: Fardad
authors.initials: F
authors.lastname: Esmailian
authors.affiliation: 1 Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center , Los Angeles, California.
authors.forename: Jaime
authors.initials: J
authors.lastname: Moriguchi
authors.affiliation: 1 Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center , Los Angeles, California.
authors.forename: Kai
authors.initials: K
authors.lastname: Ihnken
authors.affiliation: 3 Department of Anesthesiology, Cedars-Sinai Medical Center , Los Angeles, California.
authors.forename: Taizoon
authors.initials: T
authors.lastname: Yusufali
authors.affiliation: 3 Department of Anesthesiology, Cedars-Sinai Medical Center , Los Angeles, California.
authors.forename: Nicola
authors.initials: N
authors.lastname: D'Attellis
authors.affiliation: 1 Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center , Los Angeles, California.
authors.forename: Francisco
authors.initials: F
authors.lastname: Arabia
authors.affiliation: 2 Department of Surgery, Cedars-Sinai Medical Center , Los Angeles, California.
authors.forename: Alagappan
authors.initials: A
authors.lastname: Annamalai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012189:Retrospective Studies