title: Noncardiac Surgical Procedures After Left Ventricular Assist Device Implantation.
abstract: As left ventricular assist devices (LVADs) are increasingly used for patients with end-stage heart failure, the need for noncardiac surgical procedures (NCSs) in these patients will continue to rise. We examined the various types of NCS required and its outcomes in LVAD patients requiring NCS. The National Inpatient Sample Database was examined for all patients implanted with an LVAD from 2007 to 2010. Patients requiring NCS after LVAD implantation were compared to all other patients receiving an LVAD. There were 1,397 patients undergoing LVAD implantation. Of these, 298 (21.3%) required 459 NCS after LVAD implantation. There were 153 (33.3%) general surgery procedures, with abdominal/bowel procedures (n = 76, 16.6%) being most common. Thoracic (n = 141, 30.7%) and vascular (n = 140, 30.5%) procedures were also common. Patients requiring NCS developed more wound infections (9.1 vs. 4.6%, p = 0.004), greater bleeding complications (44.0 vs. 24.8%, p < 0.001) and were more likely to develop any complication (87.2 vs. 82.0%, p = 0.001). On multivariate analysis, the requirement of NCSs (odds ratio: 1.45, 95% confidence interval: 0.95-2.20, p = 0.08) was not associated with mortality. Noncardiac surgical procedures are commonly required after LVAD implantation, and the incidence of complications after NCS is high. This suggests that patients undergoing even low-risk NCS should be cared at centers with treating surgeons and LVAD specialists.
authors.affiliation: From the *Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania; †Division of Cardiothoracic Surgery, Department of Surgery; and ‡Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri; and §Department of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.forename: Senthil N
authors.initials: SN
authors.lastname: Jayarajan
authors.forename: Vishnu
authors.initials: V
authors.lastname: Ambur
authors.forename: Abeel A
authors.initials: AA
authors.lastname: Mangi
authors.forename: Elaine
authors.initials: E
authors.lastname: Chan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dauer
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; D000369:Aged, 80 and over; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D013514:Surgical Procedures, Operative / Q000009:adverse effects