Noncardiac operations in patients supported with mechanical circulatory support devices.

Abstract

Recent advances in technology as well as refinements of patient selection criteria have improved results of ventricular assistance in patients with end-stage heart disease. With a "normal" cardiac output and the resultant improvement in end-organ perfusion, some patients revert to normal or near normal physiology. Seven patients supported with cardiac assist devices who have undergone general surgical, nonassist device related procedures with the assist device in place are presented. This is a historical review of seven cases. The surgical procedures included three cholecystectomies, one dialysis catheter placement, and one thoracoscopy. Six patients had Thoratec ventricular assist devices (Thoratec Laboratories Corp., Berkeley, CA) and one was supported with a Jarvik (Symbion, Inc., Tempe, AZ) total artificial heart. In one patient, postcholecystectomy bleeding was the only complication that may have been directly attributable to having an assist device in place. Four patients underwent successful transplantation and three patients died, two during support and one after transplantation. As heart transplant waiting lists become longer and when permanent ventricular assist devices become available, an increasing number of patients on ventricular assistance will have noncardiac related pathology requiring operative intervention. In our experience, patients supported on mechanical assist devices tolerated these procedures well.