A. A. Asban1, M. Traa1, J. Yoo1, N. Melnitchouk1 1Tufts Medical Center,Colorectal/Surgery/,Boston, MA, USA
Introduction:
Advances in left ventricular assistant device (LVAD) technology have contributed to significant improvements in patient quality of life and life expectancy. Assessment of the safety of abdominal and colorectal surgery in these patients is of particular importance due to their multiple comorbidities, hemodynamic status, and challenges with abdominal positioning of the LVAD driveline.
Methods:
We conducted a retrospective review of 13 patients with left ventricular assistant devices who had undergone abdominal (including colorectal) surgeries at Tufts Medical Center between January 2003 and December 2013. Data collected include type of device implanted, patients’ comorbidities, preoperative coagulation status, intraoperative complications, need for intraoperative blood products transfusion, type of surgery performed, postoperative complications and postoperative coagulation status. The 24-hour survival and thirty-day mortality rates were gathered in addition to their ultimate LVAD outcome.
Results:
A total of 13 patients underwent 17 operations during the study period. These included 5 colorectal (29.5%) and 12 other abdominal (70.5%) surgeries. The mean duration of LVAD support before surgery was 309 days. Thirteen (77%) patients had an LVAD as a bridge to transplant and 4 (24%) as destination therapy. A total of 8 (47%) surgeries were emergency and 9 (53%) elective surgeries. The most common intraoperative complication was arrhythmia (65% operations). The most common post-operative complications were bleeding in 3 (18%) operations, venous thromboembolism in 3 (18%) operations, and surgical site infection in 2 (12%) operations. The mean perioperative INR was 1.39. Intraoperative blood transfusion was required in 4 (24%) operations and FFP in 3 (18%) operations. Eight (44%) operations required blood transfusion in the first week post-operation. All patients survived the procedures with a 24-hour mortality rate of 12% and thirty-day mortality rate of 18%. 24-hour mortality was higher in emergency cases (25%) versus elective cases (0%). None of the deaths were from complications specific to the abdominal or colorectal surgery performed.
Conclusion
The study demonstrates the feasibility of abdominal and colorectal surgery in LVAD patients. Arrhythmia is the most common intraoperative complication while bleeding and venous thromboembolism are the most common postoperative complications. Emergency operations have higher 24-hour and 30 day mortality with most causes of death being nonspecific to the abdominal surgery performed. Surgeons should consider these expected good outcomes before resolving not to perform colorectal or other abdominal procedures on this higher-risk population.
