Management of general surgical problems in patients with left ventricular assist devices

Congestive heart failure (CHF) is a major health issue resulting in significant patient morbidity and mortality. Left ventricular assist devices (LVADs) are becoming an increasingly popular method of treatment for patients with end-stage CHF. As the use of LVADs increases, there is a greater likelihood that some of these patients will live to develop general surgical problems. It is important for general surgeons to be aware of the often complex evaluation and treatment of patients with these problems. We retrospectively reviewed the charts of three patients with LVADs who underwent nonthoracic general surgical procedures. We reviewed duration of LVAD, time from LVAD implantation to operation, type of anesthesia, and any postoperative complications. Three patients with LVADs underwent five nonthoracic general surgical procedures. Anticoagulation was reversed with heparinization in four cases, the fifth case requiring fresh-frozen plasma. There was no perioperative mortality. Two morbidities occurred in separate patients, a wound infection and driveline site infection. These were managed nonoperatively. These patients raise several important concerns. They are often anticoagulated and require reversal. Staff needs to be familiar with these devices, their operation and physiology. The placement of the LVAD imposes limitations on surgical site location that require the surgeon to be prepared, flexible, and often creative.