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Updated: May 27, 2026
16:11
Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
Surgical procedures for patients receiving mechanical cardiac support
Paul J Chestovich1, Murray H Kwon, H Gill Cryer
1Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-6904, USA.
The American Surgeon
|December 1, 2011
Summary
Noncardiac surgical procedures (NCPs) in patients with mechanical cardiac support devices show high mortality, especially with extracorporeal membrane oxygenation (ECMO). Selected NCPs are feasible in ventricular assist device (VAD) patients but may delay heart transplantation.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Mechanical cardiac support devices like ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO) are crucial for patients with cardiopulmonary failure.
- Noncardiac surgical procedures (NCPs) in these patients present unique challenges and risks.
- Understanding the outcomes of NCPs in patients on VAD or ECMO support is vital for clinical decision-making.
Purpose of the Study:
- To review institutional experience with noncardiac surgical procedures in patients supported by VADs or ECMO.
- To evaluate the mortality and survival outcomes associated with NCPs in these patient populations.
- To assess the impact of NCPs on bridging to heart transplantation in VAD patients.
Main Methods:
- Retrospective review of 198 VAD patients and 165 ECMO patients undergoing NCPs between July 1998 and June 2010.
- Analysis of 64 NCPs in VAD patients and 14 NCPs in ECMO patients.
- Comparison of 30-day mortality and survival rates between VAD and ECMO groups, and between emergent and nonemergent procedures.
Main Results:
- Thirty-day mortality was significantly higher in the VAD group (25%) compared to the ECMO group (86%) (P < 0.001).
- Emergent procedures had higher mortality (58%) than nonemergent procedures (19%) (P < 0.001), with no deaths within 30 days for nonemergent procedures excluding tracheostomy.
- Kaplan-Meier survival showed a trend toward worse survival after NCP in ECMO patients, but NCP did not alter survival in VAD patients; fewer VAD patients were bridged to transplant after NCP.
Conclusions:
- Noncardiac surgical procedures in patients on mechanical cardiac support have substantial mortality, particularly in the ECMO group.
- Selected NCPs can be performed safely in VAD patients, but their necessity may delay or preclude heart transplantation.
- This study represents the largest series of NCPs on VAD support and the only series on ECMO, highlighting critical outcomes for these complex patient groups.
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