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Emergency laparoscopic cholecystectomy for a patient with an implantable left ventricular assist device: report of a
Takeshi Naitoh1, Takanori Morikawa, Naoaki Sakata
1Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Hospital, 1-1, Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan. naitot@surg1.med.tohoku.ac.jp
Insights
Acute cholecystitis can complicate cardiac surgery. A laparoscopic cholecystectomy was successfully performed after left ventricular assist device (LVAD) implantation, demonstrating a safe approach for managing gallbladder complications in heart failure patients.
Area of Science:
- Cardiology
- Surgical Innovation
- Gastroenterology
Background:
- Postoperative acute cholecystitis is a known complication following cardiac surgery.
- Left ventricular assist device (LVAD) implantation is a critical intervention for end-stage heart failure, serving as a bridge to transplantation.
- Managing concurrent conditions like gallbladder disease requires careful surgical planning.
Observation:
- A 31-year-old male patient developed severe acute cholecystitis post-LVAD implantation for dilated cardiomyopathy.
- Laparoscopic cholecystectomy was performed, necessitating strategic trocar placement to avoid the LVAD and its drive-line.
- The surgical procedure involved specific landmark identification and port placement in the umbilicus, left flank, and right subcostal area.
Findings:
- The laparoscopic cholecystectomy for acute cholecystitis in an LVAD patient was technically successful.
- The operation lasted 160 minutes with an estimated blood loss of 430 ml.
- The patient experienced an uneventful postoperative recovery, indicating the feasibility of the procedure.
Implications:
- Concomitant cholecystectomy during LVAD implantation may be beneficial for patients with pre-existing biliary abnormalities.
- This case highlights the importance of considering gallbladder pathology in cardiac surgery patients, especially those undergoing LVAD placement.
- Careful surgical technique and planning are crucial for managing complications in patients with mechanical circulatory support devices.
Abstract:
It is not uncommon for cardiac surgery to be complicated by postoperative acute cholecystitis. We recently performed laparoscopic cholecystectomy for severe acute cholecystitis, which developed after the implantation of a left ventricular assist device (LVAD) for dilated cardiomyopathy in a 31-year-old man. The LVAD is an accepted bridging treatment to heart transplantation. With the patient under general anesthesia, we made landmarks around the LVAD and a drive-line to prevent injury by trocar insertion. The first port was inserted in the umbilicus and because the subxyphoid space was occupied, the second trocar was inserted in the left flank and the other two trocars were inserted in the right subcostal area. The operation time was 160 min and the estimated blood loss was 430 ml. The patient had an uneventful postoperative course. Thus, concomitant cholecystectomy should be considered when installing an LVAD system if the patient has biliary abnormalities.