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Emergent General Surgery Operations in Patients With Left Ventricular Assist Devices
Zachary M Bauman1, Robert Cunningham1, Alex Hodson1
1Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
The American Surgeon
|September 25, 2020
Summary
Emergent general surgery (EGS) is common in left ventricular assist device (LVAD) patients, often for gastrointestinal bleeding. While procedures like EGD and colonoscopy are safe, nearly one-third of LVAD patients require surgery, with high lactic acid indicating increased mortality.
Area of Science:
- Cardiovascular Surgery
- Gastroenterology
- Critical Care Medicine
Background:
- The number of patients with left ventricular assist devices (LVADs) is increasing.
- These patients have unique characteristics that complicate noncardiac surgical problem management.
- Emergent general surgery (EGS) is often necessary but poorly described in this population.
Purpose of the Study:
- To review EGS consultations in LVAD patients.
- To understand the characteristics and outcomes of EGS interventions in LVAD recipients.
Main Methods:
- A 12-year review of 301 LVAD patients undergoing EGS consultation.
- Analysis of demographics, comorbidities, reasons for consultation, interventions, transplantation, and mortality.
- Statistical analysis using Wilcoxon, Fisher's exact, and chi-square tests.
Main Results:
- Nearly half (46.2%) of LVAD patients required EGS consultation, primarily for gastrointestinal bleeding.
- Endoscopic procedures (EGD/colonoscopy) were frequently used and generally safe.
- 28% of consultations led to surgical intervention, with 26% experiencing perioperative mortality; elevated lactic acid correlated with mortality.
Conclusions:
- EGS consultation is frequent in LVAD patients, most often for GI bleeding.
- Endoscopic management is feasible for most cases, but one-third require surgery.
- High lactic acid levels predict increased mortality in LVAD patients undergoing EGS.
Keywords:
consultationemergency general surgeryheart failureleft ventricular assist devicenoncardiac surgeryMore Related Videos
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