Perioperative management of non-cardiac surgery in patients on long-term left ventricular assist device support

The shortage of donor hearts has led to the increased use of left ventricular assist devices (LVADs) as an alternative treatment for advanced heart failure. As the population of LVAD recipients grows, so does the demand for non-cardiac surgical interventions in this group. This study aims to share our experience with non-cardiac surgeries performed in patients supported by long-term LVADs.

We retrospectively analyzed 72 patients who underwent LVAD implantation at our clinic between 2017 and 2024. Among them, 53 received the HeartMate 3 (Abbott Inc., Chicago, IL) and 19 received the HeartWare (Medtronic Inc., Minneapolis, MN).

Patients were followed for a mean duration of 48.5 months (range: 1-78 months). During this period, 19 non-cardiac surgical procedures were performed in 13 patients; some patients underwent more than one procedure. A total of 12 procedures were conducted under general anesthesia, while 7 was performed under sedation. No perioperative deaths, thromboembolic events, or device malfunctions occurred. Minor complications included one case of re-intubation and one surgical site infection, associated with repeated amputations in a patient with peripheral arterial disease.

Non-cardiac surgery in patients with long-term LVAD support appears to be safe when carefully planned. Larger studies are warranted to validate these findings.