Total Hip Arthroplasty in Patients with Left Ventricular Assist Devices: Perioperative Management and Clinical...

BACKGROUND: Left ventricular assist devices (LVADs) are commonly utilized in severe left-sided heart disease as a bridge to transplantation or long-term treatment. Total hip arthroplasty (THA) improves mobility in these patients but entails numerous perioperative risks. Our study focused on perioperative management and clinical outcomes for LVAD patients undergoing THA, aiming to provide insights into this complex setting.

METHODS: We retrospectively analyzed patients with LVADs who underwent THA at our institution from May 2019 to November 2023. The outcomes of interest were perioperative anticoagulation management, thrombotic or bleeding events, transfusion needs, mortality, surgical site complications, and reoperations. The functional outcome was evaluated using the modified Harris Hip Score (mHHS) and the EQ-5D quality of life score at their last follow-up.

RESULTS: The cohort consisted of 11 male patients, mean age 68.1 years. Patient survival was recorded over a 22.8-month mean follow-up (range, 1-53). Seven patients (63.6%) required postoperative transfusions and 5/11 patients (45.5%) experienced thromboembolic events. The mean hospital stay after THA was 13.5 days. The overall mortality related-to-disease rate in our series of LVAD patients undergoing primary THA was 27%. Three patients (27.3%) developed surgical site hematomas, which required one additional reoperation, and one of those was infected. Hip functionality improved markedly, with the mean mHHS rising from 27.5 to 72.3.

CONCLUSIONS: THA in LVAD patients is challenging yet feasible, offering significant functional improvements despite the increased perioperative morbidity. Mortality was associated with their underlying disease, but not the surgery.