Non-Cardiac Surgery After Left Ventricular Assist Device Implantation: Perioperative Management and Outcomes from a...

As survival after left ventricular assist device (LVAD) implantation improves, an increasing number of patients require non-cardiac surgery (NCS) during follow-up. This study aimed to evaluate the clinical characteristics and perioperative management of LVAD recipients undergoing NCS and to compare outcomes between elective and emergent procedures. Among 434 adults who underwent LVAD implantation between 2014 and 2026, 42 subsequently underwent NCS and were classified into elective (n = 26) and emergent (n = 16) groups. Overall, 9.68% of LVAD recipients required NCS, of which 61.9% were elective. Preoperative urea, creatinine, and international normalized ratio (INR) levels were significantly higher in the emergent group. Thirty-day mortality (31.2% vs. 3.8%; p = 0.023) and 1-year mortality (68.8% vs. 30.8%; p = 0.026) were significantly higher after emergent surgery. Kaplan-Meier analysis demonstrated significantly lower survival in the emergent group (log-rank p = 0.018). On univariable Cox regression analysis, emergent surgery was associated with a 2.87-fold higher mortality risk (HR, 2.87; 95% CI, 1.15-7.15; p = 0.024). NCS after LVAD implantation can be performed safely with appropriate patient selection, anticoagulation management, and multidisciplinary care; however, emergent surgery is associated with a less favorable preoperative clinical profile, limited opportunity for anticoagulation optimization, and substantially higher mortality.