General and acute care surgical procedures in patients with left ventricular assist devices

George J. Arnaoutakis, Gregory J. Bittle, Jeremiah G. Allen, Eric S. Weiss, Jennifer Alejo, William A. Baumgartner, Ashish S. Shah, Christopher L. Wolfgang, David T. Efron, John V. Conte

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Left ventricular assist devices (LVADs) have become common as a bridge to heart transplant as well as destination therapy. Acute care surgical (ACS) problems in this population are prevalent but remain ill-defined. Therefore, we reviewed our experience with ACS interventions in LVAD patients. Methods: A total of 173 patients who received HeartMate® XVE or HeartMate® II (HMII) LVADs between December 2001 and March 2010 were studied. Patient demographics, presentation of ACS problem, operative intervention, co-morbidities, transplantation, complications, and survival were analyzed. Results: A total of 47 (27 %) patients underwent 67 ACS procedures at a median of 38 days after device implant (interquartile range 15-110), with a peri-operative mortality rate of 5 % (N = 3). Demographics, device type, and acuity were comparable between the ACS and non-ACS groups. A total of 21 ACS procedures were performed emergently, eight were urgent, and 38 were elective. Of 29 urgent and emergent procedures, 28 were for abdominal pathology. In eight patients, the cause of the ACS problem was related to LVADs or anticoagulation. Cumulative survival estimates revealed no survival differences if patients underwent ACS procedures (p = 0.17). Among HMII patients, transplantation rates were unaffected by an ACS intervention (p = 0.2). Conclusions: ACS problems occur frequently in LVAD patients and are not associated with adverse outcomes in HMII patients. The acute care surgeon is an integral member of a comprehensive approach to effective LVAD management.

Original languageEnglish (US)
Pages (from-to)765-773
Number of pages9
JournalWorld Journal of Surgery
Volume38
Issue number4
DOIs
StatePublished - Apr 2014

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Heart-Assist Devices
Survival
Transplantation
Demography
Equipment and Supplies
Pathology
Morbidity
Transplants
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Arnaoutakis, G. J., Bittle, G. J., Allen, J. G., Weiss, E. S., Alejo, J., Baumgartner, W. A., ... Conte, J. V. (2014). General and acute care surgical procedures in patients with left ventricular assist devices. World Journal of Surgery, 38(4), 765-773. https://doi.org/10.1007/s00268-013-2403-0
Arnaoutakis, George J. ; Bittle, Gregory J. ; Allen, Jeremiah G. ; Weiss, Eric S. ; Alejo, Jennifer ; Baumgartner, William A. ; Shah, Ashish S. ; Wolfgang, Christopher L. ; Efron, David T. ; Conte, John V. / General and acute care surgical procedures in patients with left ventricular assist devices. In: World Journal of Surgery. 2014 ; Vol. 38, No. 4. pp. 765-773.
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abstract = "Background: Left ventricular assist devices (LVADs) have become common as a bridge to heart transplant as well as destination therapy. Acute care surgical (ACS) problems in this population are prevalent but remain ill-defined. Therefore, we reviewed our experience with ACS interventions in LVAD patients. Methods: A total of 173 patients who received HeartMate{\circledR} XVE or HeartMate{\circledR} II (HMII) LVADs between December 2001 and March 2010 were studied. Patient demographics, presentation of ACS problem, operative intervention, co-morbidities, transplantation, complications, and survival were analyzed. Results: A total of 47 (27 {\%}) patients underwent 67 ACS procedures at a median of 38 days after device implant (interquartile range 15-110), with a peri-operative mortality rate of 5 {\%} (N = 3). Demographics, device type, and acuity were comparable between the ACS and non-ACS groups. A total of 21 ACS procedures were performed emergently, eight were urgent, and 38 were elective. Of 29 urgent and emergent procedures, 28 were for abdominal pathology. In eight patients, the cause of the ACS problem was related to LVADs or anticoagulation. Cumulative survival estimates revealed no survival differences if patients underwent ACS procedures (p = 0.17). Among HMII patients, transplantation rates were unaffected by an ACS intervention (p = 0.2). Conclusions: ACS problems occur frequently in LVAD patients and are not associated with adverse outcomes in HMII patients. The acute care surgeon is an integral member of a comprehensive approach to effective LVAD management.",
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Arnaoutakis, GJ, Bittle, GJ, Allen, JG, Weiss, ES, Alejo, J, Baumgartner, WA, Shah, AS, Wolfgang, CL, Efron, DT & Conte, JV 2014, 'General and acute care surgical procedures in patients with left ventricular assist devices', World Journal of Surgery, vol. 38, no. 4, pp. 765-773. https://doi.org/10.1007/s00268-013-2403-0

General and acute care surgical procedures in patients with left ventricular assist devices. / Arnaoutakis, George J.; Bittle, Gregory J.; Allen, Jeremiah G.; Weiss, Eric S.; Alejo, Jennifer; Baumgartner, William A.; Shah, Ashish S.; Wolfgang, Christopher L.; Efron, David T.; Conte, John V.

In: World Journal of Surgery, Vol. 38, No. 4, 04.2014, p. 765-773.

Research output: Contribution to journalArticle

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T1 - General and acute care surgical procedures in patients with left ventricular assist devices

AU - Arnaoutakis, George J.

AU - Bittle, Gregory J.

AU - Allen, Jeremiah G.

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AU - Alejo, Jennifer

AU - Baumgartner, William A.

AU - Shah, Ashish S.

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AU - Efron, David T.

AU - Conte, John V.

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N2 - Background: Left ventricular assist devices (LVADs) have become common as a bridge to heart transplant as well as destination therapy. Acute care surgical (ACS) problems in this population are prevalent but remain ill-defined. Therefore, we reviewed our experience with ACS interventions in LVAD patients. Methods: A total of 173 patients who received HeartMate® XVE or HeartMate® II (HMII) LVADs between December 2001 and March 2010 were studied. Patient demographics, presentation of ACS problem, operative intervention, co-morbidities, transplantation, complications, and survival were analyzed. Results: A total of 47 (27 %) patients underwent 67 ACS procedures at a median of 38 days after device implant (interquartile range 15-110), with a peri-operative mortality rate of 5 % (N = 3). Demographics, device type, and acuity were comparable between the ACS and non-ACS groups. A total of 21 ACS procedures were performed emergently, eight were urgent, and 38 were elective. Of 29 urgent and emergent procedures, 28 were for abdominal pathology. In eight patients, the cause of the ACS problem was related to LVADs or anticoagulation. Cumulative survival estimates revealed no survival differences if patients underwent ACS procedures (p = 0.17). Among HMII patients, transplantation rates were unaffected by an ACS intervention (p = 0.2). Conclusions: ACS problems occur frequently in LVAD patients and are not associated with adverse outcomes in HMII patients. The acute care surgeon is an integral member of a comprehensive approach to effective LVAD management.

AB - Background: Left ventricular assist devices (LVADs) have become common as a bridge to heart transplant as well as destination therapy. Acute care surgical (ACS) problems in this population are prevalent but remain ill-defined. Therefore, we reviewed our experience with ACS interventions in LVAD patients. Methods: A total of 173 patients who received HeartMate® XVE or HeartMate® II (HMII) LVADs between December 2001 and March 2010 were studied. Patient demographics, presentation of ACS problem, operative intervention, co-morbidities, transplantation, complications, and survival were analyzed. Results: A total of 47 (27 %) patients underwent 67 ACS procedures at a median of 38 days after device implant (interquartile range 15-110), with a peri-operative mortality rate of 5 % (N = 3). Demographics, device type, and acuity were comparable between the ACS and non-ACS groups. A total of 21 ACS procedures were performed emergently, eight were urgent, and 38 were elective. Of 29 urgent and emergent procedures, 28 were for abdominal pathology. In eight patients, the cause of the ACS problem was related to LVADs or anticoagulation. Cumulative survival estimates revealed no survival differences if patients underwent ACS procedures (p = 0.17). Among HMII patients, transplantation rates were unaffected by an ACS intervention (p = 0.2). Conclusions: ACS problems occur frequently in LVAD patients and are not associated with adverse outcomes in HMII patients. The acute care surgeon is an integral member of a comprehensive approach to effective LVAD management.

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Arnaoutakis GJ, Bittle GJ, Allen JG, Weiss ES, Alejo J, Baumgartner WA et al. General and acute care surgical procedures in patients with left ventricular assist devices. World Journal of Surgery. 2014 Apr;38(4):765-773. https://doi.org/10.1007/s00268-013-2403-0