Open AccessNoncardiac Surgery in Patients on Mechanical Circulatory Support
Author(s) -
Sharven Taghavi,
Carl A. Beyer,
Halley Vora,
Senthil N. Jayarajan,
Yoshiya Toyoda,
Jay Dujon,
Lars Ola Sjoholm,
Abhijit Pathak,
Thomas A. Santora,
Amy J. Goldberg,
Joseph Rappold
Publication year - 2014
Publication title -
asaio journal
Language(s) - English
Resource type - Journals
eISSN - 1538-943X
pISSN - 1058-2916
DOI - 10.1097/mat.0000000000000140
Subject(s) - medicine , extracorporeal membrane oxygenation , perioperative , circulatory system , hemostasis , creatinine , surgery , aspirin , ventricular assist device , packed red blood cells , extracorporeal , blood product , extracorporeal circulation , anesthesia , blood transfusion , heart failure , cardiology
This study examined outcomes in patients with left ventricular assist device (LVAD) and extracorporeal membrane oxygenation (ECMO) requiring noncardiac surgical procedures and identified factors that influence outcomes. All patients with mechanical circulatory support (MCS) devices at our institution from 2002 to 2013 undergoing noncardiac surgical procedures were reviewed. There were 148 patients requiring MCS during the study period, with 40 (27.0%) requiring 62 noncardiac surgical procedures. Of these, 29 (72.5%) had implantable LVAD and 11 (27.5%) were supported with ECMO. The two groups were evenly matched with regard to age (53.6 vs. 54.5 years, p = 0.87), male sex (71.4 vs. 45.5%, p = 0.16), and baseline creatinine (1.55 vs. 1.43 mg/dl, p = 0.76). Patients on ECMO had greater demand for postoperative blood products (0.8 vs. 2.8 units of packed red blood cells, p = 0.002) and greater postoperative increase in creatinine (0.07 vs. 0.44 mg/dl, p = 0.047). Median survival was markedly worse in ECMO patients. Factors associated with mortality included ECMO support, history of biventricular assist device, and postoperative blood transfusion. Preoperative aspirin was associated with survival. These findings demonstrate the importance of careful surgical hemostasis and minimizing perioperative blood transfusions in patients on MCS undergoing noncardiac surgical procedures. In addition, low-dose antiplatelet therapy should be continued perioperatively.