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Surgical Endoscopy

, Volume 33, Issue 7, pp 2181–2186 | Cite as

Laparoscopic procedures in patients with cardiac ventricular assist devices

  • Yalini Vigneswaran
  • Victoria Wang
  • Monika Krezalek
  • Vivek Prachand
  • Stephen Wyers
  • Colleen Juricek
  • Nir Uriel
  • Valluvan Jeevanandam
  • Mustafa HussainEmail author
Article
  • 112 Downloads

Abstract

Background

Cardiac left ventricular assist device (LVAD) placement is a common therapy for heart failure. Non-cardiac surgical care of these patients can be complex given the need for anticoagulation, perioperative monitoring, comorbidities, and anatomical considerations due to the device itself. There are no guidelines or significant patient series reported to date for laparoscopic procedures in this population. We herein report the techniques and outcomes for commonly performed laparoscopic procedures in patients with LVADs at a high volume center.

Methods

From our database of patients with ventricular assist devices, we retrospectively identified patients who underwent laparoscopic abdominal surgery. Intraoperative and perioperative data were collected, including anticoagulation management, transfusions and complications. Techniques and preoperative considerations from the surgeons were also compiled and described.

Results

Of 374 patients that had placement of LVADs, 17 had an elective laparoscopic procedure: enteral access placement (n = 7), cholecystectomy (n = 6), hernia repair (n = 2), small bowel resection (n = 1) and splenectomy (n = 1). Preoperative evaluation routinely included radiologic imaging to evaluate driveline location. The most common abdominal entry technique was a periumbilical open Hasson technique (11/17). No cases were converted to open. Overall, the average blood loss was 132 ± 64 mL and the average operative time was 1.8 ± 0.3 h. Five of the 17 patients required intraoperative blood transfusion. No patients suffered perioperative thrombotic events or LVAD complications secondary to holding anticoagulation. No patients required interventions or reoperation for bleeding complications. There were no mortalities related to these procedures.

Conclusions

Laparoscopic abdominal procedures are safe and feasible in patients with LVADs. Although special consideration for bleeding and thrombotic risks, placement of ports and perioperative management is required, the presence of a LVAD itself should not be considered a contraindication for laparoscopic surgery and may in fact be the preferred method for access in these patients.

Keywords

LVAD VAD Ventricular assist device Anticoagulation Driveline 

Notes

Compliance with ethical standards

Disclosures

Dr. Jeevanandam is an advisor for Thoratec/Abbott. Dr. Uriel is an advisor for Thoraec/Abbott and HeartWare/Medtronic. Dr Yalini Vigneswaran, Dr Victoria Wang, Dr Monika Krezalek, Dr Vivek Prachand, Dr Stephen Wyers, Ms Colleen Juricek, and Dr Mustafa Hussain have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of ChicagoChicagoUSA

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