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Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery

AIM: The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery. MATERIALS AND METHODS: This is a retrospective review...

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Autores principales: Degnan, Meredith, Brodt, Jessica, Rodriguez-Blanco, Yiliam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070328/
https://www.ncbi.nlm.nih.gov/pubmed/27716699
http://dx.doi.org/10.4103/0971-9784.191545
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author Degnan, Meredith
Brodt, Jessica
Rodriguez-Blanco, Yiliam
author_facet Degnan, Meredith
Brodt, Jessica
Rodriguez-Blanco, Yiliam
author_sort Degnan, Meredith
collection PubMed
description AIM: The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery. MATERIALS AND METHODS: This is a retrospective review of the population of patients with LVADs at a single institution undergoing noncardiac procedures between 2009 and 2014. Demographic, perioperative, and procedural data collected included the type of procedure performed, anesthetic technique, vasopressor requirements, invasive monitors used, anesthesia provider type, blood product management, need for postoperative intubation, postoperative disposition and length of stay, and perioperative complications including mortality. STATISTICAL ANALYSIS: Descriptive statistics for categorical variables are presented as frequency distributions and percentages. Continuous variables are expressed as mean ± standard deviation and range when applicable. RESULTS: During the study, 31 patients with LVADs underwent a total of 74 procedures. Each patient underwent an average of 2.4 procedures. Of the total number of procedures, 48 (65%) were upper or lower endoscopies. Considering all procedures, 81% were performed under monitored anesthesia care (MAC). Perioperative care was provided by faculty outside of the division of cardiac anesthesia in 62% of procedures. Invasive blood pressure monitoring was used in 27 (36%) procedures, and a central line, peripherally inserted central catheter or midline was in place preoperatively and used intraoperatively for 38 (51%) procedures. Vasopressors were not required in the majority (65; 88%) of procedures. There was one inhospital mortality secondary to multiorgan failure; 97% of patients survived to discharge after their procedure. CONCLUSION: At our institution, LVAD patients undergoing noncardiac procedures most frequently require endoscopy. These procedures can frequently be done safely under MAC, with or without consultation by a cardiac anesthesiologist.
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spelling pubmed-50703282016-11-01 Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery Degnan, Meredith Brodt, Jessica Rodriguez-Blanco, Yiliam Ann Card Anaesth Original Article AIM: The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery. MATERIALS AND METHODS: This is a retrospective review of the population of patients with LVADs at a single institution undergoing noncardiac procedures between 2009 and 2014. Demographic, perioperative, and procedural data collected included the type of procedure performed, anesthetic technique, vasopressor requirements, invasive monitors used, anesthesia provider type, blood product management, need for postoperative intubation, postoperative disposition and length of stay, and perioperative complications including mortality. STATISTICAL ANALYSIS: Descriptive statistics for categorical variables are presented as frequency distributions and percentages. Continuous variables are expressed as mean ± standard deviation and range when applicable. RESULTS: During the study, 31 patients with LVADs underwent a total of 74 procedures. Each patient underwent an average of 2.4 procedures. Of the total number of procedures, 48 (65%) were upper or lower endoscopies. Considering all procedures, 81% were performed under monitored anesthesia care (MAC). Perioperative care was provided by faculty outside of the division of cardiac anesthesia in 62% of procedures. Invasive blood pressure monitoring was used in 27 (36%) procedures, and a central line, peripherally inserted central catheter or midline was in place preoperatively and used intraoperatively for 38 (51%) procedures. Vasopressors were not required in the majority (65; 88%) of procedures. There was one inhospital mortality secondary to multiorgan failure; 97% of patients survived to discharge after their procedure. CONCLUSION: At our institution, LVAD patients undergoing noncardiac procedures most frequently require endoscopy. These procedures can frequently be done safely under MAC, with or without consultation by a cardiac anesthesiologist. Medknow Publications & Media Pvt Ltd 2016 /pmc/articles/PMC5070328/ /pubmed/27716699 http://dx.doi.org/10.4103/0971-9784.191545 Text en Copyright: © 2016 Annals of Cardiac Anaesthesia http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Degnan, Meredith
Brodt, Jessica
Rodriguez-Blanco, Yiliam
Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery
title Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery
title_full Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery
title_fullStr Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery
title_full_unstemmed Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery
title_short Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery
title_sort perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070328/
https://www.ncbi.nlm.nih.gov/pubmed/27716699
http://dx.doi.org/10.4103/0971-9784.191545
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