Perioperative management of non-cardiac surgery in patients on long-term left ventricular assist device support

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Left ventricular assist device (LVAD) implantation is increasingly utilized for patients with advanced heart failure.Favorable outcomes at one and five years have contributed to the growing number of LVAD recipients, which in turn has increased the demand for both elective and emergency non-cardiac surgeries in this population.[1,2] LVADs are typically implanted either as a bridge to transplantation (BTT) or as destination therapy (DT).Patients receiving LVADs as DT are generally older and have more comorbidities, making them more likely to require non-cardiac interventions.This study aims to share our experience with non-cardiac surgeries performed in patients with long-term LVAD support. MethodsBetween 2017 and 2024, 72 patients underwent LVAD implantation at our clinic, including 53 with the HeartMate 3 (Abbott Inc., Chicago, IL) and 19 with the HeartWare (Medtronic Inc., Minneapolis, MN).The mean age of the patients was 46.6 years, and the mean follow-up period was 48.5 months (range: 1-78 months).This study included 13 LVAD recipients who underwent a total of 19 non-cardiac procedures; some patients required multiple surgeries.A total of 12 procedures were performed under general anesthesia, and 7 were performed under sedation.Among these patients, 9 had received the HeartMate 3 device, and 4 had the HeartWare device.LVADs were implanted as a BTT in 5 patients and as DT in the remaining 8.The cohort comprised 5 female and 8 male patients, with a mean age of 45.7 years (range: 7-70 years).Detailed demographic and clinical characteristics are presented in Table 1.The study protocol was approved by the Institutional Review Board on Gaziosmanpaşa Hospital (date: 28.10.2024,number: 1942).Background: The shortage of donor hearts has led to the increased use of left ventricular assist devices (LVADs) as an alternative treatment for advanced heart failure.As the population of LVAD recipients grows, so does the demand for non-cardiac surgical interventions in this group.This study aims to share our experience with non-cardiac surgeries performed in patients supported by long-term LVADs. Methods:We retrospectively analyzed 72 patients who underwent LVAD implantation at our clinic between 2017 and 2024.Among them, 53 received the HeartMate 3 (Abbott Inc., Chicago, IL) and 19 received the HeartWare (Medtronic Inc., Minneapolis, MN).Results: Patients were followed for a mean duration of 48.5 months (range: 1-78 months).During this period, 19 non-cardiac surgical procedures were performed in 13 patients; some patients underwent more than one procedure.A total of 12 procedures were conducted under general anesthesia, while 7 was performed under sedation.No perioperative deaths, thromboembolic events, or device malfunctions occurred.Minor complications included one case of re-intubation and one surgical site infection, associated with repeated amputations in a patient with peripheral arterial disease.Conclusion: Non-cardiac surgery in patients with long-term LVAD support appears to be safe when carefully planned.Larger studies are warranted to validate these findings.

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