Emergency abdominal surgery in patient with left ventricular assist device: Heart pump and emergency surgery

Abstract

Introduction: The use of left ventricular assist device (LVAD) for the treatment of end-stage heart failure and the fast technological development of these devices have led to an increasing number of patients with implanted LVADs with possibilities to be scheduled for different surgical interventions. Urgent abdominal operations in this group of patients are very complex and pose a particular challenge. Case report: A 61-year-old male patient with an implanted LVAD underwent urgent small bowel resection with ileostomy. Given the severity of cardiac and surgical conditions and the limited availability of LVAD specialists, the anesthetic plan had to be tailored to provide hemodynamic stability, adequate organ perfusion, thromboprophylaxis, reduce risk of infection, pump failure and device damage during surgery. Broad-spectrum antibiotics, thromboembolic and anti-ulcer prophylaxis were given before surgery. Midazolam, fentanyl, and succinylcholine were used to administer anesthesia, and sevoflurane, rocuronium, and fentanyl were used for maintenance. The greatest challenge was balancing the pump thrombosis prevention and minimal perioperative bleeding. During the perioperative period INR values were kept in reference range for LVAD. X-ray verification of the cable position was used to prevent device damage through surgical procedure. LVAD pump parameters were monitored, no alarm was sounded. On the ninth postoperative day, the patient was referred to a reference institution for further treatment. Conclusion: Perioperative management of patients with LVAD device, includes hemodynamic stability, careful handling of the device and prevention of complications like thrombosis and bleeding.

Keywords

• ventricular assist device
• abdominal surgery
• urgent surgery