Colo-colonic anastomosis in a continuous-flow left ventricular assist device patient

Abstract

Noncardiac operations are being increasingly performed on patients with left ventricular assist devices (LVADs). However, little is known on the impact of continuous-flow LVADs on the vascular supply of the colon for anastomoses. In this case, a 67-year-old male supported on an LVAD underwent four successful noncardiac operations including two intestinal anastomoses; left colon and small bowel anastomosis. To the best of our knowledge, no existing literature has reported successful colonic anastomosis on a continuous-flow LVAD. This case illustrates the plausibility of performing colonic anastomoses with appropriately selected patients supported on an LVAD. A 67-year-old male with congestive heart failure underwent LVAD placement for decompensated heart failure while awaiting orthotopic transplantation. During his recovery, he developed a stage IV sacral decubitus ulcer which required a sigmoid loop colostomy placement and a rotational flap. Subsequent stoma closure with partial sigmoid colectomy and stapled anastomosis was performed, and healed without evidence of anastomotic leak. This case illustrates the potential for colonic anastomoses for patients on continuous-flow LVAD support. Although oxygenation is known to be an important aspect of healing, this patient's outcome suggests that intestinal anastomoses can be performed on the induced pulseless environment of an LVAD. Further studies will be needed to further elucidate the success of longer segment resections and appropriate surgical candidates.

Keywords

• anastomosis
• heart failure
• ventricular assist device
• wound healing