A new study conducted at Henry Ford Hospital in Detroit suggested that non-cardiac surgery may be done on patients with heart devices, those with implants that are waiting for a heart transplant.
In the United States, the left ventricular assist device (LVAD) is becoming increasingly popular among patients with heart failure. An LVAD is a heart device, specifically a mechanical pump, designed to be implanted in the heart to encourage a weak heart to effectively pump more blood. Heart failure currently affects five million, but unfortunately, only less than 3000 donor organs are available every year in a global scale. In 2010, about 2500 patients with heart failure underwent a heart transplant.
“As these devices become a more common therapy for the treatment of end-stage heart failure, there are an increasing number of patients on device support who require various non-cardiac surgical procedures,” explains the lead author of the study, Jeffrey A. Morgan, M.D., the associate director of Mechanical Circulatory Support in the Edith and Benson Ford Heart and Vascular Institute at Henry Ford.
“However, there is insufficient data and a lack of recommendations regarding the necessity and safety of stopping anticoagulation medication for surgery. The focus of this study was to review our four-year experience with the management of non-cardiac surgery patients on LVAD.”
During the course of the study, the researchers reviewed 64 heart failure patients who underwent an LVAD implantation. They studied all patient records to point out those who underwent LVAD implantation, noting trends relating to post-operative complications such as blood clots, bleeding or device failure.
On 15 patients with LVAD support, 21 non-cardiac operations were performed. These non-cardiac surgeries ranged dental work, cataracts, artery bypasses, bowel resection, gall bladder removal and hernia repairs.
It was noted that general anesthesia was tolerated by the patients quite well. No major post-operative complications, such as sudden deaths, blood clots or device failure were noted. Bleeding was observed in about 35% of the cases, but Robert J. Brewer, M.D., surgical director of Mechanical Circulatory Support at Henry Ford and co-author of the study, suggested the preoperative use of blood thinning medications to reduce the likelihood of post-operative bleeding.