Objective: Cardiac ventricular assist device (VAD) placement is a common destination therapy for heart failure; however, no guidelines or significant series guide the use of laparoscopic procedures in this population. We herein report techniques and outcomes for commonly performed laparoscopic procedures at our high volume cardiac ventricular assist device placement center.
Methods: Retrospective review of all patients with VAD placement at our institution to identify patients with laparoscopic abdominal operations. Intraoperative data, perioperative data, and surgeons’ preoperative considerations were collected.
Results: Of 374 patients with placement of VADs, 17 had a laparoscopic procedure: enteral access (n=7), cholecystectomy (n=6), hernia repair (n=2), small bowel resection (n=1) and splenectomy (n=1). Preoperative imaging was routinely used to evaluate drive line location with relation to planned port site placement. No cases were converted to open. Overall, the average blood loss was 132±64mL and operative time was 1.8±0.3 hours.
No patients had perioperative thrombotic events or VAD complications secondary to holding anticoagulation (held an average 4.1 days before surgery and restarted 1.8 days after surgery). Five patients received intraoperative transfusions per anesthesia’s discretion and seven patients had postoperative anemia that resolved with transfusions. No patients required interventions or reoperation for bleeding. There were no mortalities related to these procedures.
Conclusions: Laparoscopic procedures are safe in patients with VADs. Although special consideration for bleeding risks, placement of ports, and perioperative management is required, the presence of a VAD itself should not be a contraindication for laparoscopic surgery and may in fact be preferred for these patients.
