Non-Cardiac Surgical Procedures After Left Ventricular Assist Device Implantation

S. Taghavi,¹ S. Jayarajan,¹ A. Mangi,² E. Chan,¹ E. Dauer,¹ L. Sjoholm,¹ A. Pathak,¹ T. Santora,¹ A. Goldberg,¹ J. Rappold.¹

¹Department of Surgery, Temple University School of Medicine, Philadelphia, PA
²Division of Cardiac Surgery, Yale University School of Medicine, New Haven, CT.

Meeting: 2015 American Transplant Congress

Abstract number: C177

Keywords: Heart, Heart assist devices, Heart failure

Session Information

Session Name: Poster Session C: "Loss of Breath": VADs and Other Pre-Heart Transplant Matters

Session Type: Poster Session

Date: Monday, May 4, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Introduction: As left ventricular assist devices (LVAD) are increasingly used for patients with end-stage heart failure, the need for non-cardiac surgical procedures (NCS) in these patients will continue to rise. We examined the various types of NCS required and examined outcomes in LVAD patients requiring NCS.

Methods: The National Inpatient Sample Database was examined for all patients implanted with an LVAD from 2007-2010. Patients requiring NCS after LVAD implantation during the same hospitalization were compared to all other patients receiving an LVAD.

Results: There were 1,397 patients undergoing LVAD implantation during the study period. Of these, 298 (21.3%) required 459 NCS after LVAD implantation. There were 153 (33.3%) general surgery procedures, with abdominal/bowel procedures (n=76, 16.6%) being most common. Thoracic (n=141, 30.7%) and vascular (n=140, 30.5%) procedures were also common. Patients requiring NCS developed more wound infections (9.1 vs. 4.6%, p=0.004), greater bleeding complications (44.0 vs. 24.8%, p<0.001) and were more likely to develop any complication (87.2 vs. 82.0%, p=0.001). The incidence of pneumonia, urinary tract infection, acute renal injury, PE/DVT, and sepsis were not different. Inpatient mortality (22.8 vs. 17.9%, p=0.10) and length of stay (42.4 vs. 38.2 days, p=0.09) were also not different. On multivariate analysis (table), the requirement of NCS procedures was not associated with mortality. Smaller hospital bed size was associated with mortality, while admission in more recent years was associated with survival.

Logistic Regression Examining Variables Associated with Mortality
	Odds Ratio	95% Confidence Interval
NCS	1.45	0.95-2.20
Age	1.01	0.99-1.03
Female	1.30	0.90-1.89
Charlson Comorbidity Index	1.05	0.95-1.16
Private Insurance	0.95	0.53-1.71
Medicare	0.96	0.53-1.73
Self Pay	2.47	0.84-7.21
Medium Hospital Bed Size	1.18	0.79-1.78
Small Hospital Bed Size	2.59	1.98-3.39
Asian	1.21	0.60-2.45
Black	0.59	0.39-1.89
Hispanic	0.77	0.43-1.39
Admission 2008	0.64	0.40-1.04
Admission 2009	0.49	0.25-0.61
Income in 26-50th Quartile	0.80	0.54-1.18
Income in 51-75th quartile	0.66	0.42-0.96
Income in 76-100th quartile	0.63	0.42-0.96

Conclusions: NCS are commonly required after LVAD implantation. NCS can safely be performed on patients implanted with LVAD without an increase in mortality.

To cite this abstract in AMA style:

Taghavi S, Jayarajan S, Mangi A, Chan E, Dauer E, Sjoholm L, Pathak A, Santora T, Goldberg A, Rappold J. Non-Cardiac Surgical Procedures After Left Ventricular Assist Device Implantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/non-cardiac-surgical-procedures-after-left-ventricular-assist-device-implantation/. Accessed May 9, 2025.

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