With increasing number of cardiac patients, more and more need for the heart transplant is arising. Since there is always a donor organ shortage, a device has been used to support the end stage cardiac patients, while they are awaiting transplant.

This is a mechanical pump known as Left ventricular assist device (LVAD). It is also used for the support of end stage patients who are not for transplant. In USA, this device is used very frequently. In India it has not been used so far.

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.

A study conducted (which focussed on pre- and post-operative management of their blood-thinning medication) showed that various surgeries like cataract, dental work, hernia repair, gallbladder removal, etc were performed on these patients. In some anti coagulants were stopped prior to the surgery and Heparin was substituted.

General anaesthesia was well tolerated by all patients. There were no deaths, nor complications due to blood clots or device malfunctions. Bleeding occurred in 35 percent of procedures. The average length of hospital stay after surgery was four to ten days.

It was concluded that an institutional guide line or possibly an international protocol will be a wise decision for management of LVAD patients.

Reference: http://www.eurekalert.org/pub_releases/2011-04/hfhs-nss041211.php

Category: Surgery in high risk subjects