Barbara David W, Olsen David A, Pulido Juan N, Boilson Barry A, Bruining David H, Stulak John M, Mauermann William J
From the Departments of *Anesthesiology, †Cardiovascular Diseases, ‡Gastroenterology, and §Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
ASAIO J. 2015 Nov-Dec;61(6):670-5. doi: 10.1097/MAT.0000000000000269.
The number of patients with left ventricular assist devices (LVADs) continues to increase, and gastrointestinal (GI) endoscopy is commonly required in this patient population. We retrospectively reviewed the experience of a single tertiary care center in managing patients with LVADs undergoing GI endoscopy between 2006 and 2013. After hospital dismissal from the LVAD placement, 53 patients underwent 172 GI endoscopic procedures. Gastrointestinal bleeding was the indication for endoscopy in 73.8% of patients. Median age at endoscopy was 66 years, and median time from LVAD implantation to initial endoscopy was 271 days (range, 31-1681 days). Anticoagulation or antiplatelet therapy was present within 1 week before 120 of 172 endoscopies (70%) and was withheld or actively reversed in 91 of 120 cases (76%). For sedation/anesthesia during endoscopy, 63 involved care by an anesthesiology team and 109 were performed with nursing sedation protocols. Noninvasive blood pressure techniques (conventional automated cuffs or Doppler pulses) were used for hemodynamic monitoring in 84%, arterial lines in 10%, and no blood pressure recordings documented/charted as inaccurate in 6%. Six patients died within 30 days of endoscopy with one death because of aspiration of blood and multiorgan failure. Patients with LVADs may safely undergo GI endoscopy with various individualized anesthetic/sedation models. Complications after endoscopy likely represent the acuity of this patient population.
植入左心室辅助装置（LVAD）的患者数量持续增加，这一患者群体通常需要接受胃肠道（GI）内镜检查。我们回顾性分析了一家三级医疗中心在2006年至2013年间管理接受GI内镜检查的LVAD患者的经验。在LVAD植入出院后，53例患者接受了172次GI内镜检查。73.8%的患者内镜检查指征为胃肠道出血。内镜检查时的中位年龄为66岁，从LVAD植入到首次内镜检查的中位时间为271天（范围31 - 1681天）。172次内镜检查中有120次（70%）在检查前1周内进行了抗凝或抗血小板治疗，其中91例（76%）停用或积极逆转了此类治疗。内镜检查期间的镇静/麻醉方面，63例由麻醉团队护理，109例按照护理镇静方案进行。84%的患者使用无创血压技术（传统自动袖带或多普勒脉搏）进行血流动力学监测，10%使用动脉导管，6%未记录血压或记录不准确。6例患者在内镜检查后30天内死亡，1例死于血液误吸和多器官功能衰竭。LVAD患者可通过各种个体化麻醉/镇静模式安全地接受GI内镜检查。内镜检查后的并发症可能反映了该患者群体的病情严重程度。
