Mathis Michael R, Sathishkumar Subramanian, Kheterpal Sachin, Caldwell Matthew D, Pagani Francis D, Jewell Elizabeth S, Engoren Milo C
From the Department of Anesthesiology (M.R.M., S.S., S.K., M.D.C., E.S.J., M.C.E.) and Department of Cardiac Surgery (F.D.P.), University of Michigan Health System, University of Michigan, Ann Arbor, Michigan.
Anesthesiology. 2017 Mar;126(3):450-460. doi: 10.1097/ALN.0000000000001488.
Patients with left ventricular assist devices presenting for noncardiac surgery are increasingly commonplace; however, little is known about their outcomes. Accordingly, the authors sought to determine the frequency of complications, risk factors, and staffing patterns.
The authors performed a retrospective study at their academic tertiary care center, investigating all adult left ventricular assist device patients undergoing noncardiac surgery from 2006 to 2015. The authors described perioperative profiles of noncardiac surgery cases, including patient, left ventricular assist device, surgical case, and anesthetic characteristics, as well as staffing by cardiac/noncardiac anesthesiologists. Through univariate and multivariable analyses, the authors studied acute kidney injury as a primary outcome; secondary outcomes included elevated serum lactate dehydrogenase suggestive of left ventricular assist device thrombosis, intraoperative bleeding complication, and intraoperative hypotension. The authors additionally studied major perioperative complications and mortality.
Two hundred and forty-six patients underwent 702 procedures. Of 607 index cases, 110 (18%) experienced postoperative acute kidney injury, and 16 (2.6%) had elevated lactate dehydrogenase. Of cases with complete blood pressure data, 176 (27%) experienced intraoperative hypotension. Bleeding complications occurred in 45 cases (6.4%). Thirteen (5.3%) patients died within 30 days of surgery. Independent risk factors associated with acute kidney injury included major surgical procedures (adjusted odds ratio, 4.4; 95% CI, 1.1 to 17.3; P = 0.03) and cases prompting invasive arterial line monitoring (adjusted odds ratio, 3.6; 95% CI, 1.3 to 10.3; P = 0.02) or preoperative fresh frozen plasma transfusion (adjusted odds ratio, 1.7; 95% CI, 1.1 to 2.8; P = 0.02).
Intraoperative hypotension and acute kidney injury were the most common complications in left ventricular assist device patients presenting for noncardiac surgery; perioperative management remains a challenge.
接受非心脏手术的左心室辅助装置患者日益常见；然而，对其手术结果知之甚少。因此，作者试图确定并发症的发生率、危险因素和人员配置模式。
作者在其学术三级医疗中心进行了一项回顾性研究，调查了2006年至2015年期间所有接受非心脏手术的成年左心室辅助装置患者。作者描述了非心脏手术病例的围手术期情况，包括患者、左心室辅助装置、手术病例和麻醉特征，以及心脏/非心脏麻醉医生的人员配置情况。通过单因素和多因素分析，作者将急性肾损伤作为主要结局进行研究；次要结局包括提示左心室辅助装置血栓形成的血清乳酸脱氢酶升高、术中出血并发症和术中低血压。作者还研究了主要围手术期并发症和死亡率。
246例患者接受了702例手术。在607例索引病例中，110例（18%）发生术后急性肾损伤，16例（2.6%）乳酸脱氢酶升高。在有完整血压数据的病例中，176例（27%）发生术中低血压。45例（6.4%）出现出血并发症。13例（5.3%）患者在术后30天内死亡。与急性肾损伤相关的独立危险因素包括大型外科手术（调整后的比值比为4.4；95%置信区间为1.1至17.3；P = 0.03）以及需要有创动脉血压监测的病例（调整后的比值比为3.6；95%置信区间为1.3至10.3；P = 0.02）或术前输注新鲜冰冻血浆（调整后的比值比为1.7；95%置信区间为1.1至2.8；P = 0.02）。
术中低血压和急性肾损伤是接受非心脏手术的左心室辅助装置患者最常见的并发症；围手术期管理仍然是一项挑战。
