Suresh Visakha, Bishawi Muath, Bryner Benjamin, Manning Michael, Patel Chetan, Milano Carmelo, Schroder Jacob, Sommer Courtney
1 School of Medicine, Duke University Medical Center, Durham, North Carolina.
2 Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
J Laparoendosc Adv Surg Tech A. 2019 Apr;29(4):441-444. doi: 10.1089/lap.2018.0431. Epub 2018 Nov 16.
An increasing number of end-stage heart failure patients are supported with left ventricular assist device (LVAD) implantation and must be maintained on consistent anticoagulation. These patients are experiencing prolonged survival and, in some, there is development of new biliary disease. However, safety and outcomes of this procedure in this unique patient group is not well reported.
This was a retrospective single-center review. All adult patients supported on an implanted, continuous flow LVAD from 2007 to 2016 were screened. Baseline characteristics, laboratory values, and operative details were collected through retrospective chart review and an institutional LVAD registry.
Of the 798 patients screened, 5 (0.63%) underwent laparoscopic cholecystectomy after LVAD implantation. In 4 patients (80%), the indication for surgery was symptomatic cholelithiasis and 1 patient (20%) had symptomatic acalculous cholecystitis. The average time from LVAD implantation to laparoscopic cholecystectomy was 254 ± 158 days. Average (corrected) preoperative international normalized ratio (INR) was 1.34 ± 0.30. Average preoperative hemoglobin was 11.28 ± 2.41 g/dL. All patients were on warfarin preoperatively and admitted before their operations for bridging with a heparin drip. Average postoperative change in hemoglobin was -1.16 ± 1.97 g/dL. The only major postoperative complication in this cohort was the development of an abdominal wall hematoma in 1 patient requiring operative evacuation. The average length of stay was 13.2 ± 4.6 days. Three patients (60%) took an average of 12 days to reach therapeutic INR.
Laparoscopic cholecystectomies can be performed safely in LVAD patients. Prolonged hospital stay is mainly owing to time required to reach a therapeutic INR postoperatively.
II, prognostic.
越来越多的终末期心力衰竭患者通过植入左心室辅助装置（LVAD）获得支持，且必须持续进行抗凝治疗。这些患者的生存期延长，部分患者还出现了新的胆道疾病。然而，针对这一特殊患者群体进行该手术的安全性和结果鲜有报道。
这是一项单中心回顾性研究。对2007年至2016年期间接受植入式连续血流LVAD支持的所有成年患者进行筛查。通过回顾性病历审查和机构LVAD登记处收集基线特征、实验室值和手术细节。
在筛查的798例患者中，5例（0.63%）在LVAD植入术后接受了腹腔镜胆囊切除术。4例患者（80%）的手术指征为有症状的胆结石，1例患者（20%）有症状的非结石性胆囊炎。从LVAD植入到腹腔镜胆囊切除术的平均时间为254±158天。术前平均（校正后）国际标准化比值（INR）为1.34±0.30。术前平均血红蛋白为11.28±2.41g/dL。所有患者术前均服用华法林，并在手术前入院接受肝素滴注桥接治疗。术后血红蛋白平均变化为-1.16±1.97g/dL。该队列中唯一的主要术后并发症是1例患者出现腹壁血肿，需要手术清除。平均住院时间为13.2±4.6天。3例患者（60%）平均需要12天达到治疗性INR。
LVAD患者可以安全地进行腹腔镜胆囊切除术。住院时间延长主要是由于术后达到治疗性INR所需的时间。
II，预后性。
