Goldstein D J, Mullis S L, Delphin E S, el-Amir N, Ashton R C, Gardocki M, Jordan D A, Catanese K A, Levin H R, Rose E A
Department of Surgery, College of Physicians and Surgeons, Columbia Presbyterian Medical Center, New York, New York, USA.
Ann Surg. 1995 Aug;222(2):203-7. doi: 10.1097/00000658-199508000-00013.
The authors describe their experience with left ventricular assist-device (LVAD) recipients undergoing noncardiac surgery and delineate surgical, anesthetic, and logistic factors important in the successful intraoperative management of these patients.
Left ventricular assist-devices have become part of the armamentarium in the treatment of end-stage heart failure. As the numbers of patients chronically supported with long-term implantable devices grows, general surgical problems that are commonly seen in other hospitalized patients are becoming manifest. Of particular interest is the intraoperative management of patients undergoing elective noncardiac surgical procedures.
The anesthesia records and clinical charts were reviewed for eight ventricular assist-device recipients undergoing general surgical procedures between August 1, 1990 and August 31, 1994.
A total of 12 procedures were performed in 6 men and 2 women averaging 52.7 years of age. Mean time elapsed from device implantation to operation was 68 +/- 35 days. Conventional inhalational and intravenous anesthetic techniques were well tolerated in these patients undergoing diverse surgical procedures. No perioperative mortality was observed. Five of eight patients went on to successful cardiac transplantation.
Hemodynamic recovery after LVAD insertion has defined a new group of patients who develop noncardiac surgical problems often seen in other critically ill patients. Recognition of the unique potential problems that the LVAD recipient may encounter in the perioperative period--in particular patient positioning, device limitations, and fluid and inotropic management--will ensure an optimal surgical outcome for LVAD recipients undergoing noncardiac surgery.
作者描述了左心室辅助装置（LVAD）接受者进行非心脏手术的经验，并阐述了对这些患者术中成功管理至关重要的手术、麻醉和后勤因素。
左心室辅助装置已成为终末期心力衰竭治疗手段的一部分。随着长期植入装置长期支持的患者数量增加，其他住院患者常见的普通外科问题日益显现。特别令人感兴趣的是接受择期非心脏外科手术患者的术中管理。
回顾了1990年8月1日至1994年8月31日期间8例接受普通外科手术的心室辅助装置接受者的麻醉记录和临床图表。
共对6名男性和2名女性进行了12例手术，平均年龄52.7岁。从装置植入到手术的平均时间为68±35天。这些接受各种外科手术的患者对传统吸入和静脉麻醉技术耐受性良好。未观察到围手术期死亡。8名患者中有5名成功进行了心脏移植。
LVAD植入后的血流动力学恢复确定了一组出现其他重症患者常见的非心脏外科问题的新患者群体。认识到LVAD接受者在围手术期可能遇到的独特潜在问题——特别是患者体位、装置限制以及液体和正性肌力药物管理——将确保接受非心脏手术的LVAD接受者获得最佳手术结果。
