Анестезия и клинические исследования
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ISSN: 2155-6148
ISSN: 2155-6148
Heidi Reich, Danny Ramzy, Alagappan Annamalai, Lawrence Czer, Fardad Esmailian, Jaime Moriguchi, Kai Ihnken, Taizoon Yusufali, Nicola D'Attellis and Francisco Arabia
Background: Technologic advances and superior survival with mechanical circulatory support (MCS) led to an expanding population that develops intra-abdominal conditions requiring intervention. Whether laparoscopy can be performed without detrimental effects on hemodynamics and device function is not well-described.
Methods: Effects of laparoscopy performed on MCS were retrospectively assessed. Intraoperative hemodynamics and device function were compared to the same time interval 24h prior to surgery using intrapatient paired t-tests. Outcomes included survival, transfusion, thromboembolic events, and infection.
Results: Twelve patients with ventricular assist devices or total artificial hearts underwent laparoscopy from 2012-2014. Median follow-up was 116 days. Operations included cholecystectomy, diagnostic laparoscopy, gastrojejunostomy, and gastrostomy. There were no differences between preoperative and intraoperative mean arterial pressure, heart rate, or inotrope or vasopressor requirements (p>0.05). Device fill volume, flow, rate, and power were unchanged (p>0.05), while pulsatility index decreased by 0.2, 95% CI [0.03, 0.36], with laparoscopy (p=0.03). All intraoperative fluctuations in hemodynamics and device function improved with reduction of pneumoperitoneum, adjusting device speed, or pharmacologic support. There were no operative mortalities. 30-day survival and survival to discharge were 75% and 50%. Despite antiplatelet therapy and preoperative INR of 2.2 ± 0.9, there were no re-operations for bleeding and 50% did not require transfusion. Two patients with recent cardiac surgery had thromboembolic events: 1 stroke, 1 device thrombus. None had postoperative bacteremia or drive-line infection.
Conclusions: Laparoscopy can be performed on mechanical circulatory support with low morbidity and mortality and minimal perturbations in hemodynamics and device function.