Perioperative Care and Clinical Outcomes of Patients with Left Ventricular Assist Devices Undergoing Noncardiac Surgery in Korea: A Retrospective Study

TL;DR

This study examines the risks and outcomes of non-cardiac surgeries in patients with heart assist devices in Korea, finding that major surgeries and early procedures are linked to higher complication rates.

Contribution

The paper provides novel insights into perioperative risk factors and outcomes for LVAD patients undergoing non-cardiac surgery in Korea.

Findings

Major surgeries and intraoperative transfusions of ≥3 units of packed red blood cells are significant predictors of in-hospital mortality.

Surgery within 180 days after LVAD implantation increases the risk of composite complications.

Postoperative complications occurred in 66.7% of patients, with a 20% mortality rate.

Abstract

Background: Since 2018, the number of left ventricular assist devices (LVAD) implantations in Korea has been steadily increasing. Consequently, an increasing number of LVAD patients are presenting for non-cardiac surgery (NCS) of varying complexity. However, recent data on the perioperative management and clinical course of these patients remain limited. We share our investigation on patient and perioperative risk factors, as well as perioperative adverse outcomes, including mortality, in LVAD patients undergoing NCS. Methods: We retrospectively reviewed medical records of 36 LVAD patients who underwent NCS at our tertiary care center between 2018 and 2024. Patients requiring VA-ECMO were excluded. The primary end point was in-hospital mortality. The secondary end point was a composite of complications, including postoperative pulmonary complications, acute kidney injury, cerebrovascular accident, postoperative bleeding or thrombosis, and hemodynamic instability. Using univariable and multivariable logistic regression analysis, we examined the correlation between perioperative factors and adverse outcomes. Results: A total of 53 NCS index cases across 40 hospitalizations were analyzed. General surgery was the most common specialty (n = 19, 35.8%), followed by thoracic surgery (n = 13, 24.5%), plastic surgery (n = 7, 13.2%), and neurosurgery (n = 4, 7.5%). Thirteen procedures (24.5%) were classified as major surgeries. Postoperative complications occurred in 24 patients (66.7%), and 8 patients (20%) experienced mortality. Multivariable regression analysis identified major surgery (adjusted odds ratio [aOR] 1.44; 95% CI 1.11–1.86; p = 0.010), and intraoperative transfusion of ≥3 units of packed red blood cells (aOR 1.47; 95% CI 1.05–2.04; p = 0.029) as significant predictors of in-hospital mortality. Undergoing NCS within 180 days after LVAD implantation was associated with an increased risk of composite complications (aOR 1.86; 95% CI 1.53–2.27; p < 0.001). Conclusions: LVAD patients undergoing non-cardiac surgery frequently experience postoperative complications. Major surgeries, significant intraoperative transfusions, and early surgery following LVAD implantation are key predictors of poor outcomes. Careful risk assessment and tailored perioperative management are essential in this population.

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