c  2012 Wiley Periodicals, Inc. 639 ORIGINAL ARTICLE Elective Noncardiac Surgery in Patients with Left Ventricular Assist Devices Mustafa Ahmed, M.D., * Houng Le, M.D.,† Juan M. Aranda Jr., M.D., * and Charles T. Klodell, M.D.‡ * Division of Cardiovascular Medicine; †Department of Anesthesiology; and ‡Department of Surgery, University of Florida College of Medicine, Gainesville, Florida ABSTRACT As the number of heart failure patients supported with left ventricular assist devices (LVAD) increases, the frequency of elective, noncardiac surgery in this patient population will similarly rise. We retrospectively analyzed our LVAD patient database and identified six patients who underwent elective, noncardiac surgery while on LVAD support. These cases are discussed, with an emphasis on the anesthetic and perioperative considerations. These patients have an acceptable risk profile for elective surgery and should be treated similarly to their age-matched counterparts not on LVAD support. doi: 10.1111/j.1540- 8191.2012.01515.x (J Card Surg 2012;27:639-642) As the number of patients on left ventricular assist devices (LVAD) support increases, so too does their need for elective surgery. The diagnosis of heart fail- ure (HF) and the mere presence of an LVAD often cause these patients to be viewed at a prohibitively high risk for elective surgery. Clinicians unfamiliar with LVAD therapy and physiology still perceive there to be "advanced heart failure" and often treat these patients as they would a patient with NYHA Class IV HF. How- ever, many of these patients are NYHA Class I to II, and with appropriate planning can undergo a broad range of surgeries with good outcomes. We present a series of patients on LVAD support who underwent a myriad of elective surgical procedures at our institution with- out significant complications. METHODS After obtaining IRB approval, an institutional data- base containing 141 consecutive LVAD implants from March 1999 to March 2010 was reviewed to deter- mine the number of patients who underwent elective noncardiac surgery while on LVAD support. RESULTS Six patients underwent elective noncardiac surgery while on LVAD support (Table 1). All patients were Conflict of interest: The authors have no conflicts of interest in the submission. This work was not supported by any grants. Address for correspondence: Mustafa Ahmed, M.D., 1600 SW Archer Road, P. O. Box 100277, Gainesville, FL 32610. Fax: +352-273-8889; e-mail: mustafa.ahmed@medicine.ufl.edu male; median age was 60.8 years (range 25 to 77). All but one patient were supported with a HeartMate II LVAD; the remaining patients had a HeartMate XVE LVAD (Thoratec Corp, Pleasanton, CA, USA). Ischemic cardiomyopathy was present in five patients, and one had a nonischemic cardiomyopathy. Procedures included urologic (n = 1), vascular (n = 1), abdominal (n = 3), and orthopedic (n = 1) surgeries. All procedures were done under general endotracheal anesthesia. Me- dian time from LVAD implantation to elective surgery was 500.8 days (range 83 to 1084 days). No patients re- quired intraoperative or immediate postoperative blood products. There were no in-hospital complications and 30-day procedural mortality was zero. Median follow- up was 764.6 days (range 30 to 2075 days). ANTICOAGULATION, ANTIPLATELET, AND ANTIBIOTIC THERAPY Anticoagulation was managed in a patient-specific fashion. Three patients were not on chronic warfarin therapy either due to lack of need based on device type or history of gastrointestinal bleeding. No patients underwent bridging with full dose heparin products, with only one patient receiving half-dose low molecular weight heparin in the immediate postoperative period. All patients were maintained on their antiplatelet regi- men without interruption. Neither bleeding nor pump- thrombosis was noted. Each patient in our series was given routine periop- erative antibiotics. Additionally, patients 3 and 4 were on chronic antibiotic therapies for previous bacteremia and existing superficial driveline infection.