Does the need for noncardiac surgery during ventricular assist device therapy impact clinical outcome? Joshua B. Brown, BA, William M. Hallinan, RN, Howard T. Massey, MD, Paul E. Bankey, MD, PhD, Julius D. Cheng, MD, Nicole A. Stassen, MD, Ayodele T. Sangosanya, MD, and Mark L. Gestring, MD, Rochester, NY Background. The role of the ventricular assist device (VAD) in the management of heart failure is expanding. Despite its success, the clinical course for patients requiring noncardiac surgery (NCS) during VAD support is not well described. The objective of this study was to identify VAD patients requiring NCS (+NCS) and compare outcomes with those not requiring NCS (--NCS). Methods. Patients undergoing VAD implant from 2000 to 2007 were reviewed. NCS procedures, survival, and complications were collected. Survival at 1 year from implant, overall survival at the study conclusion, survival time from implant, and outcome of VAD therapy were compared between groups. Results. We enrolled 142 subjects. Demographics did not differ between groups. Twenty-five subjects (18%) underwent 27 NCS procedures. Perioperative survival was 100% and 28-day survival was 64%. Survival to discharge was 56%. Bleeding occurred in 48%. Infection occurred in 33%. Estimated blood loss was 355 mL, and the international normalized ratio at time of NCS was 1.9. Laparoscopy was performed in 3 cases. There was no difference in 1-year survival (59% vs 54%), survival at study conclusion (44% vs 46%) or survival time (517 vs 523 days) between +NCS subjects and --NCS subjects. There were similar causes of death in both groups. The +NCS group was on VAD support longer (245 vs 87 days; P < .01), and less likely to undergo heart transplantation (12% vs 35%; P < .01). Conclusion. NCS is not uncommon during VAD therapy. Bleeding and infection were common complications. Despite this, NCS seems to be feasible and safe and does not seem to increase mortality in the VAD population. (Surgery 2009;146:627-34.) From the Department of Surgery, University of Rochester School of Medicine, Rochester, NY HEART FAILURE continues to be a major public health problem in the United States. It is estimated to affect >5 million Americans and 550,000 new cases are di- agnosed annually. 1 Although heart transplantation has transformed the management of the failing heart, it is clear that the number of available hearts is not sufficient to meet the current needs. 2 The ven- tricular assist device (VAD) was developed to exter- nally support the failing heart until a patient was able to undergo cardiac transplantation. As the technology evolved and improved, indications for VAD support have expanded to include short-term therapy for patients with acute cardiogenic shock as well as long-term, or destination, therapy for end-stage patients ineligible for transplantation. A recent study looking at VAD therapy supplemented with cardiac pharmacotherapy found that 73% of patients with nonischemic cardiomyopathy showed sufficient recovery after an average of 1 year to have the device explanted. 3 Furthermore, the land- mark REMATCH trial demonstrated a 48% decrease in mortality when VAD therapy was compared with medical therapy after 1 year in a population of pa- tients with severe heart failure. 2 The success of this therapeutic approach has resulted in an increased number of patients un- dergoing VAD support, and the ongoing improve- ments in technology have allowed these patients to be maintained on these devices for longer periods of time. This approach increases the likelihood that 1 of these patients will require noncardiac surgery (NCS) during the VAD therapy course. The clinical course of patients requiring NCS while undergoing VAD support has not been well characterized. The objective of this study was to Accepted for publication June 25, 2009. Reprint requests: Mark L. Gestring, MD, Department of Surgery, University of Rochester School of Medicine, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642-8410. E-mail: mark_gestring@ urmc.rochester.edu. 0039-6060/$ - see front matter Ó 2009 Mosby, Inc. All rights reserved. doi:10.1016/j.surg.2009.06.033 SURGERY 627