Laparoscopic Gastric Bypass in a Patient With an Implanted Left Ventricular Assist Device

Abstract

CONGESTIVE HEART FAILURE (CHF) is a growing health issue, with significant morbidity and mortality. Of the 5.8 million Americans affected by CHF, approximately one third of these suffer from nonischemic cardiomyopathy. 1 American Heart AssociationHeart Disease and Stroke Statistics—2010 Update. American Heart Association, Dallas, TX2010 Google Scholar Left ventricular assist devices (LVADs) provide mechanical support to the heart and potentially can reverse the progression of heart failure. 2 Thoratec CorporationLearning About The HeartMate II LVAD. www.thoratec.com/downloads/LVAD-FactSheet.pdf Google Scholar , 3 Morgan J.A. John R. Rao V. et al. Bridging to transplant with the HeartMate left ventricular assist device: The Columbia Presbyterian 12-year experience. J Thorac Cardiovasc Surg. 2004; 127: 1309-1316 Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar LVAD therapy improves heart failure symptoms by 1 to 2 New York Heart Association classes, improves hepatic and renal function, and can improve patient functional capacity. More than 5,000 patients have received a Heartmate II (Thoratec Corp, Pleasanton, CA) LVAD since 2005. 2 Thoratec CorporationLearning About The HeartMate II LVAD. www.thoratec.com/downloads/LVAD-FactSheet.pdf Google Scholar As the success of LVAD therapy grows, it can be expected to see these patients return to the operating room with increasing frequency for noncardiac procedures. Anesthetic management of LVAD patients for open surgical procedures has been discussed in detail in prior literature 3 Morgan J.A. John R. Rao V. et al. Bridging to transplant with the HeartMate left ventricular assist device: The Columbia Presbyterian 12-year experience. J Thorac Cardiovasc Surg. 2004; 127: 1309-1316 Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar , 4 Eckhauser A.E. Melvin W.V. Sharp K.W. Management of general surgical problems in patients with left ventricular assist devices. Am Surg. 2006; 72: 158-161 PubMed Google Scholar , 5 Oleyar M. Stone M. Neustein S.M. Perioperative management of a patient with a nonpulsatile left ventricular-assist device presenting for noncardiac surgery. J Cardiothorac Vasc Anesth. 2010; 24: 820-823 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar ; however, there is a void concerning management for laparoscopic procedures. 6 Kartha V. Gomez W. Wu B. et al. Laparoscopic cholecystectomy in a patient with an implantable left ventricular assist device. Br J Anaesth. 2008; 100: 652-655 Crossref PubMed Scopus (49) Google Scholar The anesthetic management for laparoscopic gastric bypass in a patient with an LVAD is reported. Verbal consent was obtained from the patient before writing this case report.