Abstract
BackgroundLeft ventricular assist devices (LVADs) currently play an important role in the treatment of patients with end-stage heart failure who require a bridge to heart transplantation or destination therapy. With the development and improvement of the LVADs, the morbidity and mortality rates are declining and life expectancies increasing, and the number of patients with LVADs requiring non-cardiac surgery is likely to increase. We present the case of a patient with implantable LVAD who underwent laparoscopic right hemicolectomy for ascending colon cancer.Case descriptionThe patient was a 66-year-old man who underwent LVAD implantation as a BTT 3 years prior. He suffered from severe anemia at follow-up, and a colonoscopy revealed ascending colon cancer. The LVAD pump was implanted in the epigastrium. The long C-shaped subfascial driveline tunnel was made, and driveline exit site was located on the left lateral abdominal wall. We assessed the positional relationship between the tumor and the driveline using X-ray and three-dimensional computed tomography (3D CT) images. 3D CT image allowed us to easily identify the location of the driveline, and we determined to perform laparoscopic right hemicolectomy. The port sites were decided upon carefully to avoid the driveline injury, and the driveline was marked on the skin before surgery. There were no adhesions in the abdominal cavity, and both the LVAD and the driveline were observable. The trocars were in nearly the same positions as in a standard laparoscopic right hemicolectomy. During the operation, the LVAD and the driveline did not interfere with the trocars. We successfully completed a standard laparoscopic right hemicolectomy despite hemorrhagic tendency. The patient was discharged without any bleeding complications during the postoperative course.ConclusionLaparoscopic surgery is feasible and safe for patients with LVADs with intensive preoperative simulation and perioperative prevention of infection.
Highlights
Left ventricular assist devices (LVADs) currently play an important role in the treatment of patients with endstage heart failure who require a bridge to heart transplantation (BTT) or destination therapy (DT)
The LVAD pump was implanted in the epigastrium
Upon observing the inside of the abdominal cavity, we found the LVAD and the driveline were observable without severe adhesions (Fig. 2b, c)
Summary
Left ventricular assist devices (LVADs) currently play an important role in the treatment of patients with endstage heart failure who require a bridge to heart transplantation (BTT) or destination therapy (DT). The number of patients with LVADs requiring surgery for abdominal cancer is likely to increase. We report a successful case of laparoscopic right hemicolectomy for a patient with LVAD. The location of driveline was marked on the skin by a cardiovascular surgeon prior to surgery, and the port sites were decided upon carefully to avoid injury to the driveline due to trocar insertion (Fig. 2a). The position of each trocar was nearly the same as the site marked before surgery and as a standard laparoscopic right hemicolectomy. As the reverse Trendelenburg position reduces venous return and the Trendelenburg position increases venous return, it was vital that changing of the operative position was performed slowly Such actions led to minimal variation in the hemodynamics. But the patient refused due to social issues
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