Abstract
Left ventricular assist device (LVAD) use has increased as a bridge to heart transplant as well as destination therapy in patients with severe heart failure. Presence of LVAD is not a contraindication to noncardiac surgery but does present special challenges to the surgical, anesthesia, and cardiac teams. We present the case of a 40-year-old woman with idiopathic cardiomyopathy necessitating LVAD who underwent left partial nephrectomy for a renal mass. She had undergone three nondiagnostic percutaneous image-guided biopsies. Left partial nephrectomy was performed. Perioperative care was without incident due to careful oversight by a multidisciplinary team. Pathology revealed high-grade clear cell renal cell carcinoma (RCC) with negative margins. Polytetrafluoroethylene (PTFE) bolsters were misidentified six months postoperatively on computed tomography (CT) at an outside institution as a retained laparotomy sponge. This is, to our knowledge, the first report of a partial nephrectomy performed in a patient with LVAD.
Highlights
Left ventricular assist device (LVAD) use has increased and become more successful and durable
While nephrectomy [4] and pyelolithotomy [3] have been described in patients with LVAD, this is the first report to our knowledge of partial nephrectomy in such a patient
Nephron sparing is crucial in patients with comorbidities which pose a long term threat to renal function such as heart disease, obesity, and diabetes mellitus
Summary
Left ventricular assist device (LVAD) use has increased and become more successful and durable. Noncardiac surgery is complicated in LVAD due to the position of the device, need for anticoagulation, and tenuous hemodynamics of these patients. Successful noncardiac surgery in LVAD patients occurs when careful coordination between anesthetic, cardiac, and surgical teams takes place [2,3,4].
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