Anesthésie et recherche clinique
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Hemodynamic Consequences of Laparoscopy for Patients on Mechanical Circulatory Support

Heidi Reich, Danny Ramzy, Alagappan Annamalai, Lawrence Czer, Fardad Esmailian, Jaime Moriguchi, Kai Ihnken, Taizoon Yusufali, Nicola D'Attellis and Francisco Arabia

Background: Technologic advances and superior survival with mechanical circulatory support (MCS) led to an expanding population that develops intra-abdominal conditions requiring intervention. Whether laparoscopy can be performed without detrimental effects on hemodynamics and device function is not well-described.

Methods: Effects of laparoscopy performed on MCS were retrospectively assessed. Intraoperative hemodynamics and device function were compared to the same time interval 24h prior to surgery using intrapatient paired t-tests. Outcomes included survival, transfusion, thromboembolic events, and infection.

Results: Twelve patients with ventricular assist devices or total artificial hearts underwent laparoscopy from 2012-2014. Median follow-up was 116 days. Operations included cholecystectomy, diagnostic laparoscopy, gastrojejunostomy, and gastrostomy. There were no differences between preoperative and intraoperative mean arterial pressure, heart rate, or inotrope or vasopressor requirements (p>0.05). Device fill volume, flow, rate, and power were unchanged (p>0.05), while pulsatility index decreased by 0.2, 95% CI [0.03, 0.36], with laparoscopy (p=0.03). All intraoperative fluctuations in hemodynamics and device function improved with reduction of pneumoperitoneum, adjusting device speed, or pharmacologic support. There were no operative mortalities. 30-day survival and survival to discharge were 75% and 50%. Despite antiplatelet therapy and preoperative INR of 2.2 ± 0.9, there were no re-operations for bleeding and 50% did not require transfusion. Two patients with recent cardiac surgery had thromboembolic events: 1 stroke, 1 device thrombus. None had postoperative bacteremia or drive-line infection.

Conclusions: Laparoscopy can be performed on mechanical circulatory support with low morbidity and mortality and minimal perturbations in hemodynamics and device function.