gms | German Medical Science

Objective: In recent years, the number of patients with left ventricular assist devices (LVAD) has increased steadily. Implantation of LVAD has become an established treatment option for patients with end stage heart failure either to bridge time to transplantation or as a definitive therapy. With the increasing number of LVAD patients, elective surgery is discussed more often. Neurosurgeons are faced with various problems in these patients, in particular how to deal with the necessary anticoagulation therapy in these patients. Thus far, no guidelines have been established and the specific risks in this complex setting are unknown.

Methods: Between January 2005 and November 2017 627 patients underwent LVAD implantation in the Department of Cardiothoracic, Transplantation and Vascular Surgery. The interdepartmental database was screened for patients, who have undergone an elective neurosurgical procedure.

Results: Seven patients were identified during the screening period (six male, one female, mean age 56 years). Diagnoses were: lumbar spinal cord stenosis (2), sphenoid wing meningioma (1), hydrocephalus (2), and large craniectomy defects (3). The following procedures were performed: interlaminar decompression (2), subtotal excision of the sphenoid wing meningioma via craniotomy (1), VP-shunting (1), cranioplasty (2), cranioplasty and VP-shunting (1). Medication with coumarin was interrupted in all instances and patients were equipped with a heparin perfusor to maintain a PTT between 40-60 seconds perioperatively. No haemorrhagic complications occurred. The patient, who underwent VP-shunting died on the day of surgery due to heart and LVAD failure.

Conclusion: Neurosurgical operations in patients with LVAD are challenging due to the necessary maintenance of anticoagulation therapy. These patients need to be treated in close collaboration between experienced neurosurgical and heart surgery teams to avoid haemorrhage and cardiac complications.