Comparison of Clinical Outcomes Between General Anesthesiologists and Cardiac Anesthesiologists in the Management of Left Ventricular Assist Device Patients in Noncardiac Surgeries and Procedures

Abstract

Objective: To describe the authors' experience and comparative results after introducing noncardiac fellowship-trained anesthesiologists to a service previously managed by fellowship-trained cardiac anesthesiologists caring for left ventricular assist device (LVAD) patients undergoing low-risk noncardiac procedures with anesthesia.

Design: A retrospective chart review.

Setting: Single-site academic medical center in the United States.

Interventions: Anesthesia and intraoperative therapy.

Measurements and main results: After initiating a brief training period for the noncardiac fellowship-trained anesthesiologists and blending the noncardiac anesthesiologists into the care of LVAD patients, the electronic medical records of 158 patients with an LVAD who underwent noncardiac procedures were reviewed. The cases were managed by either cardiac-trained anesthesiologists or noncardiac-trained anesthesiologists. Their performance was evaluated on the basis of technique and outcome. The parameters for technique were the use of intubation and mechanical ventilation, use of vasoactive medications, type of vasoactive medications administered, use of invasive monitoring, and type and amount of intravenous fluid administration. The outcomes examined included occurrence of intraoperative mean blood pressure <55 mmHg, intraoperative cardiac arrest, intraoperative device malfunction, thromboembolic complications, inability to complete procedure due to intraoperative nonsurgical complication, unplanned postoperative intensive care unit admission, unplanned hospital readmission within 30 days, and the 30-day postoperative mortality rate. This analysis demonstrated no statistically significant associations between the type of anesthesiologist and the use of fluid, amount of fluid given, use of vasopressors, or use of invasive monitoring devices. There were no significant differences in specific patient outcomes by anesthesia provider type.

Conclusions: Patients with LVADs can be managed by either a noncardiac or a cardiac fellowship-trained anesthesiologist with similar technique and outcome during low-risk noncardiac procedures and surgeries.

Keywords: cardiac anesthesiologist; general anesthesiologist; left ventricular assist device; management; noncardiac anesthesiologist; noncardiac surgery; outcomes.