The benefits of cataract surgery may outweigh the risks in some patients with left ventricular assist devices (LVADs). These patients rarely undergo cataract surgery, but under the right conditions, LVADs, the mechanical pumps that provide blood flow and hemodynamic support, need not be a contraindication for cataract surgery, say researchers at Duke Eye Center in Durham, North Carolina.1
“Our work suggests that careful preoperative planning and intraoperative monitoring with our colleagues in anesthesiology and cardiology can result in successful management of someone who might otherwise be considered at prohibitively high risk for elective surgery,” said Cassandra C. Brooks, MD.
Retrospective evaluation. The Duke researchers reviewed electronic health records of 31 patients (53 eyes) with LVADs who underwent cataract surgery. Most were male (n = 27) and Caucasian (n = 25), and their average age was 69.5 years.
The majority underwent cataract extraction and IOL implantation alone (n = 28). Of note, nearly half of surgeries (47.2%) involved the use of a femtosecond laser, intraoperative aberrometry, and/or a premium IOL.
Most of the patients were lost to follow-up, but for the 18 eyes with complete data, 11 (61.1%) were at ±0.5 D of their predicted spherical equivalent.
Perioperative planning. While it proved safe and feasible, cataract surgery in these high-risk patients was not undertaken lightly. Prior to surgery, an LVAD anesthesia team assessed each patient; in addition, an LVAD specialist was present at all surgeries.
In adherence to guidelines regarding anticoagulation for procedures with a low bleeding risk, patients continued anticoagulation therapy prior to surgery.
Safety outcomes. Despite the potential for hemodynamic compromise in patients with advanced heart disease, there were no intraoperative episodes of hemodynamic instability. Two intraoperative events unrelated to the LVAD occurred. All patients were discharged the day of surgery, and no hospitalizations or deaths were attributed to the cataract procedure within the following 30 days.
Looking ahead. Future studies will have to determine whether these outcomes can be replicated in the absence of an LVAD team. “Fortunately, none of the patients in our cohort suffered complications,” Dr. Brooks said. “But immediate access to the appropriate specialists would be highly advisable to avoid potentially fatal complications.”
This is an expanding population of patients with specialized needs for ophthalmic surgery. Yet by understanding the patients’ unique risks, and with interdisciplinary collaboration, they can undergo cataract surgery, Dr. Brooks said. “As in all surgical cases, preoperative planning is the key to success.”
1 Brooks CC et al. J Cataract Refract Surg. Published online April 16, 2020.
Relevant financial disclosures—Dr. Brooks: None.
For full disclosures and the disclosure key, see below.
Full Financial Disclosures
Dr. Brooks None.
Dr. Milea Note: This study was funded by the Singapore National Medical Research Council (CS-IRG Grant) and the SingHealth Duke–NUS Ophthalmology and Visual Sciences Academic Clinical Program.
Dr. Swaroop None.
Dr. Walter Allergan: C; Castle Biosciences: C; Genentech: C.
Dr. Wong Allergan: C; Bayer: C; Boehringer-Ingelheim: C; EyRis: O; Genentech: C; Merck: C; Novartis: C; Oxurion: C; plano: O; Roche: C; Samsung: C. Note: This study was funded by the Singapore National Medical Research Council (CS-IRG Grant) and the SingHealth Duke–NUS Ophthalmology and Visual Sciences Academic Clinical Program.
||Consultant fee, paid advisory boards, or fees for attending a meeting.
||Employed by a commercial company.
||Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
||Equity ownership/stock options in publicly or privately traded firms, excluding mutual funds.
||Patents and/or royalties for intellectual property.
||Grant support or other financial support to the investigator from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and/or pharmaceutical companies.
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