Cataract Surgery Safe in Patients With Heart Failure

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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.”

—Miriam Karmel

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1 Brooks CC et al. J Cataract Refract Surg. Published online April 16, 2020.

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Relevant financial disclosures—Dr. Brooks: None.

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