Figure 1: Physiologic consequences of carbon dioxide pneumoperitoneum. The physiologic changes during laparoscopic surgery are multifactorial, but are largely attributed to the combined influences of peritoneal absorption of carbon dioxide, elevated intraabdominal pressures, and patient positioning. The effects on various organ systems were established in healthy patients not on mechanical circulatory support devices. Concerns that patients with advanced heart disease may be more susceptible to these changes and less able to mount appropriate compensatory responses remain are counterbalanced by a small, but growing, number of reports that laparoscopy can be safely performed in patients with mechanical circulatory support devices.