Outcomes in Patients with Severe Preexisting Renal Dysfunction After Continuous-Flow Left Ventricular Assist Device Implantation. Journal Article

Local Library Link: Find It @ Loyola

Authors: Raichlin, E; Baibhav, B; Lowes, BD; Zolty, R; Lyden, ER; Vongooru, HR; Siddique, A; Moulton, MJ; Um, JY
Article Title: Outcomes in Patients with Severe Preexisting Renal Dysfunction After Continuous-Flow Left Ventricular Assist Device Implantation.
Abstract: The aim of this study was to evaluate clinical outcomes after left ventricular assist device (LVAD) implantation in patients with severe pre-LVAD renal dysfunction (RD). The cohort of 165 consecutive patients implanted with HeartMate II LVADs was divided into two groups: 1) baseline glomerular filtration rate (bGFR) = 40 ml/min/1.73 m (n = 30), and 2) GFR > 40 ml/min/1.73 m (n = 135). In both groups, GFR increased significantly at 1 month and then declined, remaining higher than the pre-LVAD level in the bGFR = 40 group and returning back to the pre-LVAD level in the bGFR > 40 group by 1 year post-LVAD follow-up. Post-LVAD dialysis was used in 20% of the bGFR = 40 patients and 7% of the bGFR > 40 patients (p = 0.02). By 3 months, 14% patients had GFR = 40 ml/min/1.73 m. Grade =2 tricuspid regurgitation (TR) (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.23-10.28; p = 0.02) and model for end-stage liver disease-XI score = 17 (OR, 4.2; 95% CI, 1.45-12.24; p = 0.01) were risk factors for severe RD at 3 months after LVAD implantation. Eight bGFR = 40 patients underwent heart transplantation. Carefully selected patients with advanced heart dysfunction and bGFR = 40 ml/min/1.73 m can improve kidney function with LVAD support and be able to bridge to isolated heart transplantation. Additional research is needed to refine patient selection for LVAD.
Journal Title: ASAIO Journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X; 1058-2916
Publisher: Unknown