Outcomes in patients with severe preexisting renal dysfunction after continuous-flow left ventricular assist device implantation

Eugenia Raichlin, Bipul Baibhav, Brian D Lowes, Ronald Zolty, Elizabeth R R Lyden, Hareeprasad R R Vongooru, Aleem Siddique, Michael J Moulton, John Y Um

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14 Scopus citations

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 m2 (n = 30), and 2) GFR > 40 ml/min/1.73 m2 (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 m2. 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 m2 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.

Original languageEnglish (US)
Pages (from-to)261-267
Number of pages7
JournalASAIO Journal
Volume62
Issue number3
DOIs
Publication statusPublished - Jan 1 2016

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Keywords

  • left ventricular assist device
  • renal dysfunction

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

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