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

Research output: Contribution to journalArticle

12 Citations (Scopus)

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
StatePublished - Jan 1 2016

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Left ventricular assist devices
Heart-Assist Devices
Glomerular Filtration Rate
Kidney
Heart Transplantation
Odds Ratio
Confidence Intervals
Tricuspid Valve Insufficiency
End Stage Liver Disease
Dialysis
Liver
Patient Selection

Keywords

  • left ventricular assist device
  • renal dysfunction

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

Cite this

Outcomes in patients with severe preexisting renal dysfunction after continuous-flow left ventricular assist device implantation. / Raichlin, Eugenia; Baibhav, Bipul; Lowes, Brian D; Zolty, Ronald; Lyden, Elizabeth R R; Vongooru, Hareeprasad R R; Siddique, Aleem; Moulton, Michael J; Um, John Y.

In: ASAIO Journal, Vol. 62, No. 3, 01.01.2016, p. 261-267.

Research output: Contribution to journalArticle

Raichlin, Eugenia ; Baibhav, Bipul ; Lowes, Brian D ; Zolty, Ronald ; Lyden, Elizabeth R R ; Vongooru, Hareeprasad R R ; Siddique, Aleem ; Moulton, Michael J ; Um, John Y. / Outcomes in patients with severe preexisting renal dysfunction after continuous-flow left ventricular assist device implantation. In: ASAIO Journal. 2016 ; Vol. 62, No. 3. pp. 261-267.
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