Renal function after implantation of continuous versus pulsatile flow left ventricular assist devices.
BACKGROUND
This study was designed to determine the effect of continuous vs pulsatile flow devices on renal function after left ventricular assist device (LVAD) implantation.


METHODS
Ninety-two patients undergoing LVAD implantation as bridge-to-transplant therapy were retrospectively analyzed. Patients receiving continuous flow devices (n = 63, 68.5%) were compared with patients receiving pulsatile flow devices (n = 29, 31.5%). Renal function was assessed by 2 calculated glomerular filtration rates (GFR) using the Modification of Diet in Renal Disease (MDRD)-derived GFR (ml/min/1.73 m(2)) and the Cockcroft-Gault-derived creatinine clearance (CrCl, ml/min).


RESULTS
Mean GFR/CrCl was comparable between the groups at LVAD implantation, in the post-implantation period, and at transplantation. Both groups had a significant increase in mean GFR at Week 1 post-implantation (continuous, 59.4 +/- 22.8 to 76.4 +/- 38.6, p = 0.001; pulsatile, 52.5 +/- 21.1 to 69.2 +/- 34.7; p = 0.007), Week 4 (continuous, 59.9 +/- 23.0 to 84.3 +/- 32.9; p < 0.001; pulsatile, 50.3 +/- 21.1 to 79.9 +/- 38.7, p = 0.007), and Week 12 (continuous, 60.3 +/- 23.1 to 75.3 +/- 30.2, p = 0.004; pulsatile, 55.5 +/- 23.1 to 74.2 +/- 27.2, p = 0.037) that was also seen with the Cockcroft-Gault-calculated CrCl. No significant increase occurred in mean GFR/CrCl to transplantation. Incidence of post-implantation renal failure was comparable between the groups (continuous, 38.1%; pulsatile, 31.0%; p = 0.512).


CONCLUSIONS
After LVAD implantation, patients with continuous flow devices and patients with pulsatile flow devices have comparable renal function.
Sandner
Sigrid E
SE
Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria. sigrid.sandner@meduniwien.ac.at
Zimpfer
Daniel
D
Zrunek
Philipp
P
Dunkler
Daniela
D
Schima
Heinrich
H
Rajek
Angela
A
Grimm
Michael
M
Wolner
Ernst
E
Wieselthaler
Georg M
GM
D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D007668:Kidney / Q000502:physiology*; D007674:Kidney Diseases / Q000209:etiology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D003404:Creatinine