title: Renal function and outcome after continuous flow left ventricular assist device implantation.
abstract: BACKGROUND
  Renal dysfunction as a risk factor with the use of left ventricular assist devices (LVAD) is controversial. We determined the effect of renal function on outcomes after continuous flow LVAD implantation.
  
  
  METHODS
  Eighty-six patients with advanced heart failure undergoing continuous flow LVAD implantation as bridge to transplantation from November 1998 to July 2007 were retrospectively analyzed. Renal function was assessed using the Modification of Diet in Renal Disease study-derived glomerular filtration rates (GFR [mL x min(-1) x 1.73 m(-2)]). Patients were categorized into two groups based on pre-LVAD GFR: those with normal renal function (GFR > 60, n = 46), and those with renal dysfunction (GFR < 60, n = 40).
  
  
  RESULTS
  Post-LVAD survival at 1, 3, and 6 months for GFR greater than 60 was 91.3%, 79.9%, 72.6%, respectively, and for GFR less than 60, it was 92.5%, 66.5%, 47.9%, respectively (p = 0.038). Bridge-to-transplant rate was lower for GFR less than 60 than for GFR greater than 60 (40.0% versus 63.0%, p = 0.033). For GFR less than 60, GFR improved on LVAD support: implant to month 6, 41.7 +/- 11.5 to 62.7 +/- 25.0 (p = 0.021). Post-LVAD survival was improved in GFR less than 60 patients who after LVAD implantation recovered renal function to GFR greater than 60 (p < 0.001). Patients with post-LVAD renal failure had significantly lower post-LVAD survival regardless of pre-LVAD renal function (p < 0.001).
  
  
  CONCLUSIONS
  Patients with renal dysfunction have poorer outcomes after continuous flow LVAD implantation. However, renal function improves after LVAD implantation and is associated with improved survival. Our data underscore the importance of end-organ function in patient selection for LVAD therapy.
authors.affiliation: Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria. sigrid.sandner@meduniwien.ac.at
authors.forename: Sigrid E
authors.initials: SE
authors.lastname: Sandner
authors.forename: Daniel
authors.initials: D
authors.lastname: Zimpfer
authors.forename: Philipp
authors.initials: P
authors.lastname: Zrunek
authors.forename: Angela
authors.initials: A
authors.lastname: Rajek
authors.forename: Heinrich
authors.initials: H
authors.lastname: Schima
authors.forename: Daniela
authors.initials: D
authors.lastname: Dunkler
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.forename: Ernst
authors.initials: E
authors.lastname: Wolner
authors.forename: Georg M
authors.initials: GM
authors.lastname: Wieselthaler