title: HeartMate II left ventricular assist device implantation in patients with advanced hepatic dysfunction.
abstract: BACKGROUND
  We sought to determine the outcomes for patients with advanced hepatic dysfunction undergoing HeartMate II left ventricular assist device (LVAD) implantation.
  
  
  METHODS
  Between November 1, 2003 and December 1, 2012, we implanted the HeartMate II continuous-flow LVAD in 338 patients, either for bridging to heart transplantation or for destination therapy. Twenty-three of these patients (19 men and 4 women; mean age, 47 ± 16 years) had advanced hepatic dysfunction, as characterized by alanine aminotransferase (ALT) or aspartate transaminase (AST) levels five times normal; serum total bilirubin levels three times normal; and/or necessity for a liver biopsy before or during device implantation. Of this group, 17 patients received the LVAD as a bridge to transplantation, and six patients received it for destination therapy.
  
  
  RESULTS
  Nine of the 23 patients required either a transjugular or a core liver biopsy during LVAD implantation. Three patients died within the first postoperative month; the 20 surviving patients had significant improvements in their hepatic parameters. The ALT decreased from 238 ± 296 to 27 ± 13 U/L (p = 0.022), AST decreased from 209 ± 199 to 29 ± 8 U/L (p = 0.009), and total bilirubin level decreased from 6.9 ± 6.0 to 0.6 ± 0.1 mg/dL (p = 0.044). The serum albumin level increased from 3.2 ± 0.6 to 4.3 ± 0.3 g/dL (p = 0.003), and creatinine clearance increased from 77.6 ± 35.2 to 110.2 ± 35.7 mL/min/1.73 m2 (p = 0.101).
  
  
  CONCLUSIONS
  Continuous-flow LVAD support may significantly improve hepatic function, allowing patients with poor preimplant liver function to become better candidates for heart transplantation.
authors.affiliation: Department of Cardiopulmonary Transplantation, Texas Heart Institute, Houston, Texas; Center for Cardiac Support, Texas Heart Institute, Houston, Texas.
authors.forename: Zumrut T
authors.initials: ZT
authors.lastname: Demirozu
authors.forename: Ruben
authors.initials: R
authors.lastname: Hernandez
authors.forename: Hari R
authors.initials: HR
authors.lastname: Mallidi
authors.forename: Steve K
authors.initials: SK
authors.lastname: Singh
authors.forename: Rajko
authors.initials: R
authors.lastname: Radovancevic
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Segura
authors.forename: Whitson B
authors.initials: WB
authors.lastname: Etheridge
authors.forename: William E
authors.initials: WE
authors.lastname: Cohn
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin