title: Outcomes in Patients with Severe Preexisting Renal Dysfunction After Continuous-Flow Left Ventricular Assist Device Implantation.
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 m (n = 30), and 2) GFR > 40 ml/min/1.73 m (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 m. 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 m 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.
authors.affiliation: From the *Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska; †Department of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, Nebraska; ‡Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Raichlin
authors.forename: Bipul
authors.initials: B
authors.lastname: Baibhav
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lowes
authors.forename: Ronald
authors.initials: R
authors.lastname: Zolty
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Lyden
authors.forename: Hareeprasad R
authors.initials: HR
authors.lastname: Vongooru
authors.forename: Aleem
authors.initials: A
authors.lastname: Siddique
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Moulton
authors.forename: John Y
authors.initials: JY
authors.lastname: Um
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome