Preoperative renal dysfunction does not affect outcomes of left ventricular assist device implantation

The Journal of Thoracic and Cardiovascular Surgery

Arman Kilic¹  Ann C. Gaffey²  Carol W. Chen³ 

[1] Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa;Division of Cardiology, University of Pennsylvania, Philadelphia, Pa;Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa

关键词: ventricular assist device;    renal failure;    outcomes;    heart failure;    morbidity;   

DOI  :  10.1016/j.jtcvs.2017.12.044

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveSelection criteria for durable left ventricular assist device (LVAD) implantation remain unclear. One such criterion is renal function. In this study we evaluated outcomes of LVAD implantation in patients with preoperative renal dysfunction.MethodsPatients with implanted LVADs as destination therapy (DT) or bridge to transplantation (BTT) at a single institution between 2006 and 2015 were included. Primary stratification was according to pre-implantation glomerular filtration rate (GFR): >60 mL/min versus ResultsTwo hundred thirty-eight patients underwent LVAD implantation during the study period as DT (60%; n = 142) or BTT (40%; n = 96). Reduced GFR was present in 56% (n = 132), with 8% (n = 18) being dialysis-dependent. Normal versus reduced GFR cohorts were well matched except for a higher incidence of coronary artery disease in the patients with reduced GFR (61% vs 48%; P = .04). Mean follow-up was 13.5 ± 17.0 months. Unadjusted and risk-adjusted survival at 1, 3, 6, and 12 months after LVAD implantation were similar between the cohorts for DT and BTT. Rates of transplantation were comparable in BTT patients (61% normal vs 53% reduced GFR; P = .43). Recovery of renal function to a GFR >60 mL/min occurred in 43% (n = 17) and 57% (n = 42) of patients with reduced GFR in the BTT and DT cohorts, respectively, by 1 year post implantation.ConclusionsWell selected patients with preexisting renal dysfunction can undergo LVAD implantation with acceptable outcomes. Approximately half of LVAD recipients with preimplantation renal dysfunction will recover normal renal function within the first postoperative year. Renal dysfunction alone should not serve as an absolute contraindication to LVAD therapy.

【 授权许可】

Unknown