BACKGROUND: Post-operative renal failure is a common complication after left ventricular assist device (LVAD) implantation. This study was designed to evaluate predictors and outcomes of acute renal failure after LVAD insertion. METHODS: Two-hundred one patients undergoing LVAD implantation at a single institution from June 1996 through April 2004 were retrospectively analyzed. Patients were categorized into 2 groups: those who required post-operative continuous veno-venous hemodialysis (CVVHD) (Group 1, n = 65, 32.3%) and those who did not (Group 2, n = 136, 67.7%). Independent predictors of post-operative renal failure requiring CVVHD were determined using multivariate logistic regression techniques. RESULTS: Patients who had post-operative renal failure requiring CVVHD were older (53.7 +/- 12.9 vs 48.2 +/- 14.2 years, p = 0.009), had a higher incidence of intra-aortic balloon pump use (46.6% vs 26.2%, p = 0.006), and had a higher pre-operative mean LVAD score (5.8 +/- 3.5 vs 3.8 +/- 3.3, p = 0.001) than those without renal failure. LVAD score was the only independent predictor of post-operative renal failure requiring CVVHD (odds ratio = 1.226, p = 0.006). Sepsis rate was higher (33.3% vs 6.9%, p < 0.001) and bridge-to-transplantation rate was lower (52.4% vs 83.5%, p < 0.001) in Group 1 than in Group 2. Post-LVAD survival rates at 1, 3, 5 and 7 years for Group 1 and Group 2 were 43.2%, 39.1%, 34.7% and 34.7% vs 79.2%, 74.0%, 68.3% and 66.4%, respectively (log rank, p < 0.001). CONCLUSIONS: Acute renal failure necessitating CVVHD remains a serious complication after LVAD and confers significant morbidity and mortality. Pre-operative evaluation of patient risk factors and optimization of peri-operative hemodynamics are of utmost importance to prevent this major complication.
BACKGROUND: Post-operative renal failure is a common complication after left ventricular assist device (LVAD) implantation. This study was designed to evaluate predictors and outcomes of acute renal failure after LVAD insertion. METHODS: Two-hundred one patients undergoing LVAD implantation at a single institution from June 1996 through April 2004 were retrospectively analyzed. Patients were categorized into 2 groups: those who required post-operative continuous veno-venous hemodialysis (CVVHD) (Group 1, n = 65, 32.3%) and those who did not (Group 2, n = 136, 67.7%). Independent predictors of post-operative renal failure requiring CVVHD were determined using multivariate logistic regression techniques. RESULTS:Patients who had post-operative renal failure requiring CVVHD were older (53.7 +/- 12.9 vs 48.2 +/- 14.2 years, p = 0.009), had a higher incidence of intra-aortic balloon pump use (46.6% vs 26.2%, p = 0.006), and had a higher pre-operative mean LVAD score (5.8 +/- 3.5 vs 3.8 +/- 3.3, p = 0.001) than those without renal failure. LVAD score was the only independent predictor of post-operative renal failure requiring CVVHD (odds ratio = 1.226, p = 0.006). Sepsis rate was higher (33.3% vs 6.9%, p < 0.001) and bridge-to-transplantation rate was lower (52.4% vs 83.5%, p < 0.001) in Group 1 than in Group 2. Post-LVAD survival rates at 1, 3, 5 and 7 years for Group 1 and Group 2 were 43.2%, 39.1%, 34.7% and 34.7% vs 79.2%, 74.0%, 68.3% and 66.4%, respectively (log rank, p < 0.001). CONCLUSIONS:Acute renal failure necessitating CVVHD remains a serious complication after LVAD and confers significant morbidity and mortality. Pre-operative evaluation of patient risk factors and optimization of peri-operative hemodynamics are of utmost importance to prevent this major complication.
Authors: Samuel T Coffin; Dia R Waguespack; Nicholas A Haglund; Simon Maltais; Jamie P Dwyer; Mary E Keebler Journal: Cardiorenal Med Date: 2015-01-09 Impact factor: 2.041
Authors: Elizabeth A Genovese; Mary Amanda Dew; Jeffrey J Teuteberg; Marc A Simon; Jay K Bhama; Christian A Bermudez; Kathleen L Lockard; Steve Winowich; Robert L Kormos Journal: J Heart Lung Transplant Date: 2010-07-01 Impact factor: 10.247
Authors: O V Blagova; A V Nedostup; E A Kogan; V A Sulimov; S A Abugov; A G Kupriyanova; V A Zaydenov; A E Donnikov; E V Zaklyazminskaya; E A Okisheva Journal: J Atr Fibrillation Date: 2016-06-30
Authors: J Raymond Fitzpatrick; John R Frederick; Vivian M Hsu; Elliott D Kozin; Mary Lou O'Hara; Elan Howell; Deborah Dougherty; Ryan C McCormick; Carine A Laporte; Jeffrey E Cohen; Kevin W Southerland; Jessica L Howard; Mariell L Jessup; Rohinton J Morris; Michael A Acker; Y Joseph Woo Journal: J Heart Lung Transplant Date: 2008-12 Impact factor: 10.247
Authors: Guruprasad A Giridharan; Thomas J Lee; Mickey Ising; Michael A Sobieski; Steven C Koenig; Laman A Gray; Mark S Slaughter Journal: Artif Organs Date: 2012-08 Impact factor: 3.094
Authors: Daniel W Ross; Gerin R Stevens; Rimda Wanchoo; David T Majure; Sandeep Jauhar; Harold A Fernandez; Massini Merzkani; Kenar D Jhaveri Journal: Clin J Am Soc Nephrol Date: 2017-10-25 Impact factor: 8.237