Left ventricular assist device implantation may be feasible in appropriately selected patients with severe renal insufficiency

Pasrija, Chetan; Tran, Douglas; George, Praveen; Sorensen, Erik N.; Kaczorowski, David J.; Ton, Van-Khue; Kon, Zachary N.; Vorhees, Hannah; Sawan, Mariem A.; Griffith, Bartley P.

doi:10.1016/j.jtcvs.2019.03.098

Cited by 8 publications

(8 citation statements)

References 13 publications

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“…The improvement was uninfluenced by basal eGFR 37,38 . Even patients with an eGFR <30 mL/min/1.73 m 2 experienced a pronounced improvement in RF 40 . This early improvement after LVAD implantation could be explained by the complex interplay of haemodynamic and nonhaemodynamic mechanisms between heart and kidneys.…”

Section: Effects Of Lvad Support On Renal Functionmentioning

confidence: 96%

“…37,38 Even patients with an eGFR <30 mL/ min/1.73 m 2 experienced a pronounced improvement in RF. 40 This early improvement after LVAD implantation could be explained by the complex interplay of haemodynamic and nonhaemodynamic mechanisms between heart and kidneys. As well as the influence of more or less acute and recent disruptions in heart function on their renal physiology, patients with a long history of HF have chronically hypoperfused kidneys, which have been exposed to the same conditions that damaged the heart (diabetes, dyslipidaemia, hypertension, etc).…”

Section: Early Effectsmentioning

confidence: 99%

“…Taken together, these results suggest that LVAD may not be the best type of MCS for candidates with severe renal dysfunction. Pasrija et al 40 demonstrated that dedicated management strategies for such patients may overcome the dismal prognosis associated with severe renal dysfunction. In a single‐centre retrospective analysis on 58 patients, algorithmic management strategy was adopted to improve renal perfusion and reduce CVP (inotropes, intra‐aortic balloon pump, haemoglobin >9.0 g/dL, etc), and even patients with eGFR <30 mL/min/1.73 m 2 underwent LVAD implantation with no substantial increase in mortality.…”

Section: Predictors Of Mortality In the Lvad Population With A Specia...mentioning

confidence: 99%

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Heart, kidney and left ventricular assist device: a complex trio

Gambaro

Lombardi

Gottin

et al. 2021

Eur J Clin Investigation

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Background: Heart failure (HF) is a complex syndrome affecting the whole body, kidneys included. The left ventricular assist device (LVAD) is a valid option for patients with very severe HF. Focusing on renal function, LVAD implantation could theoretically reverse the detrimental effects of HF syndrome on kidneys. However, implanting an LVAD is a high-risk surgical procedure, and LVAD patients have higher risk of bleeding, device thrombosis, strokes, renal impairment, multi-organ failure and infections. Furthermore, an LVAD has its own particular effects on the renal system. Methods: In this review, we provide a comprehensive overview of the complex interaction between LVAD and the kidneys from the pathophysiological and clinical perspectives. An analysis of the different effects of pulsatile-flow and continuousflow LVAD is provided. Results: Despite their limitations, creatinine-based estimated glomerular filtration rate (eGFR) formulas help to stratify patients by their post-LVAD placement prognosis. Poor basal renal function, the onset of acute kidney injury or the need for renal replacement therapy after LVAD implantation negatively influences a patient's prognosis. LVAD can also prompt an improvement in renal function, however, with some counterintuitive effects on a patient's prognosis. Conclusion: It is still hard to say whether different trends in eGFR depend on different renal conditions before LVAD placement, on a patient's better overall status or on a particular patient management strategy before and/or after the device's implantation. Steps should be taken to solve this question because finding the best candidates for LVAD implantation is of paramount importance to ensure the best outcomes.

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Section: Effects Of Lvad Support On Renal Functionmentioning

confidence: 96%

Section: Early Effectsmentioning

confidence: 99%

Section: Predictors Of Mortality In the Lvad Population With A Specia...mentioning

confidence: 99%

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Heart, kidney and left ventricular assist device: a complex trio

Gambaro

Lombardi

Gottin

et al. 2021

Eur J Clin Investigation

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“…A retrospective analysis of 4,917 patients from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) who had CF-LVAD implantation revealed that patients with estimated glomerular filtration rate (eGFR) < 30 mL/minute/1.73 m 2 or those with dialysis dependence had excess mortality of 22% in the first three months [29]. An additional study demonstrated that patients with a preoperative GFR < 15 mL/minute/1.73 m 2 who were prophylactically initiated on temporary renal replacement therapy postoperatively showed an increase in GFR to >30 mL/minute/1.73 m 2 in about 11 of the 21 patients studied [30]. Among 17 patients in a study by Lamba et al who required chronic intermittent hemodialysis (n = 13) or peritoneal hemodialysis (n = 4) prior to implantation, 14 patients required CRRT prior to implantation [31].…”

Section: Esrd and Hemodialysis (Hd) Versus Continuous Renal Replaceme...mentioning

confidence: 98%

Outcomes With Left Ventricular Assist Device in End-Stage Renal Disease: A Systematic Review

Lakhdar¹,

Nassar²,

Buttar³

et al. 2022

Cureus

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Renal dysfunction is a common comorbidity in patients with advanced heart failure who may benefit from mechanical circulatory support (MCS). Unfortunately, renal function may result after left ventricular assist device (LVAD) implantation. The purpose of this study is to examine the outcomes of advanced heart failure patients with end-stage renal disease (ESRD) requiring mechanical circulatory support as a bridge to transplant (BTT) or destination therapy (DT). We searched Medline, Embase, and Cochrane in September 2021. The following keywords were used: left ventricular assist device or LVAD and end-stage renal disease or ESRD. Our study included case reports, case series, descriptive studies, and randomized control trials. Review articles, guidelines, systematic reviews, and meta-analyses were excluded. We also excluded pediatric cases. We identified 278 articles; 92 were duplicated, 186 articles entered the screening phase, and 133 articles were excluded by title and abstract. After the full-text screening, 40 articles were excluded. This systematic review included 13 articles. Among the contraindications to LVAD implantation, a general contraindication is for patients found to have stage 4 chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR): <30 mL/minute/1.73 m 2 ), while those on dialysis are an absolute contraindication LVAD implantation. Despite the limited data and publications on LVADs in patients with ESRD, LVAD implantation as a bridge to transplantation or destination therapy may be considered in selected patients without increasing morbidity and mortality. Therefore, shared decision-making around the treatment of advanced heart failure with these patients and the care team is essential.

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“…In high-risk patients, pre-emptive initiation of RRT before systemic congestion ensues may be beneficial, especially if urine output remains inadequate after high-dose diuretics. This theory was tested in a small study of 21 patients with eGFR <30 mL/min/1.73 m 2 treated with aggressive pre-operative optimization including IABP placement and immediate RRT after weaning CPB, with similar rates of RVF and 1-year survival as patients with normal eGFR ( 255 ).…”

Section: Early and Acute Right Ventricular Failurementioning

confidence: 99%

Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review

Ródenas-Alesina

Brahmbhatt

Rao

et al. 2022

Front. Cardiovasc. Med.

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Left ventricular assist devices (LVADs) are increasingly common across the heart failure population. Right ventricular failure (RVF) is a feared complication that can occur in the early post-operative phase or during the outpatient follow-up. Multiple tools are available to the clinician to carefully estimate the individual risk of developing RVF after LVAD implantation. This review will provide a comprehensive overview of available tools for RVF prognostication, including patient-specific and right ventricle (RV)-specific echocardiographic and hemodynamic parameters, to provide guidance in patient selection during LVAD candidacy. We also offer a multidisciplinary approach to the management of early RVF, including indications and management of right ventricular assist devices in this setting to provide tools that help managing the failing RV.

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Left ventricular assist device implantation may be feasible in appropriately selected patients with severe renal insufficiency

Cited by 8 publications

References 13 publications

Heart, kidney and left ventricular assist device: a complex trio

Heart, kidney and left ventricular assist device: a complex trio

Outcomes With Left Ventricular Assist Device in End-Stage Renal Disease: A Systematic Review

Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review

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