Left Ventricular Assist Devices and the Kidney

Ross, Daniel W.; Stevens, Gerin R.; Wanchoo, Rimda; Majure, David T.; Jauhar, Sandeep; Fernandez, Harold A.; Merzkani, Massini; Jhaveri, Kenar D.

doi:10.2215/cjn.04670417

Cited by 45 publications

(45 citation statements)

References 56 publications

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“…Second, recurrent malignant arrhythmias are now well recognized contributors to and can be consequences of advanced heart failure . Third, co‐morbidities can complicate the evaluation of patients with advanced heart failure, and sometimes influence candidacy for MCS or heart transplantation, although it should be recognized that in some cases co‐morbidities may improve after application of advanced therapies . End‐organ damage, in particular kidney or liver dysfunction and pulmonary hypertension, may be a consequence of acute congestion and/or low‐output state, but it may be difficult to distinguish primary and secondary dysfunction or to predict reversibility.…”

Section: Definition Of Advanced Heart Failurementioning

confidence: 99%

“…TandemHeart is a device that connects the left atrium with the iliofemoral artery. 186,187 TandemHeart consists of a 21 Fr inflow cannula (inserted via the femoral vein to the right atrium and trans-septally into the left atrium), a centrifugal continuous extracorporeal blood pump, and an outflow arterial cannula (15)(16)(17)(18)(19) Fr, inserted in the iliofemoral artery). A membrane oxygenator can be added to the TandemHeart circuit to provide respiratory support.…”

Section: Tandemheart ® Percutaneous Ventricular Assist Device (Cardiamentioning

confidence: 99%

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Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Crespo-Leiro

Metra

Lund

et al. 2018

European J of Heart Fail

601

555

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This article updates the Heart Failure Association of the European Society of Cardiology (ESC) 2007 classification of advanced heart failure and describes new diagnostic and treatment options for these patients. Recognizing the patient with advanced heart failure is critical to facilitate timely referral to advanced heart failure centres. Unplanned visits for heart failure decompensation, malignant arrhythmias, co-morbidities, and the 2016 ESC guidelines criteria for the diagnosis of heart failure with preserved ejection fraction are included in this updated definition. Standard treatment is, by definition, insufficient in these patients. Inotropic therapy may be used as a bridge strategy, but it is only a palliative measure when used on its own, because of the lack of outcomes data. Major progress has occurred with short-term mechanical circulatory support devices for immediate management of cardiogenic shock and long-term mechanical circulatory support for either a bridge to transplantation or as destination therapy. Heart transplantation remains the treatment of choice for patients without contraindications. Some patients will not be candidates for advanced heart failure therapies. For these patients, who are often elderly with multiple co-morbidities, management of advanced heart failure to reduce symptoms and improve quality of life should be emphasized. Robust evidence from prospective studies is lacking for most therapies for advanced heart failure. There is an urgent need to develop evidence-based treatment algorithms to prolong life when possible and in accordance with patient preferences, increase life quality, and reduce the burden of hospitalization in this vulnerable patient population.

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Section: Definition Of Advanced Heart Failurementioning

confidence: 99%

Section: Tandemheart ® Percutaneous Ventricular Assist Device (Cardiamentioning

confidence: 99%

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Crespo-Leiro

Metra

Lund

et al. 2018

European J of Heart Fail

601

555

View full text Add to dashboard Cite

show abstract

“…A left ventricular assist device (LVAD) is an implantable mechanical pump to elevate cardiac output (Cowger & Radjef, 2018). Experts have suggested that LVAD may benefit those with Type 2 cardiorenal syndrome (Ross et al, 2018). LVAD use in patients not eligible for heart transplantation (HTx) improved 1‐year survival and quality of life (Cowger & Radjef, 2018).…”

Section: Diagnosis Prognosis and Treatment Of Cardiorenal Syndromementioning

confidence: 99%

“…In terms of kidney function, LVAD's long‐term impact is concerning despite initial improvement in renal function, including in chronic kidney disease patients (Kazory, 2013; Roehm, Vest, & Weiner, 2018). Notably, acute kidney injury is observed in 15% to 45% of patients on left ventricular assist devices (Roehm et al, 2018; Ross et al, 2018). The Aortix (Procyrion), a percutaneous cardiac pumping device, has shown promising results in improving renal perfusion and cardiac output and is in process for the next clinical trial phase (Cowger & Radjef, 2018).…”

Section: Diagnosis Prognosis and Treatment Of Cardiorenal Syndromementioning

confidence: 99%

Cardiorenal syndrome: Multi‐organ dysfunction involving the heart, kidney and vasculature

Savira

Magaye

Liew

et al. 2020

British J Pharmacology

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Cardiorenal syndrome (CRS) is a multi-organ disease, encompassing heart, kidney and vascular system dysfunction. CRS is a worldwide problem, with high morbidity, mortality, and inflicts a significant burden on the health care system. The pathophysiology is complex, involving interactions between neurohormones, inflammatory processes, oxidative stress and metabolic derangements. Therapies remain inadequate, mainly comprising symptomatic care with minimal prospect of full recovery. Challenges include limiting the contradictory effects of multi-organ targeted drug prescriptions and continuous monitoring of volume overload. Novel strategies such as multi-organ transplantation and innovative dialysis modalities have been considered but lack evidence in the CRS context. The adjunct use of pharmaceuticals targeting alternative pathways showing positive results in preclinical models also warrants further validation in the clinic. In recent years, studies have identified the involvement of gut dysbiosis, uraemic toxin accumulation, sphingolipid imbalance and other unconventional contributors, which has encouraged a shift in the paradigm of CRS therapy.

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“…Decisions on patient selection vary by center, with some centers having even more stringent kidney function requirements for LVAD placement 8. Several recent publications address long‐term dialysis management in people with LVADs, although this is often in the context of ESRD developing after LVAD implantation 9. With advancing technologies, management challenges change.…”

Section: Introductionmentioning

confidence: 99%

Implantable Ventricular Assist Device Use and Outcomes in People With End‐Stage Renal Disease

Walther

Niu

Winkelmayer

et al. 2018

JAHA

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BackgroundPeople with end‐stage renal disease (ESRD) are at risk for advanced heart failure, but little is known about use and outcomes of durable mechanical circulatory support in this setting. We examined use and outcomes of implantable ventricular assist devices (VADs) in a national ESRD cohort.Methods and ResultsWe performed a retrospective cohort study of Medicare beneficiaries with ESRD who underwent implantable VAD placement from 2006 to 2014. We examined in‐hospital and 1‐year mortality, all‐cause and cause‐specific hospitalizations, and heart/kidney transplantation outcomes. We investigated as predictors demographic factors, time‐period of VAD implantation, primary or post‐cardiotomy implantation, and duration of ESRD before VAD implantation. We identified 96 people with ESRD who underwent implantable VAD placement. At time of VAD implantation, 74 (77.1%) were receiving hemodialysis, 10 (10.4%) were receiving peritoneal dialysis and 12 (12.5%) had renal transplant. Time from incident ESRD to VAD implantation was median 4.0 (interquartile range 1.1, 8.2) years. Mortality during the implantation hospitalization was 40.6%. Within 1 year of implantation 61.5% of people had died. On multivariable analysis, males had half the mortality risk of females. Lower mortality risk was also seen with VAD implantation in a primary setting, and with more recent year of implantation, but these results did not reach statistical significance.ConclusionsMedicare beneficiaries with ESRD are undergoing durable VAD implantation, often several years after incident ESRD, although in low numbers. Mortality is high among these patients, highlighting the need for investigations to improve treatment selection and management.

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Left Ventricular Assist Devices and the Kidney

Cited by 45 publications

References 56 publications

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Cardiorenal syndrome: Multi‐organ dysfunction involving the heart, kidney and vasculature

Implantable Ventricular Assist Device Use and Outcomes in People With End‐Stage Renal Disease

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