Acute kidney injury after implantation of a left ventricular assist device: a comparison of axial-flow (HeartMate II) and centrifugal-flow (HeartWare HVAD) devices

Abstract

Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly being used to treat advanced, refractory chronic heart failure. Herein, we sought to determine the incidence of postoperative acute kidney injury (AKI) in axial-flow (HeartMate II; HM-II) and centrifugal-flow (HVAD) CF-LVAD recipients, as well as the effect of AKI on mortality. The study cohort comprised 520 patients who received a HM-II (n = 398) or HVAD (n = 122) at our center between November 2003 and March 2016. Their records were reviewed to determine the incidence of RIFLE-defined AKI after LVAD implantation. We compared the perioperative characteristics, postoperative complications, and survival rates of the patients with and without AKI and differentiated the outcomes based on device type (HM-II or HVAD). Seventy-five patients (14.4%) developed AKI postoperatively. Patients with AKI after LVAD implantation had significantly reduced survival compared to patients without AKI (p = 0.01). Cox proportional hazards models showed that AKI was a significant independent predictor of mortality (HR = 1.54, p = 0.03). Preoperative mechanical circulatory support and prolonged cardiopulmonary bypass time were independent predictors of AKI. The incidence of AKI was similar for HM-II and HVAD recipients (p = 0.25). There was no significant difference in AKI rates for the HM-II and HVAD recipients. Developing AKI adversely affected survival.

Post-operative renal failure management in mechanical circulatory support patients

“…In 100 LVAD patients, 28 of whom developed postoperative ARF, higher pre-operative CVP was independently associated with post-operative acute renal failure postoperatively suggesting an association between renal failure and subclinical right ventricular dysfunction (46). In another observational study of 520 patients receiving axial flow (HeartMate II) or centrifugal flow (HVAD) devices, an association between post-operative AKI and right heart failure was noted (47). Careful support of right heart function may help to preserve renal function and therefore treatments should be directed at avoiding hypoxic pulmonary vasoconstriction, high airway pressures, and respiratory acidosis, consideration of pulmonary vasodilators, use of appropriate inotropic agents including milrinone, and consideration of Right Ventricular Assist Device implantation or temporary right heart support with Ventricular-Pulmonary Arterial ECMO, where required.…”

“…The overall issue of LVADs and renal function has recently been reviewed (42). Pre-existing renal dysfunction is seen in about 25% of patients with advanced heart failure (43) due to decreased cardiac output and kidney perfusion, renal venous congestion and is associated with adverse outcomes and mortality (44)(45)(46)(47)(48)(49). This has important implications for candidate selection and ability to bridge to transplant (50).…”

“…In a review of 520 patients following LVAD implantation for advanced, refractory chronic heart failure, 75 (14%) developed AKI that was an independent predictor of mortality (hazard ratio 1.54). Pre-operative MCS and prolonged cardiopulmonary bypass time were independent predictors of AKI (47). An observational study of 100 LVAD patients reported that the 28% who developed post-operative acute renal failure were more likely to have been intubated pre-operatively and had higher pre-operative central venous pressure (46).…”

Journal of Artificial Organs 2018: the year in review

“…Anjum et al [6] examined the incidence of postoperative acute kidney injury (AKI) in axial-flow (HeartMate II; HM-II) and centrifugal-flow (HVAD) CF-LVAD recipients, as well as the effect of AKI on mortality. They concluded that there was no significant difference in AKI rates for the HM-II and HVAD recipients, whereas patients with AKI after LVAD implantation had significantly reduced survival compared to patients without AKI.…”

Detection of thrombosis in a magnetically levitated blood pump by vibrational excitation of the impeller

“…The development of contactless support technologies for the impeller has led to an increase in the durability of ventricular assist devices (VADs). Such VADs utilize the hydrodynamic bearings, for example, HVAD (Medtronic Inc., Minneapolis, MN, USA), or magnetic bearings, for example, HeartMate 3 (Abbott Laboratories, Chicago, IL, USA), for levitation of the impeller and have been in clinical use worldwide . Although much technical progress has been made in VADs, pump thrombosis and stroke are still serious issues in this field .…”