Effect of Pulsatile and Non-pulsatile Left Ventricular Assist Devices on the Renin-Angiotensin System in Patients with End-Stage Heart Failure

Welp, H; Rukosujew, Andreas; Tjan, T. D. T.; Hoffmeier, A.; Kösek, V; Scheld, Hans H.; Drees, G.

doi:10.1055/s-0029-1240709

Cited by 62 publications

(36 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of greater concern is the possibility that this decline in eGFR represents an adverse renal effect of nonpulsatile blood flow (47). Welp et al compared the effect of pulsatile-and continuousflow LVADs on the RAAS in heart failure patients (48). As expected preimplantation, peripheral renin activity and plasma aldosterone concentrations were elevated in both LVAD groups.…”

Section: Continuous Blood Flow and Renal Functionmentioning

confidence: 90%

“…These findings could be explained by improvements in elevated right heart and renal vein pressures, which increase interstitial pressures that in turn decrease cross-sectional area of intrarenal vessels and diastolic flow. Improvements in renal function by LVADs appears to be mediated by several factors, including reductions in vascular resistance within the kidney from changes in renal venous pressure, RAAS, and sympathetic activity, as well as improvements in cardiac output (48,(71)(72)(73).…”

Section: Improvement Of Rd After Lvad Placementmentioning

confidence: 99%

See 1 more Smart Citation

Renal Failure in Patients with Left Ventricular Assist Devices

Patel

Adeseun

Ahmed

et al. 2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryImplantable left ventricular assist devices (LVADs) are increasingly being used as a bridge to transplantation or as destination therapy in patients with end stage heart failure refractory to conventional medical therapy. A significant number of these patients have associated renal dysfunction before LVAD implantation, which may improve after LVAD placement due to enhanced perfusion. Other patients develop AKI after implantation. LVAD recipients who develop AKI requiring renal replacement therapy in the hospital or who ultimately require longterm outpatient hemodialysis therapy present management challenges with respect to hemodynamics, volume, and dialysis access. This review discusses the mechanics of a continuous-flow LVAD (the HeartMate II), the effects of continuous blood flow on the kidney, renal outcomes of patients after LVAD implantation, dialysis modality selection, vascular access, hemodynamic monitoring during the dialytic procedure, and other issues relevant to caring for these patients.

show abstract

Section: Continuous Blood Flow and Renal Functionmentioning

confidence: 90%

Section: Improvement Of Rd After Lvad Placementmentioning

confidence: 99%

Renal Failure in Patients with Left Ventricular Assist Devices

Patel

Adeseun

Ahmed

et al. 2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…The effect of LVAD therapy on kidney function and physiology has been studied recently with conflicting results and without a clear pathophysiological understanding [11,12,13,14,15,16,17,18,19]. One current limitation to studying this pathophysiology is that LVAD implantation trends have changed from historically pulsatile to exclusively continuous flow device types.…”

Section: What Effect Does Lvad Physiology Have On Kidney Function?mentioning

confidence: 99%

“…Historical physiological studies in patients who received PF-LVAD therapy have demonstrated improved systemic perfusion [20] and decreased levels of renin, aldosterone, and vasopressin [21]. Welp et al [12] demonstrated that the renin levels improved in PF-LVAD and CF-LVAD patient groups, but the improvement was more marked in the PF-LVAD group. Initial clinical studies focused on the effect of LVADs on kidney function over the first 3-12 months after device implantation.…”

Section: What Effect Does Lvad Physiology Have On Kidney Function?mentioning

confidence: 99%

Kidney Dysfunction and Left Ventricular Assist Device Support: A Comprehensive Perioperative Review

et al. 2015

View full text Add to dashboard Cite

Left ventricular assist devices (LVADs) are used increasingly as a bridge to transplantation or as destination therapy in end-stage heart failure patients who do not respond to optimal medical therapy. Many of these patients have end-organ dysfunction, including advanced kidney dysfunction, before and after LVAD implantation. Kidney dysfunction is a marker of adverse outcomes, such as increased morbidity and mortality. This review discusses kidney dysfunction and associated management strategies during the dynamic perioperative time period of LVAD implantation. Furthermore, we suggest potential future research directions to better understand the complex relationship between renal pathophysiology and mechanical circulatory support.

show abstract

“…19 Although we did not measure renal-adrenal hormones in this study, 1 recent report showed that both plasma renin activity and aldosterone were much greater in patients with nonpulsatile than pulsatile LVADs. 20 The greater plasma renin activity leads to a greater level of angiotensin II in patients with nonpulsatile devices, which in animal research contributes substantially to background SNA. 21 Furthermore, a chronic increase in aldosterone has a similar sympathoexcitatory action, such as observed in patients with primary hyperaldosteronism in whom MSNA is markedly elevated.…”

Section: Mechanisms For Sympathetic Activation With Nonpulsatile Flowmentioning

confidence: 99%

Sympathetic Neural and Hemodynamic Responses to Upright Tilt in Patients With Pulsatile and Nonpulsatile Left Ventricular Assist Devices

Markham

Palmer

et al. 2013

Circ: Heart Failure

100

View full text Add to dashboard Cite

Background— Left ventricular assist devices (LVADs) are now widely accepted as an option for patients with advanced heart failure. First-generation devices were pulsatile, but they had poor longevity and durability. Newer generation devices are nonpulsatile and more durable, but remain associated with an increased risk of stroke and hypertension. Moreover, little is understood about the physiological effects of the chronic absence of pulsatile flow in humans. Methods and Results— We evaluated patients with pulsatile (n=6) and nonpulsatile (n=11) LVADs and healthy controls (n=9) during head-up tilt while measuring hemodynamics and muscle sympathetic nerve activity. Patients with nonpulsatile devices had markedly elevated supine and upright muscle sympathetic nerve activity (mean±SD, 43±15 supine and 60±21 bursts/min at 60° head-up tilt) compared with patients with pulsatile devices (24±7 and 35±8 bursts/min; P <0.01) and controls (11±6 and 31±6 bursts/min; P <0.01); however, muscle sympathetic nerve activity was not different between patients with pulsatile flow and controls ( P =0.34). Heart rate, mean arterial pressure, and total peripheral resistance were greater, whereas cardiac output was smaller, in LVAD patients compared with controls in both supine and upright postures. However, these hemodynamic variables were not significantly different between patients with pulsatile and nonpulsatile flow. Conclusions— Heart failure patients with continuous, nonpulsatile LVADs have marked sympathetic activation, which is likely due, at least in part, to baroreceptor unloading. We speculate that such chronic sympathetic activation may contribute to, or worsen end-organ diseases, and reduce the possibility of ventricular recovery. Strategies to provide some degree of arterial pulsatility, even in continuous flow LVADs may be necessary to achieve optimal outcomes in these patients.

show abstract

Effect of Pulsatile and Non-pulsatile Left Ventricular Assist Devices on the Renin-Angiotensin System in Patients with End-Stage Heart Failure

Cited by 62 publications

References 15 publications

Renal Failure in Patients with Left Ventricular Assist Devices

Renal Failure in Patients with Left Ventricular Assist Devices

Kidney Dysfunction and Left Ventricular Assist Device Support: A Comprehensive Perioperative Review

Sympathetic Neural and Hemodynamic Responses to Upright Tilt in Patients With Pulsatile and Nonpulsatile Left Ventricular Assist Devices

Contact Info

Product

Resources

About