HeartMate II Left Ventricular Assist Device Implantation in Patients with Advanced Hepatic Dysfunction

Abstract

Continuous-flow LVAD support may significantly improve hepatic function, allowing patients with poor preimplant liver function to become better candidates for heart transplantation.

Periportal fibrosis without cirrhosis does not affect outcomes after continuous flow ventricular assist device implantation

“…A possible explanation for this discrepancy is our use of MELD-XI scores, which eliminates INR from the equation to account for anticoagulation. Given evidence that VAD implantation has been shown to improve reversible liver disease in patients with heart failure, 14 and conflicting reports of association between MELD and survival in patients treated with VAD implantation for heart failure, the utility of MELD scores for predicting outcomes remains unclear.…”

“…In cases of reversible hepatopathy, VAD implantation may improve hepatic function to the point at which heart transplantation is possible. 14,15 This study seeks to determine the effects of hepatic fibrosis without cirrhosis on outcomes after VAD implantation for the treatment of heart failure.…”

Should Patients with Hepatic Fibrosis Undergo LVAD Implantation: A Comparative Analysis

“…A similar series reported by Demirozu et al suggested that LVAD implantation in patients with hepatic dysfunction was actually associated with improvements in hepatic function postoperatively. 10 However, an important distinction to emphasize is that, the Demirozu series did not focus exclusively on the advanced subgroup of patients with biopsy-proven hepatic fibrosis. 10 Other groups have demonstrated that the preoperative MELD and MELD-XI scores are independent predictors of RV failure requiring RVAD implantation 11 and post-LVAD mortality, 12,13 respectively, following LVAD implantation.…”

“…10 However, an important distinction to emphasize is that, the Demirozu series did not focus exclusively on the advanced subgroup of patients with biopsy-proven hepatic fibrosis. 10 Other groups have demonstrated that the preoperative MELD and MELD-XI scores are independent predictors of RV failure requiring RVAD implantation 11 and post-LVAD mortality, 12,13 respectively, following LVAD implantation. yost et al demonstrated that a MELD > 9 was significantly associated with RV failure and that the need for RVAD support significantly reduced survival.…”

Assessing the liver to predict outcomes in heart transplantation

“…Likewise, novel biomarkers of hepatic fibrosis and apoptosis, including fibroblast growth factor-23, Toll-like receptor 4, and epitopes of hepatic cytokeratin-18, 17-19 may help target appropriate candidates for liver biopsy. For patients found to have moderate to severe fibrosis, mechanical circulatory support could provide a bridge to recovery of hepatic function, 20 although data are lacking on reversal of biopsy findings. Heart transplant alone has also been shown to ameliorate laboratory abnormalities-but not the pathology-associated with congestive hepatopathy.…”