Impact of preoperative versus postoperative dialysis on left ventricular assist device outcomes: An analysis from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support database

Mehaffey, J. Hunter; Cantor, Ryan S.; Myers, Susan; Teman, Nicholas R.; Kern, John A.; Ailawadi, Gorav; Pagani, Francis D.; Kirklin, James K.; Yount, Kenan W.; Yarboro, Leora T.

doi:10.1016/j.xjon.2022.01.005

Cited by 3 publications

(5 citation statements)

References 21 publications

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“…Current literature on renal events in VAD supported patients is limited to the impact of pre‐existing chronic kidney disease, and adverse kidney events occurring around the time of implant. Reassuringly, a recent analysis of the STS INTERMACS database suggested patients who required pre‐implant RRT but have renal recovery within the first month of support had similar survival to those who never required RRT 9 . However, overall survival was lower in pre‐implant RRT patients who continued to require RRT at 1 month after implant, and in those newly commenced on RRT post‐operatively 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Reassuringly, a recent analysis of the STS INTERMACS database suggested patients who required pre‐implant RRT but have renal recovery within the first month of support had similar survival to those who never required RRT 9 . However, overall survival was lower in pre‐implant RRT patients who continued to require RRT at 1 month after implant, and in those newly commenced on RRT post‐operatively 9 . Negative predictors of renal recovery included BiVAD support, inotrope requirement at 1 week and various biochemical parameters 9 .…”

Section: Discussionmentioning

confidence: 99%

“…However, overall survival was lower in pre‐implant RRT patients who continued to require RRT at 1 month after implant, and in those newly commenced on RRT post‐operatively 9 . Negative predictors of renal recovery included BiVAD support, inotrope requirement at 1 week and various biochemical parameters 9 . Post‐implant AKI, particularly with RRT requirement, has been shown to increase the risk of in‐hospital mortality, 30‐day rehospitalization and 30‐day mortality 10–12 .…”

Section: Discussionmentioning

confidence: 99%

“… 9 Negative predictors of renal recovery included BiVAD support, inotrope requirement at 1 week and various biochemical parameters. 9 Post‐implant AKI, particularly with RRT requirement, has been shown to increase the risk of in‐hospital mortality, 30‐day rehospitalization and 30‐day mortality. 10 , 11 , 12 Multiple, and often contradictory, predictors of post‐implant RRT requirement have been described, including both older and younger age, intra‐aortic balloon pump use, higher pre‐implant creatinine and RAP, and longer cardiopulmonary bypass time.…”

Section: Discussionmentioning

confidence: 99%

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Major adverse kidney events predict reduced survival in ventricular assist device supported patients

Barua,

Conte,

Cherrett

et al. 2023

ESC Heart Failure

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AimsThere is limited data describing major adverse kidney events (MAKE) in patients supported with ventricular assist devices (VAD). We aim to describe the association between MAKE and survival, risk factors for MAKE, and renal trajectory in VAD supported patients.Methods and resultsWe conducted a single‐centre retrospective analysis of consecutive VAD implants between 2010 and 2019. Baseline demographics, biochemistry, and adverse events were collected for the duration of VAD support. MAKE was defined as the first event to occur of sustained drop (>50%) in estimated glomerular filtration rate (eGFR), progression to stage V chronic kidney disease, initiation or continuation of renal replacement therapy beyond implant admission or death on renal replacement therapy at any time. One‐hundred and seventy‐three patients were included, median age 56.8 years, 18.5% female, INTERMACS profile 1 or 2 in 75.1%. Thirty‐seven patients experienced MAKE. On multivariate analysis, post‐implant clinical right ventricular failure and the presence of chronic haemolysis, defined by the presence of schistocytes on blood film analysis, were significantly associated with increased risk of MAKE (adjusted odds ratio 9.88, P < 0.001 and adjusted odds ratio 3.33, P = 0.006, respectively). MAKE was associated with reduced survival (hazard ratio 4.80, P < 0.001). Patients who died or experienced MAKE did not demonstrate the expected transient 3‐month improvement in eGFR, seen in other cohorts.ConclusionsMAKE significantly impacts survival. In our cohort, MAKE was predicted by post‐implant right ventricular failure and chronic haemolysis. The lack of early eGFR improvement on VAD support may indicate higher risk for MAKE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Major adverse kidney events predict reduced survival in ventricular assist device supported patients

Barua,

Conte,

Cherrett

et al. 2023

ESC Heart Failure

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“…Some essential kidney variables should be carefully studied before deciding on DT-LVAD: Firstly, glomerular function and laboratory biomarkers. Patients with eGFR < 30 mL/min/ 1.73 m 2 , calculated by chronic kidney disease epidemiology collaboration (CKD-EPI) [68], or on dialysis are generally ineligible for this therapy [69][70][71] due to their high mortality (40.6% during hospitalization and 61.5% at 1-year [72]). The change in kidney function over time provides a lot of information: decline in GFR (maximum physiological expected 1 mL/min/1.73 m 2 per year), especially if it is rapid, is strongly related to poor prognosis.…”

Section: Renal Disfunctionmentioning

confidence: 99%

Left Ventricular Assist Device as a Destination Therapy: Current Situation and the Importance of Patient Selection

Melendo-Viu

Dobarro

Roubín

et al. 2023

Life

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Advanced heart failure is a growing problem for which the best treatment is cardiac transplantation. However, the shortage of donors’ hearts made left ventricular assist devices as destination therapy (DT-LVAD) a highly recommended alternative: they improved mid-term prognosis as well as patients’ quality of life. Current intracorporeal pumps with a centrifugal continuous flow evolved in the last few years. Since 2003, when first LVAD was approved for long-term support, smaller device sizes with better survival and hemocompatibility profile were reached. The most important difficulty lies in the moment of the implant. Recent indications range from INTERMACS class 2 to 4, with close monitoring in intermediate cases. Moreover, a large multiparametric study is needed for considering the candidacy: basal situation, with a special interest in frailty, comorbidities, including renal and hepatic dysfunction, and medical background, considering every prior cardiac condition, must be evaluated. In addition, some clinical risk scores can be helpful to measure the possibility of right heart failure or morbi-mortality. With this review, we sought to summarize all the device improvements, with their updated clinical results, as well as to focus on all the patient selection criteria.

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Evaluation and Management of Kidney Dysfunction in Advanced Heart Failure: A Scientific Statement From the American Heart Association

Tang,

Bakitas,

Cheng

et al. 2024

Circulation

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Early identification of kidney dysfunction in patients with advanced heart failure is crucial for timely interventions. In addition to elevations in serum creatinine, kidney dysfunction encompasses inadequate maintenance of sodium and volume homeostasis, retention of uremic solutes, and disrupted endocrine functions. Hemodynamic derangements and maladaptive neurohormonal upregulations contribute to fluctuations in kidney indices and electrolytes that may recover with guideline-directed medical therapy. Quantifying the extent of underlying irreversible intrinsic kidney disease is crucial in predicting whether optimization of congestion and guideline-directed medical therapy can stabilize kidney function. This scientific statement focuses on clinical management of patients experiencing kidney dysfunction through the trajectory of advanced heart failure, with specific focus on (1) the conceptual framework for appropriate evaluation of kidney dysfunction within the context of clinical trajectories in advanced heart failure, including in the consideration of advanced heart failure therapies; (2) preoperative, perioperative, and postoperative approaches to evaluation and management of kidney disease for advanced surgical therapies (durable left ventricular assist device/heart transplantation) and kidney replacement therapies; and (3) the key concepts in palliative care and decision-making processes unique to individuals with concomitant advanced heart failure and kidney disease.

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Impact of preoperative versus postoperative dialysis on left ventricular assist device outcomes: An analysis from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support database

Cited by 3 publications

References 21 publications

Major adverse kidney events predict reduced survival in ventricular assist device supported patients

Major adverse kidney events predict reduced survival in ventricular assist device supported patients

Left Ventricular Assist Device as a Destination Therapy: Current Situation and the Importance of Patient Selection

Evaluation and Management of Kidney Dysfunction in Advanced Heart Failure: A Scientific Statement From the American Heart Association

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