Preoperative renal dysfunction does not affect outcomes of left ventricular assist device implantation

Abstract

Well selected patients with preexisting renal dysfunction can undergo LVAD implantation with acceptable outcomes. Approximately half of LVAD recipients with preimplantation renal dysfunction will recover normal renal function within the first postoperative year. Renal dysfunction alone should not serve as an absolute contraindication to LVAD therapy.

Adult Congenital Heart Disease: Current Early Expectations After Cardiac Transplantation

“…Not to be overlooked is the fact that 3 times as many patients with nACHD receive pretransplant VADs that can dually reverse end-organ dysfunction (eg, liver, kidney) and minimize the need for inotropic support. 12 This treatment additionally may allow select patients more mobility and, with further therapies, an opportunity to lose weight. 13,14 Further, it could allow for cardiac rehabilitation before transplantation.…”

Commentary: Understanding the relationship between acute kidney injury and durable ventricular assist device implantation: Is it a preoperative or postoperative event?

“…Although the benefits are substantial, the complexity of the operation in the setting of advanced heart failure is challenging and can result in significant end-organ dysfunction, complicating the perioperative course and long-term survival. Whereas numerous studies have examined the outcome of durable VAD implantation in the setting of renal dysfunction or dialysis, [1][2][3][4] few have focused on the impact of durable VAD implantation on the incidence of new acute kidney injury.…”

Left ventricular assist device outcomes and preoperative kidney dysfunction: The truth be told

“…What are we to conclude from the work by Kilic and colleagues? 3 First, because most patients in the reduced GFR group had moderate levels of renal dysfunction, it is reasonable to conclude that a moderate level of preoperative renal dysfunction has modest (clinically insignificant) or no risk for death after LVAD implantation. Of note, because there were so few patients at the extreme of preoperative renal dysfunction, those with a GFR less than 30 mL/min or with preoperative dialysis, it is difficult or not justified to extrapolate conclusions for this subset of patients beyond those observed with only moderate levels of dysfunction.…”