Improvement in Severe Kidney Dysfunction after Implantation of Continuous-Flow Left Ventricular Assist Devices

Purpose Severe renal dysfunction is common among patients with advanced heart failure and is a contraindication for isolated heart transplantation. Left ventricular assist device (LVAD) may improve circulation and renal function in these patients. This study aimed to determine the effect of severe renal dysfunction on outcomes after LVAD implantation. Methods and Materials A retrospective analysis of 72 consecutive patients implanted with HeartMate II LVAD was conducted. Patients were divided into two groups based on GFR during pre- LVAD hemodynamic optimization: 1-GFR > 40 and 2- GFR ≤ 40 ml. Results In all patients, GFR increased at 1 and 3 months after LVAD implantation and declined at 6 month to the pre-operative value. In the GFR ≤ 40 group improvement in GFR over 6 months was statistically significant compared to pre-operative value.[table1]Post-LVAD survival at 1, 3, and 6 month was 94%, 85% and 65% for the GFR > 40 group, and 100%, 70% and 57% for the GFR ≤ 40 group (p=0.11). Notably, renal function worsened in 21 (29%) patients at 1 month after LVAD implantation. Severe right ventricle dysfunction before and early after LVAD independently predicted worsening in renal function; these patients also had significantly lower post-LVAD survival (p Conclusions Severe renal dysfunction improved after LVAD implantation. Worsening renal function at 1 month after LVAD is predicted by right ventricle dysfunction before and early after LVAD implantation and is associated with poorer survival. Changes in Kidney Function Overall GFR (n=72) GFR >40 (n=57) GFR ≤ 40 (n=15) Pre LVAD 60 +/− 26 68 +/− 26 35 +/− 3 1 month post LVAD (p) 73 +/−25 (0.001) 75 +/− 24 (0.06) 63 +/− 26 (0.002) 3 months post LVAD (p) 76 +/− 33 (0.001) 79 +/− 34 (0.04) 61 +/− 24 (0.009) 6 months post LVAD (p) 63 +/− 26 (0.058) 65 +/− 26 (0.5) 54 +/− 25 (0.02)