(590) - Renal Function Recover With Left Ventricular Assist Device Support

Abstract

Purpose: In heart failure patients with renal insufficiency (RI), we hypothesize that mechanical circulatory support with the left ventricular assist device (LVAD) will promote renal function recovery (RR). We sought to quantify RR with LVAD support over six months of follow-up. Methods: RR data at 30, 90 and 180 days were analyzed for all LVAD patients with RI at the time of surgery. RI was defined as either the use of hemodialysis (HD) or a glomerular filtration rate (GFR) less than 60 ml/min/ 1.73m2. Mean GFR calculations exclude those patients on HD. Results: Between January, 2008 and December, 2013, 47 of 127 (37%) LVAD recipients (age 57±12yrs, 72% men) had RI at the time of surgery. Of these 47 patients, 8.5% of LVAD implantations were elective, 91% were urgent, 1.5% were emergent and 21% were redo operations. The mean preoperative creatinine level was 1.84± 0.6 mg/dL with a MELD score of 16.5± 6. Most patients (74.5%) were on inotrope support at the time of implantation. Among the study group, the overall 30-day mortality was 15%. The mean pre-operative GFR was 48± 7. We observed renal function recovery at each follow-up, with 30, 90 and 180-day mean GFRs of 79±33, 71± 31 and 63± 21, respectively (Fig). Mean improvement in GFR for 30, 90 and 180 days was 34± 31, 26± 29 and 19± 20, respectively (All with p < 0.001). Four of the 47 patients (8.5%) with RI required HD pre-operatively. Of these, 3 recovered renal function; 2 by 30 days and 1 by 90 days. An additional four patients (8.5%) that were previously non-HD-dependent required HD post-operatively. Two of these 4 patients recovered renal function during the study period. Conclusion: Renal insufficiency improves significantly with LVAD support. While improvements in GFR are marked in the first 30 days, they remain above pre-operative levels during 6-month follow-up. Additionally, among those patients requiring either preor post-operative HD, a majority (62.5%) recovered renal function.