Abstract 12738: Improvement in Renal Function After Left Ventricular Assist Device Placement is a Prognostic Marker for Survival

Abstract

Introduction: Chronic renal dysfunction is common in end stage heart failure. Left Ventricular Assist Devices (LVADs) are increasingly being used in such patients. In this study, we evaluated patients who had poor renal function prior to LVAD placement with subsequent improvement in renal function after LVAD implantation. Hypothesis: Patients with poor renal function after LVAD implant have a poor prognosis. Methods: In this study, 229 patients with LVADs were enrolled. Patients were divided into 3 groups. Group 1 had patients with pre- and post-implant GFR of <60. Group II consisted of pre-implant Glomerular Filtration Rate (GFR) of <60, but subsequent improvement to ≥60 post-LVAD, and Group III comprised of patients with pre- and post-LVAD GFR of ≥60. Chi square testing and Kaplan-Meier (KM) survival analysis was performed. Results: The three groups had a mean pre-implant and post-implant GFR: Group I (N=95), 43±13 vs. 45±10, Group 2 (N=56) 48±8 vs. 75±15 and Group III (N=78) 81±18 vs. 89±22 respectively. There was a significant difference in overall survival between the three groups (42% vs 63% vs 73%, p<0.001). KM survival analysis also revealed significant differences in survival between the groups (Mean survival of 1037 days vs 1675 days vs 1745 days, p=0.015). When individual groups were analyzed, there was a significant difference between Group I vs II and Group I vs III, however; there was no difference in survival between Group II and III (Figure 1). Conclusions: Our findings suggest that patients with poor renal function pre-LVAD can be distinguished into two distinct phenotypes consisting of patients who improve their GFR to ≥60 after LVAD surgery and patients whose low GFR persists even after LVAD implantation. Survival of patients with improvement in GFR tended to normalize to their peers with pre-implant GFR of ≥60. Post-LVAD GFR can serve as an important prognostic marker for LVAD patients.