Effect of Perioperative Renal Replacement Therapy on Mechanical Circulatory Support Outcomes

Abstract

PurposeThe reversibility of acute renal dysfunction with mechanical circulatory support (MCS) remains controversial. We sought to examine outcomes at our center in MCS patients who required perioperative renal replacement therapy (RRT).Methods and MaterialsBetween 8/10-11/12, 75 patients underwent MCS implant at our institution. 29 required perioperative RRT (RRT). 42 patients did not require RRT (No RRT). 4 chronic RRT patients are excluded. Preoperative characteristics are shown in Table 1.ResultsMore RRT patients were INTERMACS Class 1 and received biventricular MCS (p=0.005 and 0.001 respectively). Survival was significantly different with 30, 180, and 360 day survival of 95, 77, and 77% and 55, 28, and 21% in No RRT vs. RRT (p<0.001).9 [figure 1] (31%) patients requiring RRT were discharged home, of which, 8 no longer require RRT. RRT subjects most commonly died from multisystem organ failure. Interestingly, estimated variable costs were similar between groups ($293,899 vs $254,613 p=0.29). Multivariate logistic regression identified biventricular support as a strong predictor of death in the RRT group (p=0.02).ConclusionsThe need for perioperative RRT is associated with high mortality. Consistent with INTERMACS, our study suggests that caution should be exercised when considering MCS in these patients.Tabled 1Preoperative Risk FactorsOverallNo RRTRRTpN7142 (59%)29 (41%)Age (years)61.0±13.159.6±14.063.0±11.70.28Male Sex57 (80.0%)29 (69.0%)25 (86.0%)0.096Preop Creatine (mg/dl)1.46±0.871.30±0.551.69±1.200.0714Preop Creatine Clearance (ml/min)67.8±36.773.7±38.759.3±32.30.1042INTERMACS 133 (46%)12 (29%)21 (72%)0.005INTERMACS 217 (24%)12 (29%)5 (17%)INTERMACS 3-521 (30%)18 (43%)3 (10%) Open table in a new tab The reversibility of acute renal dysfunction with mechanical circulatory support (MCS) remains controversial. We sought to examine outcomes at our center in MCS patients who required perioperative renal replacement therapy (RRT). Between 8/10-11/12, 75 patients underwent MCS implant at our institution. 29 required perioperative RRT (RRT). 42 patients did not require RRT (No RRT). 4 chronic RRT patients are excluded. Preoperative characteristics are shown in Table 1. More RRT patients were INTERMACS Class 1 and received biventricular MCS (p=0.005 and 0.001 respectively). Survival was significantly different with 30, 180, and 360 day survival of 95, 77, and 77% and 55, 28, and 21% in No RRT vs. RRT (p<0.001).9 [figure 1] (31%) patients requiring RRT were discharged home, of which, 8 no longer require RRT. RRT subjects most commonly died from multisystem organ failure. Interestingly, estimated variable costs were similar between groups ($293,899 vs $254,613 p=0.29). Multivariate logistic regression identified biventricular support as a strong predictor of death in the RRT group (p=0.02). The need for perioperative RRT is associated with high mortality. Consistent with INTERMACS, our study suggests that caution should be exercised when considering MCS in these patients.