Impella for Optimization in Patients with Renal Failure Requiring Left Ventricular Assisted Device Implantation

Abstract

<h3>Purpose</h3> Renal failure is often considered as a barrier for Left Ventricular Assist Device (LVAD) implantation as outcomes are worse for patients who need chronic dialysis. Temporary mechanical support like Impella device has been used as a bridge to LVAD; however, the impact of such strategy on postoperative renal function is not well studied. In this study, we assess the impact of Impella support prior to LVAD implant on renal function. <h3>Methods</h3> Institutional IRB approval was obtained for a retrospective review of all patients who underwent LVAD from 2015 to 2020. We identified patients who required surgical Impella (5.0 or 5.5) support prior to LVAD implantation. The primary outcome was a change in renal function pre and post implantation. The secondary outcome included the need for hemodialysis or continuous renal replacement therapy. <h3>Results</h3> A total of 70 patients underwent LVAD implantation with 18.5% (n=13) patients bridged to LVAD with Impella. The average age of patients supported with Impella was 65.8 (24-76). 23% (n=3) of these patients had a normal Cr (creatinine) prior to Impella support and at time of discharge their average Cr was 0.63 mg/dL (0.5-0.81). 76.5% (n=10) patients had an AKI (Acute kidney injury) prior to Impella implantation with an average Cr of 2.5 mg/dL (1.41—4.68) with 5 patients having a diagnosis of chronic kidney disease at baseline. 8 of the 10 patients who had an AKI have achieved significant renal recovery with average Cr improvement of 1.4 mg/dL (0.35-2.35) with 3 achieving complete recovery. Despite a large operation, the other 2 had only a small decline in Cr 0.31 mg/dL (0.24-0.38). No patients required renal replacement therapy during hospitalization or at discharge or long-term hemodialysis. <h3>Conclusion</h3> Pre-implant impella support is associated with improved renal function following LVAD implantation and helped avoid renal replacement therapy. Further prospective studies for perioperative impact of impella support are warranted.