Raising the (LVAD) Bar: Temporary RVAD Support and its Effects on Renal Function

Abstract

Purpose Right heart failure (RHF) is a crucial risk factor in the development of acute kidney injury. By decreasing the right-ventricular filling pressures and increasing cardiac output, right ventricular assist devices (RVAD) may prevent the development of cardiorenal syndrome. We report our institutional experience on the development of renal function and outcome after left ventricular assist device (LVAD) and temporary RVAD implantation in congestive heart failure patients. Methods We retrospectively reviewed the data of 72 consecutive patients who received a continuous-flow LVAD and temporary RVAD due to terminal heart failure at our center from 12/ 2001 and 12/ 2019. Mean age of patient population was 58 ± 12 years, with 86.1% of the patients being male. Sixty-three patients (87.5%) were able to be successfully weaned from temporary RVAD support. However, two patients (2.8%) required an RVAD to be re-implanted due to progressive RHF. Median time of temporary RVAD support was 13 days (4 - 90 days). Renal function was determined by the Modification of Diet in Renal Disease (MDRD)-derived glomerular filtration rates (GFR), and patients were categorized into two groups based on pre-implant GFR: (1) normal renal function, defined by GFR > 60 (n=29), and (2) impaired renal function, defined by GFR Results The patient group with impaired renal function (RF) experienced a significant improvement of GFR: GFR at time of implant to month six, 41.94 ± 11.37 to 65.21± 39.52 (p=0.003), and after one-year GFR improved from 41.94 ± 11.37 to 55.73 ± 23.22 (p=0.012). Post-implant renal replacement therapy was indicated in eighteen patients (41.86%) of the impaired RF group vs. ten patients (34.48%) in the normal RF group. Post-implant survival after LVAD and temporary RVAD support at one, six, and 12 months for GFR 60 group, 89.7%, 72.4% and 72.4%, respectively (p=0.576). Conclusion LVAD and temporary RVAD support improves renal function in patients with renal dysfunction prior to implantation. Our data indicates that impaired renal function prior to implantation does not guarantee a worsened outcome.