Results of HeartMate II left ventricular assist device
implantation on renal function in patients requiring
post-implant renal replacement therapy
Zumrut T. Demirozu, MD,
a,c
Whitson B. Etheridge, MD,
b
Rajko Radovancevic, MD,
a,c
and
O. H. Frazier, MD
a,c
From the
a
Department of Cardiopulmonary Transplantation, the
b
Department of Nephrology, and the
c
Center for Cardiac Support,
Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas.
BACKGROUND: Renal function is often compromised in patients with advanced heart failure.
METHODS: We evaluated renal function in heart failure patients supported by the HeartMate II
(Thoratec Corporation, Pleasanton, CA) continuous-flow left ventricular assist device (LVAD) who
required renal replacement therapy (RRT) by continuous venovenous hemofiltration dialysis (CVVHD)
or hemodialysis, or both. Indications for RRT included oliguria (urine 400 ml/day) unresponsive to
diuretic therapy for 24 hours with a creatinine level 2.0 mg/dl or 1.5 times that of the pre-implant
creatinine level, severe acidemia, and volume overload.
RESULTS: Of 107 consecutive patients who underwent HeartMate II implantation at our center and had
been supported for 30 days, 15 (13 men and 2 women) required post-implant RRT. Of the 15 patients,
3 received CVVHD and 12 received CVVHD and hemodialysis. Renal function improved within 2 months
of support compared with average values before support (creatinine clearance, 64 39 vs 92 55 ml/min,
p = 0.041; glomerular filtration rate, 46.9 20.7 vs 73.2 38.9 ml/min/1.73 m
2
; p = 0.032). Renal
function improved after HeartMate II implantation in 10 patients, and RRT was removed. Of these 10
patients, 2 underwent heart transplantation 4 months after RRT was removed, 1 underwent heart and kidney
transplantation 4 years later, 2 died at home of conditions unrelated to renal function 6 months after RRT
was removed, and 5 are awaiting heart transplantation, with good quality of life.
CONCLUSIONS: In this study, patients who experienced clinical recovery after the LVAD implant had
subsequent recovery of renal function after continuous-flow LVAD support.
J Heart Lung Transplant 2011;30:182–7
© 2011 International Society for Heart and Lung Transplantation. All rights reserved.
KEYWORDS:
left ventricular assist
device (LVAD);
continuous
venovenous
hemofiltration dialysis
(CVVHD);
hemodialysis (HD)
Left ventricular assist device (LVAD) implantation is a
viable therapy for patients with severe end-stage heart dis-
ease, providing the potential for effective hemodynamic
support and improved quality of life.
1,2
However, the pres-
ence of coexisting conditions, including renal failure, has a
substantial effect on outcomes for these LVAD patients, and
deteriorating renal function is common among patients with
advanced heart failure. In addition, many centers require
that patients have a creatinine clearance (CrCl) of at least 50
ml/min before they can be eligible for heart transplantation.
3
No definitive tests are available to reliably predict if im-
paired renal function is reversible. Inotropic infusion and in-
traaortic balloon pump (IABP) insertion are commonly used in
these patients and may improve their abnormal hemodynamic
state and renal function. If these measures fail, LVAD implan-
tation may be another option for improving peripheral tissue
perfusion and end-organ function.
4
The aim of this study was
to review our experience with end-stage heart failure patients
who required continuous-flow LVAD support and renal re-
placement therapy (RRT) after LVAD implantation.
Methods
The analysis included 107 consecutive patients who received the
HeartMate II continuous-flow LVAD (Thoratec Corporation,
Reprint requests: O.H. Frazier, MD, Texas Heart Institute, PO Box
20345, MC 3-147, Houston, TX 77225-0345. Telephone: 832-355-3000.
Fax: 832-355-6798.
E-mail address: lschwenke@heart.thi.tmc.edu
http://www.jhltonline.org
1053-2498/$ -see front matter © 2011 International Society for Heart and Lung Transplantation. All rights reserved.
doi:10.1016/j.healun.2010.08.019