Article Abstract

The influence of less invasive ventricular assist device implantation on renal function

Authors: Marcel Ricklefs, Jan Heimeshoff, Jasmin S. Hanke, Anamika Chatterjee, Günes Dogan, Malakh Shrestha, Christina Feldmann, Leonhard Wert, Axel Haverich, Jan D. Schmitto

Abstract

Background: End-stage heart failure is associated with severe after-effects such as heart valve insufficiency, cardiac arrhythmias or end-organ dysfunctions. Renal failure or ‘cardiorenal syndrome’ is a critical end-organ disorder associated with advanced heart failure, which occurs due to low-output failure. Drug therapy or surgical interventions involving left ventricular assist device (LVAD) implantation may impede the progress of heart insufficiency and its after-effects including renal failure. In this study, we investigated the impact of a minimally invasive ventricular assist device implantation through upper hemisternotomy combined with anterolateral thoracotomy on renal function, in patients with perioperative renal failure.
Methods: We analyzed data obtained from 103 patients (80 males, 23 females; mean age 53.8±11.7) who underwent LVAD implantation at our clinic within a 15-year interval (2001–2016) and were dialyzed due to renal dysfunction. 90 patients were operated with the conventional LVAD implantation technique (standard approach surgery, SAS) and 13 underwent less invasive approach implantation (less invasive surgery, LIS).
Results: For all patients, data analysis showed significant increase of glomerular filtration rate (GFR) (44.2±56.48 mL/min; 95% CI: 33.81–55.28; P<0.001) along with a significant decrease in the levels of creatinine (−1.08±1.83 mg/dL; 95% CI: 0.75–1.46; P<0.001) and urea (−4.62±13.66 mmol/L; 95% CI: 1.95–7.29; P<0.001). There was a considerable difference in change of renal parameters in patients treated with LIS in comparison to patients who underwent SAS, which was however not statistically significant (GFR: P=0.494; creatinine: P=0.543; urea P=0.918).
Conclusions: LVAD implantation improves kidney function in patients with renal dysfunction. A considerable difference in the change of renal parameters was detected in patients with LIS as compared to SAS, which was not significant possibly due to the limited size of the patient cohort (n=13).