The Influence of Pre-Left Ventricular Assist Device (LVAD) Implantation Glomerular Filtration Rate on Long-Term LVAD Outcomes

Burhan Mohamedali, Geetha Bhat

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background Chronic kidney disease (CKD) is a known predictor for adverse outcomes in patients with advanced heart failure requiring left ventricular assist devices (LVADs). The effect of pre-LVAD glomerular filtration rate (GFR) on post-LVAD outcomes in CKD patients is not completely understood. Additionally, a subset of patients improve their GFR after LVAD placement. In this study we sought to determine the effects of pre-LVAD GFR on post-LVAD outcomes. Methods Two hundred and seventy consecutive patients with LVADs were enrolled. Patients were stratified based on a GFR cut-off of 60 mL/min/1.73 m2. Patients with preoperative GFR <60 were further divided into two subgroups based post-LVAD discharge GFR of 60. Post-LVAD major adverse effects were analysed. Results Patients with pre-implant GFR <60 had higher all cause mortality than patients with pre-implant GFR ≥60 (45% vs. 27%, p = 0.006). These patients also had higher incidence of early right ventricular failure and congestive heart failure hospitalisations. Kaplan-Meier survival analysis confirmed poor survival in this group. When the subgroup analysis of patients in the GFR <60 cohort was performed, the above findings were heavily weighted towards patients who did not improve their GFR to ≥60 post-LVAD. Conclusion Pre-implant GFR is an important prognostic marker in LVAD patients. Patients with pre-implant GFR <60 are at higher risk of cardiovascular morbidity and mortality. Our findings suggest that the patients who do not improve their GFR post-LVAD are at the highest risk.

Original languageEnglish (US)
Pages (from-to)1216-1223
Number of pages8
JournalHeart Lung and Circulation
Volume26
Issue number11
DOIs
StatePublished - Nov 2017

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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