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Ann Thorac Surg 2006;81:1745-1751
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Relationship Between Renal Function and Left Ventricular Assist Device Use

^a Cardiology Division, Vanderbilt University, Nashville, Tennessee
^b Radiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
^c WorldHeart, Inc, Oakland, California
^d Department of Cardiothoracic Surgery, Stanford University, Stanford, California
^e Division of Cardiology, Duke University, Durham, North Carolina
^f Division of Cardiology, Columbia University, New York, New York
^g Department of Cardiothoracic Surgery, University of Maryland, Baltimore, Maryland
^h Baltimore Veterans Administration Medical Center, Baltimore, Maryland

Accepted for publication November 29, 2005.

^_* Address correspondence to Dr Butler, Cardiology Division, 383-PRB, Vanderbilt University Medical Center, Nashville, TN 37232 (Email: javed.butler{at}vanderbilt.edu).

BACKGROUND: Poor renal function may affect outcomes after left ventricular assist device (LVAD) placement. Conversely, LVADs may optimize circulation and improve renal function.

METHODS: To assess the relationship between renal function and LVAD use, changes in creatinine clearances (CrCl, in mL/min) were assessed retrospectively in 220 patients who underwent LVAD placement. These patients were also divided into four groups based on CrCl quartiles (< 47, 48–68, 69–95, and > 95) and compared for outcomes post-LVAD placement.

RESULTS: Eighty-four patients died on LVAD support. Survival on LVAD was worse for patients with the worst baseline CrCl (42%, 52%, 63%, and 79% for 6 month and 26%, 34%, 47%, and 66% for 12 month survival for quartiles 1–4; both p < 0.01 for trend). Adjusting for other covariates, patients in the lowest CrCl quartile were at a higher risk of dying postimplant (odds ratio 1.95, 95% confidence interval 1.14–3.63). Paired sample analysis showed the following changes in CrCl: preoperative to week 1, 77.0 ± 46.6 to 92.1 ± 51.1 (p < 0.01; n = 202), week 1 to 2, 89.4 ± 49.2 to 95.2 ± 52.4 (p = 0.01, n = 171), week 2 to 3, 107.5 ± 58.1 to 113.7 ± 66.1 (p = 0.16, n = 74), and week 3 to 4, 111.1 ± 56.6 to 110.5 ± 56.8 (p = 0.87, n = 60). For the 60 patients with baseline CrCl less than 50, CrCl increased from 36.7 ± 9.2 to 60.1 ± 35.5 (p < 0.01; n = 55 pairs) from preimplant to week 1. In 37 of these patients (62%) on intraaortic balloon pump support preimplant, CrCl increased from 38.4 ± 8.2 to 67.9 ± 40.3 mL/minute (p < 0.01) during week 1 postimplant. Recovery of renal function to CrCl greater than 50 was associated with a trend towards better 30-day survival (84% vs 66%, p = 0.09).

CONCLUSIONS: Baseline poor renal function is associated with worse outcomes after LVAD implantation. However, renal function improves substantially and rapidly in post-LVAD survivors and is associated with improved outcomes. These data underscore the importance of careful patient selection for LVAD therapy.