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273 Use of Nesiritide and Renal Function Following Total Artificial Heart Implantation
S96
The Journal of Heart and Lung Transplantation, Vol 30, No 4S, April 2011
survival following device exchange was observed between CF and PF patients (Figure 1B, p ⫽ 0.73). Conclusions: CF LVADs have a markedly improved freedom from device exchange compared to PF LVADs. Infection appears to be a more common indication for device exchange in CF devices with a decreased incidence of mechanical failure. No difference in conditional survival was seen following device exchange in CF and PF patients.
Methods and Materials: We performed a retrospective analysis of 42 patients implanted with a TAH. Early in our experience, nesiritide (NES) was not used routinely. Glomerular filtration rate (GFR) before and 24 hrs after TAH implant was assessed. Based on these results, low dose NES was routinely used at TAH implant and then withdrawn following postop stabilization. GFR preceding NES withdrawal was compared to GFR 24 hrs after withdrawal. Results: 7 patients were not on NES at implant. 1 was transplanted ⬍ 24 hrs following implant. 1 required hemodialysis (HD) immediately postop. In the remaining 5 patients, mean GFR decreased from 116 ⫾ 18.6 to 73.2 ⫾ 23.2 ml/min/1.73 m2 (p ⫽ 0.15). 35 patients were on NES at implant. 2 were on HD and 1 was on pheresis at implant. 6 required HD immediately postop. 3 patients remained on nesiritide until transplant. The remaining 23 pts had NES withdrawn with a mean GFR decrease from 102.3 ⫾ 8.4 to 85.3 ⫾ 8.9 ml/min/1.73 m2 (p ⬍ 0.001). Many patients required restarting NES. 16 patients were successfully weaned off NES. The response of GFR to NES in a representative patient is shown. Conclusions: Loss of BNP following ventriculectomy adversely affects GFR. Nesiritide and subsequent cautious withdrawal is an effective strategy to minimize renal dysfunction following TAH implant. This supports the notion that BNP has a role in renal homeostasis. 274 Arrhythmias in Patients with Cardiac Implantable Electrical Devices (CIED) Following Implantation of a Left Ventricular Assist Device (LVAD) A.N. Rosenbaum,1 S. Sakaguchi,1 R. John,2 P.M. Eckman.1 1Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN; 2Department of Surgery, Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN.
273 Use of Nesiritide and Renal Function Following Total Artificial Heart Implantation W.K. Stribling,1 K.B. Shah,1 K.J. Gunnerson,2 G.J. Katlaps,3 M.L. Hess,1 V. Kasirajan,3 D.G. Tang.3 1Cardiology, Virginia Commonwealth University, Richmond, VA; 2Critical Care Medicine, Virginia Commonwealth University, Richmond, VA; 3Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA. Purpose: The effect of B-type natriuretic peptide (BNP) on renal function in congestive heart failure is controversial. Total Artificial Heart (TAH) patients undergo ventriculectomy removing the major endogenous source of BNP. They represent a unique population to study the effect of BNP on renal function. We hypothesize that BNP withdrawal after TAH results in renal failure.
Purpose: Published data on rates of arrhythmias and shocks following LVAD implantation are limited, particularly derived from CIED-level data. Systematic analysis of the impact of LVAD implant on lead integrity has also been limited. Methods and Materials: We performed a retrospective review of 142 consecutive patients who had a previous CIED in place and were implanted with a continuous flow LVAD from November 2005 to April of 2010 at a single institution. Data were gathered from medical records and CIED interrogation records. Results: The baseline patient characteristics are summarized in Table 1. Of note, significantly lower beta blocker usage was observed after VAD implant. There was a trend toward more arrhythmias after VAD implant. Statistically significant increases in shocks per month and shock-treated episodes per month were noted after implant, as summarized in Table 2. There was no statistically significant difference in lead impedance following VAD implant. Table 1
Baseline Characteristics
Characteristic
No. (%)
Age Male Ischemic etiology History of Atrial Fibrillation History of Atrial Fibrillation Ablation History of Ventricular Tachycardia Ablation Requiring inpatient cardioversion Death before discharge Incidence of lead dislodgment requiring revision
56.6 ⫾ 13.6 116 (81.7%) 85 (59.9%) 53 (37.3%) 11 (7.8%) 4 (2.8%) 10 (7.0%) 9 (6.3%) 3 (2.1%)
Average Follow-Up Medications
PreVAD
PostVAD
p-value
-blocker ACEi/ARB Amiodarone
99 (69.7%) 90 (63.4%) 42 (29.6%)
41 (28.9%) 39 (27.5%) 59 (41.5%)
⬍0.001 ⬍0.001 0.01
57 days
The Journal of Heart and Lung Transplantation, Vol 30, No 4S, April 2011
survival following device exchange was observed between CF and PF patients (Figure 1B, p ⫽ 0.73). Conclusions: CF LVADs have a markedly improved freedom from device exchange compared to PF LVADs. Infection appears to be a more common indication for device exchange in CF devices with a decreased incidence of mechanical failure. No difference in conditional survival was seen following device exchange in CF and PF patients.
Methods and Materials: We performed a retrospective analysis of 42 patients implanted with a TAH. Early in our experience, nesiritide (NES) was not used routinely. Glomerular filtration rate (GFR) before and 24 hrs after TAH implant was assessed. Based on these results, low dose NES was routinely used at TAH implant and then withdrawn following postop stabilization. GFR preceding NES withdrawal was compared to GFR 24 hrs after withdrawal. Results: 7 patients were not on NES at implant. 1 was transplanted ⬍ 24 hrs following implant. 1 required hemodialysis (HD) immediately postop. In the remaining 5 patients, mean GFR decreased from 116 ⫾ 18.6 to 73.2 ⫾ 23.2 ml/min/1.73 m2 (p ⫽ 0.15). 35 patients were on NES at implant. 2 were on HD and 1 was on pheresis at implant. 6 required HD immediately postop. 3 patients remained on nesiritide until transplant. The remaining 23 pts had NES withdrawn with a mean GFR decrease from 102.3 ⫾ 8.4 to 85.3 ⫾ 8.9 ml/min/1.73 m2 (p ⬍ 0.001). Many patients required restarting NES. 16 patients were successfully weaned off NES. The response of GFR to NES in a representative patient is shown. Conclusions: Loss of BNP following ventriculectomy adversely affects GFR. Nesiritide and subsequent cautious withdrawal is an effective strategy to minimize renal dysfunction following TAH implant. This supports the notion that BNP has a role in renal homeostasis. 274 Arrhythmias in Patients with Cardiac Implantable Electrical Devices (CIED) Following Implantation of a Left Ventricular Assist Device (LVAD) A.N. Rosenbaum,1 S. Sakaguchi,1 R. John,2 P.M. Eckman.1 1Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN; 2Department of Surgery, Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN.
273 Use of Nesiritide and Renal Function Following Total Artificial Heart Implantation W.K. Stribling,1 K.B. Shah,1 K.J. Gunnerson,2 G.J. Katlaps,3 M.L. Hess,1 V. Kasirajan,3 D.G. Tang.3 1Cardiology, Virginia Commonwealth University, Richmond, VA; 2Critical Care Medicine, Virginia Commonwealth University, Richmond, VA; 3Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA. Purpose: The effect of B-type natriuretic peptide (BNP) on renal function in congestive heart failure is controversial. Total Artificial Heart (TAH) patients undergo ventriculectomy removing the major endogenous source of BNP. They represent a unique population to study the effect of BNP on renal function. We hypothesize that BNP withdrawal after TAH results in renal failure.
Purpose: Published data on rates of arrhythmias and shocks following LVAD implantation are limited, particularly derived from CIED-level data. Systematic analysis of the impact of LVAD implant on lead integrity has also been limited. Methods and Materials: We performed a retrospective review of 142 consecutive patients who had a previous CIED in place and were implanted with a continuous flow LVAD from November 2005 to April of 2010 at a single institution. Data were gathered from medical records and CIED interrogation records. Results: The baseline patient characteristics are summarized in Table 1. Of note, significantly lower beta blocker usage was observed after VAD implant. There was a trend toward more arrhythmias after VAD implant. Statistically significant increases in shocks per month and shock-treated episodes per month were noted after implant, as summarized in Table 2. There was no statistically significant difference in lead impedance following VAD implant. Table 1
Baseline Characteristics
Characteristic
No. (%)
Age Male Ischemic etiology History of Atrial Fibrillation History of Atrial Fibrillation Ablation History of Ventricular Tachycardia Ablation Requiring inpatient cardioversion Death before discharge Incidence of lead dislodgment requiring revision
56.6 ⫾ 13.6 116 (81.7%) 85 (59.9%) 53 (37.3%) 11 (7.8%) 4 (2.8%) 10 (7.0%) 9 (6.3%) 3 (2.1%)
Average Follow-Up Medications
PreVAD
PostVAD
p-value
-blocker ACEi/ARB Amiodarone
99 (69.7%) 90 (63.4%) 42 (29.6%)
41 (28.9%) 39 (27.5%) 59 (41.5%)
⬍0.001 ⬍0.001 0.01
57 days