567 Renal Dysfunction Following Syncardia Total Artificial Heart Implantation Does Not Affect Survival Following Heart Transplantation

567 Renal Dysfunction Following Syncardia Total Artificial Heart Implantation Does Not Affect Survival Following Heart Transplantation

Abstracts 567 Renal Dysfunction Following Syncardia Total Artificial Heart Implantation Does Not Affect Survival Following Heart Transplantation A. Ka...

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Abstracts 567 Renal Dysfunction Following Syncardia Total Artificial Heart Implantation Does Not Affect Survival Following Heart Transplantation A. Kalya,1 K. Boyle,1 R. Goel,1 F. Arabia,2 O. Pajaro,2 R. Scott,1 R. Gopalan,1 D. Jaroszewski,2 D. Kasper,1 Q. Wu,3 L. Staley,2 C. Pierce.2 1Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ; 2 Cardiothoracic Surgery, Mayo Clinic, Phoenix, AZ; 3Biostatistics, Mayo Clinic, Phoenix. Purpose: We have reported that patients (pts) undergoing implantation of Total Artificial Heart (TAH) have a higher incidence of acute kidney injury (AKI) requiring dialysis. The aim of this study was to determine the renal function over the course of TAH support, and its impact on survival following heart transplantation (HTx). Methods and Materials: 26 pts underwent TAH implant as a bridge to HTx. Serum Creatinine (Cr; mg/dL) and glomerular filtration rate (GFR: ml/min) were compared before and after TAH, and followed for 1 year post HTx. The pts were divided into 2 main groups: Group A (20 pts) not on HD before TAH and Group B (6pts) on HD pre TAH and listed for heart kidney Tx (HKTx). The significance of the difference between the survival curves following HTx of the 2 groups was assessed with Log-Rank test. Results: Pts ages 53⫾9 years (2 females), and INTERMACS score of 1.8⫾0.63. Pts in Group A had good renal function (GFR 71⫾25 and Cr 1.2⫾0.4) and group B pts were on HD pre TAH. No significant differences in pts characteristics or hemodynamics noted between the groups pre TAH (except for group B pts on HD). 9 pts in group A (45%) had AKI (GFR 13.2 ⫾9) requiring HD post TAH (for 12⫾17days). 7 out of 9 pts in group A (78%) recovered renal function, and were off HD for 4 weeks before listing for HTx, and the other 2 pts failed to recover and were listed for HKTx. Group A pts GFR was 60.8⫾27 before HTx. Survival among pts needing HD and not needing HD in Group A (p⫽0.20), and between Group A and B (p⫽0.36) was not significant. Conclusions: Despite the higher incidence of AKI among patients undergoing TAH as a bridge to HTx, significant recovery of renal function was seen following TAH support. Longer support with TAH will likely improve renal function and may prevent listing for heart kidney Tx. GFR (52.5⫾11) remained stable 1 year post HTx in pts who recovered after HD. No significant impact on mortality was noted among the patients needing HD in both groups. 568

S197 long-term bleeding-free support without increase of thromboembolism rate. 569 Preliminary Study: Increased Levels of cGMP in Recipients of Continuous Flow LVADs, Implications for Gastrointestinal Bleeding L. Grosman-Rimon, D.Z.I. Cherney, S. Pollock Bar-Ziv, M.A. McDonald, L. Tumiati, V. Rao. Exercise Sciences, University of Toronto, Toronto, ON, Canada; Medicine, Toronto General Hospital, Toronto, ON, Canada; Heart Transplant, Hospital for Sick Children, Toronto, ON, Canada; Department of Medicine, Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada; Cardiovascular Surgery, Toronto General Hospital, Toronto, ON, Canada; Cardiovascular Surgery, Toronto General Hospital, Toronto, ON, Canada. Purpose: Recent reports suggest that rates of GI bleeding are markedly higher in patients with continuous flow-left ventricular assist device (CFLVAD) compared to patients with pulsatile pumps. Previous studies in uremic patients with renal failure suggest that elevated cGMP levels are associated with higher rates of gastrointestinal (GI) bleeding. Therefore, we examined the hypothesis that cGMP levels are elevated in CF-LVAD recipients. Methods and Materials: Seven CF-LVAD recipients at least 3 months post-implant and 7 healthy controls were assessed. Blood samples were obtained to compare CRP (mg/L), cGMP (pmol/mL) and NO (␮mol/L) levels between the CF-LVAD recipients and control groups. Results: CRP levels were significantly higher in the CF-LVAD recipients compared to those of healthy controls (10.0⫾4.2 vs. 3.3⫾0.3, p⬍0.05). Despite the increase in CRP levels, cGMP levels were significantly higher in CF-LVAD recipients (5.4⫾1.7 vs. 1.3⫾0.2, p⬍ 0.05). There was a trend to higher levels of NO in the CF-LVAD compared with the healthy control group. Conclusions: Surgical implantation of a CF-LVAD is one of the most promising therapies available for heart failure patients. Nevertheless, the long-term effects of LVAD support are unknown. We found that despite elevated levels of CRP, which interfere with NO/cGMP production, cGMP levels were increased significantly in these patients. This increase in cGMP may be related to a higher incidence of GI bleeding in CF-LVAD recipients, as cGMP impairs platelet aggregation. Further studies are required to determine whether elevated cGMP levels can be used as clinical markers for increased risk of GI bleeding in CF-LVAD.

Outpatient Antiplatelet Therapy in Rotary Blood Pump Recipients: Single-Center Experience A. Stepanenko, N. Dranishnikov, A. Canteli, J. Vierecke, B. Jurmann, H. Lehmkuhl, T. Drews, E.V. Potapov, T. Krabatsch, R. Hetzer. Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. Purpose: Routine use of antiplatelet therapy in all recipients of modern rotary blood pump is associated with increased risk for bleeding episodes. Our study evaluated current hospital antiplatelet therapy regimes in relationship to thromboembolic/bleeding events in long-term follow-up. Methods and Materials: We evaluated incidence of thromboembolic/ bleeding events in 161 outpatients (axial type: Incor I, n⫽14, HeartMate II, n⫽62; centrifugal type: DuraHeart, n⫽1, HeartWare, n⫽84). Antiplatelet therapy changes were retrospectively analyzed. Results: Antiplatelet therapy during follow-up of 252.8 pt/years is shown in table 1. Cumulative bleeding episode rate for axial type pumps: 0.15 per pt/y. (epistaxis, n⫽ 17, GI bleeding, n⫽6); for centrifugal type: 0.15 per pt/y. (epistaxis, n⫽ 11, GI bleeding, n⫽3). Cumulative ischemic CVA events rate for axial type: 0.095 per pt/y. (TIA, n⫽10; stroke, n⫽5); for centrifugal type: 0.08 (TIA, n⫽7, stroke, n⫽1). Cumulative event rate for intracerebral bleed for axial type: n⫽1, 0.006 per pt/y.; for centrifugal type: n⫽2, 0.02 per pt/y. Conclusions: Observed incidence of thromboembolic and bleeding events in rotary blood pump recipients is low. Individualized regimes of antiplatelet therapy with initially higher anticoagulation level and subsequent deescalation of aggressivity may lead to

570 Impact of Antiplatelet Therapy on Pump Thrombosis in Axial Flow Devices D. Abramov, G. Ruiz, R. Chawla, M. Hofmeyer, L.E. Cooper, A.O. Griffin, C. Birther, M. McMenamy, R. Lowery, S.W. Boyce, S.S. Najjar. Department of Heart Failure, Washington Hospital Center, Washington, DC. Purpose: Patients with axial flow Ventricular Assist Devices (VADs) are usually treated with both antiplatelet and anticoagulant therapies to prevent thrombotic complications. Because of the high risk of bleeding attributed, in part, to acquired vonWillebrand disease, we stopped administering