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Improvement in Severe Kidney Dysfunction after Implantation of Continuous-Flow Left Ventricular Assist Devices
Abstracts
S275 experienced post-transplant rejection.[table2]Survival at 5 years was 59% ⫾ 8% in Thoratec PVAD and 95% ⫾ 3% in Heart Mate II patients. Conclusions: Our data suggest that despite higher rates of sensitization in patients supported by Heart Mate II they experience less rejections. Several explanations for the lack of impact of sensitization on posttransplantation rejection have been proposed. Further research is needed into the exact nature, specificities and titers of antibodies associated with continuous-flow LVADs. 764
improvements in renal function, hemodynamic profile, and decreased diuretic dose (po0.01 for all). Conclusions: Serum uric acid values decreased after CF-LVAD implant, although several mechanisms may be operative. Further work may clarify these mechanisms. 763 Impact of Continuous and Pulsatile-Flow Left Ventricular Assist Devices on Post-Transplant Rejection M. Urban,1 O. Szarszoi,1 J. Pirk,1 H. Riha,2 I. Netuka.1 1Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; 2Anesthesiology and Critical Care, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. Purpose: LVADs have become an established treatment for end stage heart failure patients. The use of mechanical support systems has been associated with overproduction of antibodies with potential donor reactivity. The aim of our study was to assess the impact of different LVAD types on sensitization, post transplantation rejection and survival. Methods and Materials: This was a retrospective cohort study of 81 heart transplant recipients who were bridged with either pulsatile (Thoratec PVAD) or continuous-flow (Heart Mate II) devices. Results: There were no differences in baseline demographic and clinical characteristics between the groups.[table1]Early mortality was 10.8% in Thoratec PVAD and 2.3% in Heart Mate II group (p ¼ 0.173). Six patients (16.2%) supported with Thoratec PVAD became sensitized versus 17 patients (38.6%) supported with Heart Mate II (p ¼ 0.026). Significantly more patients in Thoratec PVAD group than Heart Mate II group Table 1
Age, years Male gender BSA, m2 COPD Diabetes Mellitus Hypertension Non-ischemic etiology of heart failure Donor age, years Male donor Ischemic time, min
Thoratec PVAD (N ¼ 37)
Heart Mate II (N ¼ 44)
p
47 ⫾ 13 30 (81.1%) 1.94 ⫾ 0.2 6 (16.2%) 9 (24.3%) 7 (19.9%) 20 (54.1%)
48 ⫾ 13 39 (88.6%) 1.99 ⫾ 0.3 6 (13.6%) 9 (20.5%) 13 (29.5%) 22 (50%)
0.688 0.340 0.327 0.745 0.676 0.239 0.7
32 ⫾ 11 32 (86.5%) 151 ⫾ 42
38 ⫾ 11 35 (79.5%) 142 ⫾ 62
0.026 0.411 0.444
Table 2
Right heart failure Renal failure Rejection
Thoratec PVAD (N ¼ 37)
Heart Mate II (N ¼ 44)
p
2 (5.4%) 4 (10.8%) 15 (40.5%)
1 (2.3%) 5 (11%) 2 (4.5%)
0.590 NS o 0.01
Improvement in Severe Kidney Dysfunction after Implantation of Continuous-Flow Left Ventricular Assist Devices S. Saxena,1 J. Um,2 I. Dumitru,1 B. Cookman,1 S. Pilmaier,1 T. Ryan,2 S. Yannone,2 M. Moulton,2 B. Lowes,1 E. Raichlin.1 1Cardiology, University of Nebraska Medical Center, Omaha, NE; 2SurgeryCardiovasular & Thoracic Surgery, University of Nebraska Medical Center, Omaha, NE. Purpose: Severe renal dysfunction is common among patients with advanced heart failure and is a contraindication for isolated heart transplantation. Left ventricular assist device (LVAD) may improve circulation and renal function in these patients. This study aimed to determine the effect of severe renal dysfunction on outcomes after LVAD implantation. Methods and Materials: A retrospective analysis of 72 consecutive patients implanted with HeartMate II LVAD was conducted. Patients were divided into two groups based on GFR during preLVAD hemodynamic optimization: 1-GFR 4 40 and 2- GFR r 40 ml. Results: In all patients, GFR increased at 1 and 3 months after LVAD implantation and declined at 6 month to the pre-operative value. In the GFR r 40 group improvement in GFR over 6 months was statistically significant compared to pre-operative value.[table1]Post-LVAD survival at 1, 3, and 6 month was 94%, 85% and 65% for the GFR 4 40 group, and 100%, 70% and 57% for the GFR r 40 group (p¼0.11). Notably, renal function worsened in 21 (29%) patients at 1 month after LVAD implantation. Severe right ventricle dysfunction before and early after LVAD independently predicted worsening in renal function; these patients also had significantly lower post-LVAD survival (p o 0.009) over 9.2 ⫾ 6.86 month follow-up Changes in Kidney Function
Pre LVAD 1 month post LVAD (p) 3 months post LVAD (p) 6 months post LVAD (p)
Overall GFR (n¼72)
GFR 440 (n¼57)
60 73 76 63
68 75 79 65
þ/ 26 þ/25 (0.001) þ/ 33 (0.001) þ/ 26 (0.058)
þ/ þ/ þ/ þ/
GFR r 40 (n¼15)
26 35 þ/ 24 (0.06) 63 þ/ 34 (0.04) 61 þ/ 26 (0.5) 54 þ/
3 26 (0.002) 24 (0.009) 25 (0.02)
Conclusions: Severe renal dysfunction improved after LVAD implantation. Worsening renal function at 1 month after LVAD is predicted by right ventricle dysfunction before and early after LVAD implantation and is associated with poorer survival. 765 Elevated Levels of Inflammation in Patients on Long-Term Continuous Flow Left Ventricular Assist Device (CF-LVAD) Support L. Grosman-Rimon,1,2,3 D.Z.I. Cherney,1,2,3 M.A. McDonald,1,2,3 S. Pollock Bar-Ziv,1,2,3 L. Tumiati,1,2,3 A. Mociornita,1,2,3 A. Ghashghai,1,2,3 A. Chruscinski,1,2,3 V. Rao.1,2,3 1Cardiovascular Surgery, Toronto General Hospital, Toronto, ON, Canada; 2The Graduate Department of Exercise Sciences, University of Toronto, Toronto, ON, Canada; 3Department of Surgery, University of Toronto, Toronto, ON, Canada. Purpose: Elevated levels of inflammatory markers shortly after implantation predict mortality in patients supported with left ventricular assist devices (LVADs). However, no study has investigated the long-term effects of continuous-flow LVAD (CF-LVAD)
S275 experienced post-transplant rejection.[table2]Survival at 5 years was 59% ⫾ 8% in Thoratec PVAD and 95% ⫾ 3% in Heart Mate II patients. Conclusions: Our data suggest that despite higher rates of sensitization in patients supported by Heart Mate II they experience less rejections. Several explanations for the lack of impact of sensitization on posttransplantation rejection have been proposed. Further research is needed into the exact nature, specificities and titers of antibodies associated with continuous-flow LVADs. 764
improvements in renal function, hemodynamic profile, and decreased diuretic dose (po0.01 for all). Conclusions: Serum uric acid values decreased after CF-LVAD implant, although several mechanisms may be operative. Further work may clarify these mechanisms. 763 Impact of Continuous and Pulsatile-Flow Left Ventricular Assist Devices on Post-Transplant Rejection M. Urban,1 O. Szarszoi,1 J. Pirk,1 H. Riha,2 I. Netuka.1 1Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; 2Anesthesiology and Critical Care, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. Purpose: LVADs have become an established treatment for end stage heart failure patients. The use of mechanical support systems has been associated with overproduction of antibodies with potential donor reactivity. The aim of our study was to assess the impact of different LVAD types on sensitization, post transplantation rejection and survival. Methods and Materials: This was a retrospective cohort study of 81 heart transplant recipients who were bridged with either pulsatile (Thoratec PVAD) or continuous-flow (Heart Mate II) devices. Results: There were no differences in baseline demographic and clinical characteristics between the groups.[table1]Early mortality was 10.8% in Thoratec PVAD and 2.3% in Heart Mate II group (p ¼ 0.173). Six patients (16.2%) supported with Thoratec PVAD became sensitized versus 17 patients (38.6%) supported with Heart Mate II (p ¼ 0.026). Significantly more patients in Thoratec PVAD group than Heart Mate II group Table 1
Age, years Male gender BSA, m2 COPD Diabetes Mellitus Hypertension Non-ischemic etiology of heart failure Donor age, years Male donor Ischemic time, min
Thoratec PVAD (N ¼ 37)
Heart Mate II (N ¼ 44)
p
47 ⫾ 13 30 (81.1%) 1.94 ⫾ 0.2 6 (16.2%) 9 (24.3%) 7 (19.9%) 20 (54.1%)
48 ⫾ 13 39 (88.6%) 1.99 ⫾ 0.3 6 (13.6%) 9 (20.5%) 13 (29.5%) 22 (50%)
0.688 0.340 0.327 0.745 0.676 0.239 0.7
32 ⫾ 11 32 (86.5%) 151 ⫾ 42
38 ⫾ 11 35 (79.5%) 142 ⫾ 62
0.026 0.411 0.444
Table 2
Right heart failure Renal failure Rejection
Thoratec PVAD (N ¼ 37)
Heart Mate II (N ¼ 44)
p
2 (5.4%) 4 (10.8%) 15 (40.5%)
1 (2.3%) 5 (11%) 2 (4.5%)
0.590 NS o 0.01
Improvement in Severe Kidney Dysfunction after Implantation of Continuous-Flow Left Ventricular Assist Devices S. Saxena,1 J. Um,2 I. Dumitru,1 B. Cookman,1 S. Pilmaier,1 T. Ryan,2 S. Yannone,2 M. Moulton,2 B. Lowes,1 E. Raichlin.1 1Cardiology, University of Nebraska Medical Center, Omaha, NE; 2SurgeryCardiovasular & Thoracic Surgery, University of Nebraska Medical Center, Omaha, NE. Purpose: Severe renal dysfunction is common among patients with advanced heart failure and is a contraindication for isolated heart transplantation. Left ventricular assist device (LVAD) may improve circulation and renal function in these patients. This study aimed to determine the effect of severe renal dysfunction on outcomes after LVAD implantation. Methods and Materials: A retrospective analysis of 72 consecutive patients implanted with HeartMate II LVAD was conducted. Patients were divided into two groups based on GFR during preLVAD hemodynamic optimization: 1-GFR 4 40 and 2- GFR r 40 ml. Results: In all patients, GFR increased at 1 and 3 months after LVAD implantation and declined at 6 month to the pre-operative value. In the GFR r 40 group improvement in GFR over 6 months was statistically significant compared to pre-operative value.[table1]Post-LVAD survival at 1, 3, and 6 month was 94%, 85% and 65% for the GFR 4 40 group, and 100%, 70% and 57% for the GFR r 40 group (p¼0.11). Notably, renal function worsened in 21 (29%) patients at 1 month after LVAD implantation. Severe right ventricle dysfunction before and early after LVAD independently predicted worsening in renal function; these patients also had significantly lower post-LVAD survival (p o 0.009) over 9.2 ⫾ 6.86 month follow-up Changes in Kidney Function
Pre LVAD 1 month post LVAD (p) 3 months post LVAD (p) 6 months post LVAD (p)
Overall GFR (n¼72)
GFR 440 (n¼57)
60 73 76 63
68 75 79 65
þ/ 26 þ/25 (0.001) þ/ 33 (0.001) þ/ 26 (0.058)
þ/ þ/ þ/ þ/
GFR r 40 (n¼15)
26 35 þ/ 24 (0.06) 63 þ/ 34 (0.04) 61 þ/ 26 (0.5) 54 þ/
3 26 (0.002) 24 (0.009) 25 (0.02)
Conclusions: Severe renal dysfunction improved after LVAD implantation. Worsening renal function at 1 month after LVAD is predicted by right ventricle dysfunction before and early after LVAD implantation and is associated with poorer survival. 765 Elevated Levels of Inflammation in Patients on Long-Term Continuous Flow Left Ventricular Assist Device (CF-LVAD) Support L. Grosman-Rimon,1,2,3 D.Z.I. Cherney,1,2,3 M.A. McDonald,1,2,3 S. Pollock Bar-Ziv,1,2,3 L. Tumiati,1,2,3 A. Mociornita,1,2,3 A. Ghashghai,1,2,3 A. Chruscinski,1,2,3 V. Rao.1,2,3 1Cardiovascular Surgery, Toronto General Hospital, Toronto, ON, Canada; 2The Graduate Department of Exercise Sciences, University of Toronto, Toronto, ON, Canada; 3Department of Surgery, University of Toronto, Toronto, ON, Canada. Purpose: Elevated levels of inflammatory markers shortly after implantation predict mortality in patients supported with left ventricular assist devices (LVADs). However, no study has investigated the long-term effects of continuous-flow LVAD (CF-LVAD)