The Effect of Severity of Renal Dysfunction on Clinical Outcomes in Patients With Continuous-Flow Left Ventricular Assist Device Implantation

The Effect of Severity of Renal Dysfunction on Clinical Outcomes in Patients With Continuous-Flow Left Ventricular Assist Device Implantation

Abstracts S229 6( 15) 6( 16) The Effect of Severity of Renal Dysfunction on Clinical Outcomes in Patients With Continuous-Flow Left Ventricular Assi...

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Abstracts S229 6( 15)

6( 16)

The Effect of Severity of Renal Dysfunction on Clinical Outcomes in Patients With Continuous-Flow Left Ventricular Assist Device Implantation M. Pinninti , C. Rivera, C. Cho, V. Thohan, T. Hastings, O. Cheema, F. Downey, J. Crouch, E. Weiss, N. Sulemanjee.  Aurora St. Luke’s Medical Center, Milwaukee, WI.

Long-Term Ventricular Assist Device vs. Inotropic Therapy as a Bridge to Transplant in Heart Failure Patients With Pulmonary Hypertension and High Pulmonary Vascular Resistance: Pulmonary Hemodynamic and Post-Transplant Outcomes C. Kunavarapu ,1 B. Menchaca,2 A. Lonning,2 M. Lopez,2 A. Mehr,3 M. Kwan.1  1Advanced Heart Failure and Transplant, Texas Transplant Institute, San Antonio, TX; 2Methodist Heart Hospital, San Antonio, TX; 3Cardiology, University of Texas Health Science Center San Antonio, San Antonio, TX.

Purpose: Use of LVAD therapy is widespread with clinical outcomes depending on factors including patient co-morbidities. Limited data is available regarding the effect of renal dysfunction severity on clinical outcomes in CF-LVAD implantations. We evaluated this by staging of chronic kidney disease (CKD) at the time of LVAD implantation and its effect on change in renal function and clinical outcomes such as survival, length of hospital stay, readmission rate, and transplant rate at follow-up up to 1 year. Methods: We retrospectively collected data for 198 consecutive CFLVAD implantations from January 2009 until June 2014 at our institution. Sixty-seven involved CKD stages I/II, 98 Stage III, 23 Stage IV, and 10 Stage V. Mixed effects model for repeated measures was used for analysis. P-value was used for the interaction effect of time and CKD stage. Results: Our cohort was 75% male with average age of 58.2 years, 73.4% were bridge to transplant, and 48.7% had an ischemic etiology. 32.7% were INTERMACS Stage 1-2 and 59.4% were Stage 3-4 at time of implant. For patients with CKD stages I/II, glomerular filtration rate (GFR) increased immediately but returned to pre-LVAD levels by 3 months. Patients with CKD stages III and IV also experienced immediate increase in renal function, which was sustained at 1 year. CKD Stage V patients showed no significant improvement in GFR up to 6 months. There was no statistically significant difference in the length of hospital stay, in-hospital mortality, post-discharge mortality up to 1 year, rate of transplantation, or 30-day readmission rate by stage of CKD, although a trend was noted with worse clinical outcomes in patients with a higher CKD stage. Conclusion: Our cohort with varying stages of renal dysfunction did not have statistically significant difference in clinical outcomes for a follow-up period of 1 year after LVAD implantation, although a trend was noted. Larger cohort is needed to demonstrate statistical significance. 

Purpose: Patients with chronic heart failure commonly develop fixed pulmonary hypertension (PH), a relative contraindication for heart transplantation (HT). We sought to compare the effects of inotropic therapy (INO) or Left ventricular assist device (LVAD) support on pulmonary hemodynamics and post HT outcomes in patients with PH and high pulmonary vascular resistance (PVR). Methods: We retrospectively reviewed the records of all adult patients who underwent heart TX from Jan 2010 to Aug 2014. Patients who had a baseline mixed PH (defined as a PVR of >  2.5 WU with a pulmonary capillary wedge pressure (PCWP) of >  18 mm of Hg and mean pulmonary artery pressure (mPAP) of >  30 mm of Hg on a right heart catheterization (RHC) prior to initiation of either LVAD support or INO therapy as BTT were selected. RHC data after initiation of support and post TX, in addition to demographics, comorbidities, and post TX outcomes were collected. Results: Of the 104 patients who underwent TX during the above period, 13 patients in the LVAD (Heart Mate II or a HeartWare device) and 28 patients in the inotropic therapy as BTT met the criteria. At baseline, LVAD patients had higher panel reactive antibodies 54% vs. 4% and stayed longer on the therapy 340 ±149 vs. 143 ±108 days. The baseline pulmonary hemodynamics were similar between the two groups, mPAP 40.1 vs 39.2 mm of Hg, PCWP 24 vs. 23.3 mm of Hg, PVR 4.92 vs. 5.4 WU, fick cardiac output (CO) 3.3 vs 3.14 liters/min. and TPG 15.5 vs. 15.9 mm of Hg. There were statistically significant differences in improvement from baseline to support in mPAP -12.45 vs. -4.75 (p value 0.051) PCWP -10.82 vs. -1.57 (p value 0.017) and CO 1.2 vs. 0.4 ( p value 0.048) on LVAD vs. Inotropic therapy support in favor of LVAD. There was no difference in mean change of PVR -2.18 vs. -1,83 and TPG -3.1 vs -3.22. LVAD patients required more packed red blood cell units 11.8 ±8.5 vs. 4.1 ±3.26 (p value 0.005) at the time of TX. The six month survival was 92.3% in the LVAD group vs. 82.1% in INO group (p value 0.644). Conclusion: LVADs unload the left ventricle better by improving the mPAP, PCWP and CO better when compared to INO therapy in patients with severe mixed PH. The post HT survival remains good in these patients despite higher blood product requirement. 6( 17) Time-Dependent Gene Network Analysis Suggests Orchestrated Stage-Specific PMBC-Response to Injury in Mechanical Circulatory Support Related Organ Dysfunction Syndrome N. Wisniewski ,1 G. Bondar,1 M. Cadeiras,1 Y. Korin,2 J. Schaenman,3 E. Chang,1 M. Bakir,1 J. Chittoor,1 J. Maque,1 V. Groysberg,1 C. Starling,1 M. Kwon,1 X. Chan,1 P. Ping,1 E. Reed,2 M. Deng.1  1Department of Medicine (Cardiology), University of California, Los Angeles, Los Angeles, CA; 2Department of Pathology, University of California, Los Angeles, Los Angeles, CA; 3Department of Medicine (Microbiology), University of California, Los Angeles, Los Angeles, CA. Purpose: Because classical approaches have proven ineffective in understanding MultiOrgan Dysfunction Syndrome (MOD) following Mechanical Circulatory Support (MCS) implantation, we hypothesized that a systems biology approach can deliver new insights into the time course of the syndrome. Methods: We collected Peripheral Blood Mononuclear Cell (PBMC) samples from 10 patients undergoing MCS implantation, with 3 matched controls. PBMC samples were obtained on days -1, 1, 3, 5 and 8 postoperatively. Severity of organ dysfunction was assessed using the MELD-XI score. Purified mRNA was subjected to whole-genome NGS analysis. Gene network analysis was performed using Weighted Gene Coexpression Network Analysis (WGCNA). Results: The inferred network consisted of 20 modules. Eigengenes representing modules were computed for each patient. Functional processes were identified with each module using gene ontology analysis. We examined the median eigengene expression levels at each time point, normalized each