Is there a difference in postoperative diuresis and renal function between patients with axial and centrifugal left ventricular assist devices?

    Authors

    Keywords

    ventricular assist devices, diuresis, renal function

    DOI

    https://doi.org/10.15836/ccar2017.364

    Full Text

    Introduction : Despite being a mainstay of modern advanced heart failure (AHF) therapy, more knowledge is to be gained on the effect of left ventricular assist device (LVAD) treatment on end organs, especially the possible differences between pulsatile and continuous blood flow. ( 1 , 2 ) We have observed a clinically significant increase in diuresis in our HeartMate3 patient (pt) population, despite minimization/withdrawal of diuretic therapy, and have aimed to examine potential differences in postimplantation renal function (RF) and diuresis between patients treated with Heart MateII (HMII, axial) and Heart Mate3 (HM3, centrifugal) devices. Patients and Methods : 35 pts were implanted with a HeartMate LVAD during a 4-year period at our centre (2 pts who have expired in the first postoperative month and 8 with lacking data were excluded from further analysis) - 15 pts received HMII (15 men, mean age 62.73±4.15) and 10 pts received HM3 (8 men, mean age 55.8±10.69, p value for age=0.03). Most of the pts received the device for the treatment of AHF due to ischemic cardiomyopathy (60%), dilated cardiomyopathy (36%) and LVNC (4%) (etiology was similarly distributed between the groups). During the 2nd, 3rd and 4th postimplantation week, daily diuresis was measured, as well as fluid intake, diuretic therapy and estimated glomerular filtration rate (eGFR). Results : RF was preserved, even in the early postoperative period (1st postoperative month), in both pt populations ( Figure 1A ). Only one pt required intermittent hemodialysis during this period. There was no significant difference in fluid intake or diuretic therapy between the two groups. Despite having similar values of eGFR (centrifugal: 90.67±10.21 mL/min/SA, axial: 85.67±3.51 mL/min/SA, ns), we observed that the pt population receiving HM3 had greater absolute values of diuresis in the 3rd and 4th week compared to those receiving HMII, although not reaching statistical significance ( Figure 1B ). Renal function expressed as estimated glomerular filtration rate (eGFR) was similar between the two groups during the follow up period. Absolute values of diuresis differed between the two groups, especially in week 4, although not statistically significant. Conclusion : We have objectified an increase in postimplantation diuresis in our cohort of pts treated with continuous vs. axial HM LVADs, however without reaching statistically significant difference in these measurements, while having equally preserved RF. A study in a larger pt population is warranted to obtain better insight to this observation in the early postimplantation period.

    Cardiologia Croatica
    Back to search

    Is there a difference in postoperative diuresis and renal function between patients with axial and centrifugal left ventricular assist devices?

    Extended Abstract
    Issue9-10
    Published
    Pages364
    PDF via DOIhttps://doi.org/10.15836/ccar2017.364
    ventricular assist devices
    diuresis
    renal function

    Authors

    Nina Jakuš*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ivo PlanincORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dora FabijanovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Boško SkorićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Daniel LovrićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Hrvoje JurinORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jure SamardžićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jana LjubasUniversity Hospital Centre Zagreb, Zagreb, Croatia
    MačekORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Hrvoje GašparovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Bojan BiočinaORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Maja ČikešORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Introduction : Despite being a mainstay of modern advanced heart failure (AHF) therapy, more knowledge is to be gained on the effect of left ventricular assist device (LVAD) treatment on end organs, especially the possible differences between pulsatile and continuous blood flow. ( 1 , 2 ) We have observed a clinically significant increase in diuresis in our HeartMate3 patient (pt) population, despite minimization/withdrawal of diuretic therapy, and have aimed to examine potential differences in postimplantation renal function (RF) and diuresis between patients treated with Heart MateII (HMII, axial) and Heart Mate3 (HM3, centrifugal) devices. Patients and Methods : 35 pts were implanted with a HeartMate LVAD during a 4-year period at our centre (2 pts who have expired in the first postoperative month and 8 with lacking data were excluded from further analysis) - 15 pts received HMII (15 men, mean age 62.73±4.15) and 10 pts received HM3 (8 men, mean age 55.8±10.69, p value for age=0.03). Most of the pts received the device for the treatment of AHF due to ischemic cardiomyopathy (60%), dilated cardiomyopathy (36%) and LVNC (4%) (etiology was similarly distributed between the groups). During the 2nd, 3rd and 4th postimplantation week, daily diuresis was measured, as well as fluid intake, diuretic therapy and estimated glomerular filtration rate (eGFR). Results : RF was preserved, even in the early postoperative period (1st postoperative month), in both pt populations ( Figure 1A ). Only one pt required intermittent hemodialysis during this period. There was no significant difference in fluid intake or diuretic therapy between the two groups. Despite having similar values of eGFR (centrifugal: 90.67±10.21 mL/min/SA, axial: 85.67±3.51 mL/min/SA, ns), we observed that the pt population receiving HM3 had greater absolute values of diuresis in the 3rd and 4th week compared to those receiving HMII, although not reaching statistical significance ( Figure 1B ). Renal function expressed as estimated glomerular filtration rate (eGFR) was similar between the two groups during the follow up period. Absolute values of diuresis differed between the two groups, especially in week 4, although not statistically significant. Conclusion : We have objectified an increase in postimplantation diuresis in our cohort of pts treated with continuous vs. axial HM LVADs, however without reaching statistically significant difference in these measurements, while having equally preserved RF. A study in a larger pt population is warranted to obtain better insight to this observation in the early postimplantation period.