Lower baseline estimated glomerular filtration rate (eGFR), a history of coronary artery disease (CAD), and need for pre-operative extracorporeal membrane oxygenation (ECMO) support were found to predict the risk for hemodialysis for renal failure after total artificial heart implantation, according to a study published in the Journal of Cardiac Failure.
This was a retrospective review of 87 patients who received a total artificial heart within the Virginia Commonwealth University Health System between 2006 and 2017. Patients’ medical records were reviewed for baseline clinical data closest to the implantation date. A logistic regression analysis was performed to identify predictors of renal failure following total artificial heart implantation. Renal function was assessed with serum creatinine concentration and eGFR.
A total of 24 patients (28%) required hemodialysis after total artificial heart implantation. Patients who did vs did not require post-implantation hemodialysis were more likely to have a history of CAD (58% vs 29%, respectively; P =.01), to require pre-operative ECMO (33% vs 4.8%, respectively; P =.001), mechanical ventilation (33% vs 7.9%, respectively; P =.006), to have lower baseline eGFR (54±29 vs 67±24 mL/min/1.73m2, respectively; P =.04), lower preoperative serum albumin concentrations (3.3±0.4 vs 3.5±0.5, respectively; P =.07), and lower hematocrit (29±5.6 vs 34±6.3, respectively; P =.003), and had a higher risk for mortality on device at 1 year (33% vs 5%, respectively; hazard ratio, 6.6; 95% CI, 1.8-23; P =.001).
Limitations of this study include its retrospective and single-center design and small sample size.
“These data offer an opportunity to further risk-stratify patients considered for the total artificial heart,” noted the study authors.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Desai KV, Tang DG, Quader M, et al. Predictors of renal failure in patients treated with the total artificial heart [published online May 26, 2020]. J Card Fail. doi:10.1016/j.cardfail.2020.05.011