Serial Changes in Renal Function as a Prognostic Indicator in Advanced Heart Failure Patients With Left Ventricular Assist System

Background. Left ventricular assist system (LVAS) implantation is an established treatment for patients with advanced heart failure. We investigated the clinical implication of serial changes in renal function after LVAS implantation. Methods. This study included 110 patients who underwent pulsatile LVAS implantation intended as a bridge to transplantation and were alive more than 2 weeks after implantation. Data collection of demographic and hematologic values was performed 1 day before (baseline) and 2 weeks after implantation. All patients were monitored for 2 years or until death. Results. The 2-year postimplantation mortality rate was 31.8%. Multivariate Cox regression analysis showed the baseline estimated glomerular filtration rate (eGFR) was an independent predictor of death (hazard ratio, 0.90 for each 10 mL/min increase, p < 0.05). The eGFR significantly increased at 2 weeks after LVAS implantation (70.5 +/- 37.8 to 121.0 +/- 78.8 mL/min, p < 0.01). Kaplan-Meier curves with log-rank tests showed significantly poorer event-free survival rates in the group with an inframedian value of change in eGFR at 2 weeks after implantation (Delta eGFR; p = 0.03) as well as in the group with the lowest tertile of eGFR at 2 weeks after implantation (2w-eGFR; p < 0.01). Multivariate Cox regression analysis showed that Delta eGFR (hazard ratio, 0.89 for each 10 mL/min increase) and 2w-eGFR (hazard ratio, 0.92 for each 10 mL/min increase) were independent predictors of death (p < 0.01, respectively). Conclusions. Impaired renal function, and in particular, a poor response of eGFR to LVAS implantation, may have a strong association with worse outcome. (Ann Thorac Surg 2012; 93: 816-24) (C) 2012 by The Society of Thoracic Surgeons