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Type 2 Cardiorenal Syndrome in the Left Ventricular Assist Device (LVAD) Population
Journal article   Peer reviewed

Type 2 Cardiorenal Syndrome in the Left Ventricular Assist Device (LVAD) Population

S. Feitell, J. Patel, P. Pirlamarla, J. Whittier, E. Gongora, T. Rowe, S. Hankins and H.J. Eisen
The Journal of heart and lung transplantation, v 32(4), pp S227-S227
Apr 2013
DOI: https://doi.org/10.1016/j.healun.2013.01.577
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Type 2 Cardiorenal Syndrome after LVAD has not been well evaluated in patients with Mechanical Circulatory Support. It has been observed over time that a subset of patients continues to develop worsening renal function over time despite maximal medical therapy and LVAD support. It also appears that these patients maintain higher Doppler pressure recordings over time despite aggressive blood pressure management. We performed a retrospective chart review of all 27 Destination Therapy patients who survived more than one year after HeartMate II implantation between 2008 and 2011. Doppler pressure readings were obtained via manual blood pressure cuff and Doppler Ultrasound and recorded at time of discharge after LVAD implantation and again at one year follow up visit. Renal function was assessed via Modification of Diet in Renal Disease (MDRD) equation to estimate GFR at time of discharge and again at one year follow up. The mean Doppler pressure recorded at time of discharge post-LVAD implantation was 86.2 mm Hg. The mean doppler pressure recorded at one year post implant was 98.3 mm Hg (p = 0.0191). The mean GFR at time of discharge was 96.28 + 5.99 ml/min while at one year was 71.30 ml/min (p= 0.015). The average increase in beta blocker dose over one year was 82% (p = 0.0091). The average increase in ACE/ARB dose over one year was 114% (p=0.08, NS). Cardiorenal Syndrome in the LVAD population is not well understood. We have demonstrated that there is a statistically significant decline in GFR to stage II Chronic Kidney Disease, with a simultaneous rise in doppler pressure over one year in patients after LVAD implantation. It is unclear if the continuous flow LVADs contribute to this phenomenon and what role the renin-angiotensin-aldosterone axis may play in this patient population, suggesting that further investigation is required.

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#3 Good Health and Well-Being

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Web of Science research areas
Cardiac & Cardiovascular Systems
Respiratory System
Surgery
Transplantation
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