Predictors of Renal Failure in Patients Treated With the Total Artificial Heart

• Published in: Journal of cardiac failure 2020-07, Vol.26 (7), p.588-593
• Main Authors: Desai, Kevin V., Tang, Daniel G., Quader, Mohammed, Kasirajan, Vigneshwar, Thacker, Leroy, Sawey, Edward J., Tchoukina, Inna, Shah, Keyur B.
• Format: Article
• Language: English
• Subjects: dialysis; heart failure; Mechanical circulatory support; renal disease
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2020.05.011

•There is a high prevalence of hemodialysis-dependent renal failure after total artificial heart implantation.•Renal failure is associated with increased incidence of mortality after device implantation.•Patients with poorer renal function have higher risk of postoperative renal failure.•Patients with ischemic heart disease have high risk of postoperative renal failure.•Patients requiring extracorporeal membrane oxygenation are at increased risk of renal failure postoperatively. The incidence of hemodialysis (HD)-dependent renal failure after total artificial heart (TAH) implantation is high. We sought to determine the preoperative predictors of HD after TAH implantation. We studied 87 patients after TAH implantation at our institution between April 2006 and March 2017. Baseline clinical data were obtained from the medical records, and patients were followed until death or heart transplantation. We performed logistic regression analysis to identify predictors of HD after TAH implantation. Of the patients, 24 (28%) required postimplantation HD. Those requiring HD were more likely to have histories of coronary artery disease (58% vs 29%; P = 0.01), required preoperative membrane oxygenation (33% vs 4.8%; P = 0.001) and had lower baseline estimated glomerular filtration rates (54 ± 29 vs 67 ± 24 mL/min/1.73m2; P = 0.04). Patients requiring HD were at a higher risk of death on device at 1 year (33% vs 5%, P = 0.001; log rank test: P =0.001, hazard ratio 6.6 [95% CI:1.8–23], P = 0.003). The incidence of postimplantation HD is high and is associated with increased likelihood of mortality. Lower baseline estimated glomerular filtration rates, histories of coronary artery disease and preoperative membrane oxygenation support are predictors of postimplantation requirement of HD. These data may help to identify patients at risk for adverse outcomes after TAH implantation.