scholarly journals Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242931
Author(s):  
Tristan de Nattes ◽  
Pierre-Yves Litzler ◽  
Arnaud Gay ◽  
Catherine Nafeh-Bizet ◽  
Arnaud François ◽  
...  
Keyword(s):  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Kidney Injury ◽  
Subsequent Development ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Proximal Tubulopathy

Background Chronic subclinical hemolysis is frequent in patients implanted with Left Ventricular Assist Device (LVAD) and is associated with adverse outcomes. Consequences of LVADs-induced subclinical hemolysis on kidney structure and function is currently unknown. Methods Thirty-three patients implanted with a Heartmate II LVAD (Abbott, Inc, Chicago IL) were retrospectively studied. Hemolysis, Acute Kidney Injury (AKI) and the evolution of estimated Glomerular Filtration Rate were analyzed. Proximal Tubulopathy (PT) groups were defined according to proteinuria, normoglycemic glycosuria, and electrolytic disorders. The Receiver Operating Characteristic (ROC) curve was used to analyze threshold of LDH values associated with PT. Results Median LDH between PT groups were statistically different, 688 IU/L [642–703] and 356 IU/L [320–494] in the “PT” and “no PT” groups, respectively p = 0.006. To determine PT group, LDH threshold > 600 IU/L was associated with a sensitivity of 85.7% (95% CI, 42.1–99.6) and a specificity of 84.6% (95% CI, 65.1–95.6). The ROC's Area Under Curve was 0.83 (95% CI, 0.68–0.98). In the “PT” group, patients had 4.2 [2.5–5.0] AKI episodes per year of exposure, versus 1.6 [0.4–3.7] in the “no PT” group, p = 0.03. A higher occurrence of AKI was associated with subsequent development of Chronic Kidney Disease (CKD) (p = 0.02) and death (p = 0.05). Conclusions LVADs-induced subclinical hemolysis is associated with proximal tubular functional alterations, which in turn contribute to the occurrence of AKI and subsequent CKD. Owing to renal toxicity of hemolysis, measures to reduce subclinical hemolysis intensity as canula position or pump parameters should be systematically considered, as well as specific nephroprotective therapies.

scholarly journals Complications, Risk Factors, and Staffing Patterns for Noncardiac Surgery in Patients with Left Ventricular Assist Devices

2017 ◽  
Vol 126 (3) ◽  
pp. 450-460 ◽  
Author(s):  
Michael R. Mathis ◽  
Subramanian Sathishkumar ◽  
Sachin Kheterpal ◽  
Matthew D. Caldwell ◽  
Francis D. Pagani ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Noncardiac Surgery ◽  
Assist Device ◽  
Ventricular Assist ◽  
Intraoperative Hypotension ◽  
Left Ventricular Assist

Abstract Background Patients with left ventricular assist devices presenting for noncardiac surgery are increasingly commonplace; however, little is known about their outcomes. Accordingly, the authors sought to determine the frequency of complications, risk factors, and staffing patterns. Methods The authors performed a retrospective study at their academic tertiary care center, investigating all adult left ventricular assist device patients undergoing noncardiac surgery from 2006 to 2015. The authors described perioperative profiles of noncardiac surgery cases, including patient, left ventricular assist device, surgical case, and anesthetic characteristics, as well as staffing by cardiac/noncardiac anesthesiologists. Through univariate and multivariable analyses, the authors studied acute kidney injury as a primary outcome; secondary outcomes included elevated serum lactate dehydrogenase suggestive of left ventricular assist device thrombosis, intraoperative bleeding complication, and intraoperative hypotension. The authors additionally studied major perioperative complications and mortality. Results Two hundred and forty-six patients underwent 702 procedures. Of 607 index cases, 110 (18%) experienced postoperative acute kidney injury, and 16 (2.6%) had elevated lactate dehydrogenase. Of cases with complete blood pressure data, 176 (27%) experienced intraoperative hypotension. Bleeding complications occurred in 45 cases (6.4%). Thirteen (5.3%) patients died within 30 days of surgery. Independent risk factors associated with acute kidney injury included major surgical procedures (adjusted odds ratio, 4.4; 95% CI, 1.1 to 17.3; P = 0.03) and cases prompting invasive arterial line monitoring (adjusted odds ratio, 3.6; 95% CI, 1.3 to 10.3; P = 0.02) or preoperative fresh frozen plasma transfusion (adjusted odds ratio, 1.7; 95% CI, 1.1 to 2.8; P = 0.02). Conclusions Intraoperative hypotension and acute kidney injury were the most common complications in left ventricular assist device patients presenting for noncardiac surgery; perioperative management remains a challenge.

Remote hemodynamic guidance before and after left ventricular assist device implantation: short-term results from the HEMO-VAD pilot study

2021 ◽  
Author(s):  
Jesse F Veenis ◽  
Sumant P Radhoe ◽  
Nicolas M van Mieghem ◽  
Olivier C Manintveld ◽  
Kadir Caliskan ◽  
...  
Keyword(s):  
Pilot Study ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Kidney Injury ◽  
Left Ventricular ◽  
High Risk Group ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Before And After

Aim: We aimed to assess the safety and feasibility of using CardioMEMS monitoring in patients before and after left ventricular assist device (LVAD) surgery. Patients & methods: Ten patients accepted for elective LVAD surgery were included, received a CardioMEMS at baseline and were categorized based on mean pulmonary artery pressure (mPAP) ≤25 mmHg (n = 4) or mPAP >25 mmHg [n = 6]) before LVAD surgery. Results: The combined end point of all-cause mortality, acute kidney injury and/or renal replacement therapy, and right ventricular failure occurred more often in patients with an mPAP >25 mmHg (83 vs 0%, p = 0.017). Conclusion: This pilot study demonstrates that combining CardioMEMS monitoring with LVAD therapy is safe and generates the hypothesis that patients with an mPAP >25 mmHg before LVAD surgery identify a very high-risk group for adverse clinical outcomes.

Prediction of acute kidney injury after left ventricular assist device implantation: Evaluation of clinical risk scores

2019 ◽  
Vol 44 (2) ◽  
pp. 162-173 ◽  
Author(s):  
Kevin Pilarczyk ◽  
Henning Carstens ◽  
Maria Papathanasiou ◽  
Peter Luedike ◽  
Achim Koch ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Risk Scores ◽  
Assist Device ◽  
Ventricular Assist ◽  
Device Implantation ◽  
Left Ventricular Assist
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