Impact of preoperative versus postoperative dialysis on left ventricular assist device outcomes: An analysis from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support databaseCentral MessagePerspective
Objective: Chronic kidney disease and renal failure are common in patients being considered for left ventricular assist device support. We sought to evaluate the outcomes of patients undergoing left ventricular assist device implantation with preoperative dialysis and those with new-onset postoperat...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-03-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273622000146 |
| _version_ | 1811337303199580160 |
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| author | J. Hunter Mehaffey, MD, MSc Ryan Cantor, PhD Susan Myers, MS Nicholas R. Teman, MD John A. Kern, MD Gorav Ailawadi, MD Francis Pagani, MD James Kirklin, MD Kenan Yount, MD, MBA Leora Yarboro, MD |
| author_facet | J. Hunter Mehaffey, MD, MSc Ryan Cantor, PhD Susan Myers, MS Nicholas R. Teman, MD John A. Kern, MD Gorav Ailawadi, MD Francis Pagani, MD James Kirklin, MD Kenan Yount, MD, MBA Leora Yarboro, MD |
| author_sort | J. Hunter Mehaffey, MD, MSc |
| collection | DOAJ |
| description | Objective: Chronic kidney disease and renal failure are common in patients being considered for left ventricular assist device support. We sought to evaluate the outcomes of patients undergoing left ventricular assist device implantation with preoperative dialysis and those with new-onset postoperative renal failure requiring dialysis. Methods: All patients (n = 14,090) undergoing primary left ventricular assist device implantation who were listed in the Interagency Registry for Mechanically Assisted Circulatory Support database (2014-2019) were evaluated. Landmark analysis then stratified patients alive at 1 month by preoperative dialysis and at 1 month postoperatively, preoperative dialysis only, postoperative dialysis only, and no dialysis. Results: Of 14,090 patients undergoing left ventricular assist device implantation, patients on dialysis (400%, 3%) preoperatively had significantly higher mortality at 1 month (18% vs 6%, P < .0001). However, of patients on preoperative dialysis, 131 (32.8%) no longer required dialysis at 1 month postoperatively and had long-term survival similar to patients who never required dialysis (no dialysis vs recovered, P = .13). Long-term survival was significantly worse in patients with persistent dialysis and new dialysis at 1 month postoperatively (P < .0001). Time to first stroke, major nondevice infection, any bleeding event, and gastrointestinal bleeding were all worse in patients on preoperative or postoperative dialysis (all P < .0001). Device infection, malfunction, or thrombosis was not associated with dialysis status (P > .05). Negative predictors of recovery include biventricular assist device (odds ratio, 0.20) and inotropes 1 week postimplant (odds ratio, 0.19). Conclusions: Preoperative renal failure is associated with 3 times higher mortality and worse morbidity in patients receiving a left ventricular assist device. However, one-third of patients with preoperative dialysis will recover renal function postimplant with similar long-term survival and quality of life as those without dialysis. |
| first_indexed | 2024-04-13T17:52:52Z |
| format | Article |
| id | doaj.art-f1ee3e006d5f4f5abcff2e7b66b54149 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-04-13T17:52:52Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-f1ee3e006d5f4f5abcff2e7b66b541492022-12-22T02:36:38ZengElsevierJTCVS Open2666-27362022-03-019122143Impact of preoperative versus postoperative dialysis on left ventricular assist device outcomes: An analysis from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support databaseCentral MessagePerspectiveJ. Hunter Mehaffey, MD, MSc0Ryan Cantor, PhD1Susan Myers, MS2Nicholas R. Teman, MD3John A. Kern, MD4Gorav Ailawadi, MD5Francis Pagani, MD6James Kirklin, MD7Kenan Yount, MD, MBA8Leora Yarboro, MD9Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VaKirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, AlaKirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, AlaDivision of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VaDivision of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VaDivision of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va; Department of Cardiothoracic Surgery, University of Michigan, Ann Arbor, MichDepartment of Cardiothoracic Surgery, University of Michigan, Ann Arbor, MichKirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, AlaDivision of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VaDivision of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va; Address for reprints: Leora Yarboro, MD, Department of Surgery, University of Virginia, 1215 Lee St, Charlottesville, VA 22903.Objective: Chronic kidney disease and renal failure are common in patients being considered for left ventricular assist device support. We sought to evaluate the outcomes of patients undergoing left ventricular assist device implantation with preoperative dialysis and those with new-onset postoperative renal failure requiring dialysis. Methods: All patients (n = 14,090) undergoing primary left ventricular assist device implantation who were listed in the Interagency Registry for Mechanically Assisted Circulatory Support database (2014-2019) were evaluated. Landmark analysis then stratified patients alive at 1 month by preoperative dialysis and at 1 month postoperatively, preoperative dialysis only, postoperative dialysis only, and no dialysis. Results: Of 14,090 patients undergoing left ventricular assist device implantation, patients on dialysis (400%, 3%) preoperatively had significantly higher mortality at 1 month (18% vs 6%, P < .0001). However, of patients on preoperative dialysis, 131 (32.8%) no longer required dialysis at 1 month postoperatively and had long-term survival similar to patients who never required dialysis (no dialysis vs recovered, P = .13). Long-term survival was significantly worse in patients with persistent dialysis and new dialysis at 1 month postoperatively (P < .0001). Time to first stroke, major nondevice infection, any bleeding event, and gastrointestinal bleeding were all worse in patients on preoperative or postoperative dialysis (all P < .0001). Device infection, malfunction, or thrombosis was not associated with dialysis status (P > .05). Negative predictors of recovery include biventricular assist device (odds ratio, 0.20) and inotropes 1 week postimplant (odds ratio, 0.19). Conclusions: Preoperative renal failure is associated with 3 times higher mortality and worse morbidity in patients receiving a left ventricular assist device. However, one-third of patients with preoperative dialysis will recover renal function postimplant with similar long-term survival and quality of life as those without dialysis.http://www.sciencedirect.com/science/article/pii/S2666273622000146dialysisINTERMACSLVADoutcomesrenal failure |
| spellingShingle | J. Hunter Mehaffey, MD, MSc Ryan Cantor, PhD Susan Myers, MS Nicholas R. Teman, MD John A. Kern, MD Gorav Ailawadi, MD Francis Pagani, MD James Kirklin, MD Kenan Yount, MD, MBA Leora Yarboro, MD Impact of preoperative versus postoperative dialysis on left ventricular assist device outcomes: An analysis from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support databaseCentral MessagePerspective JTCVS Open dialysis INTERMACS LVAD outcomes renal failure |
| title | Impact of preoperative versus postoperative dialysis on left ventricular assist device outcomes: An analysis from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support databaseCentral MessagePerspective |
| title_full | Impact of preoperative versus postoperative dialysis on left ventricular assist device outcomes: An analysis from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support databaseCentral MessagePerspective |
| title_fullStr | Impact of preoperative versus postoperative dialysis on left ventricular assist device outcomes: An analysis from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support databaseCentral MessagePerspective |
| title_full_unstemmed | Impact of preoperative versus postoperative dialysis on left ventricular assist device outcomes: An analysis from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support databaseCentral MessagePerspective |
| title_short | Impact of preoperative versus postoperative dialysis on left ventricular assist device outcomes: An analysis from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support databaseCentral MessagePerspective |
| title_sort | impact of preoperative versus postoperative dialysis on left ventricular assist device outcomes an analysis from the society of thoracic surgeons interagency registry for mechanically assisted circulatory support databasecentral messageperspective |
| topic | dialysis INTERMACS LVAD outcomes renal failure |
| url | http://www.sciencedirect.com/science/article/pii/S2666273622000146 |
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