Severe renal dysfunction complicating cardiogenic shock is not a contraindication to mechanical support as a bridge to cardiac transplantation

• Published in: Journal of the American College of Cardiology Vol. 41; no. 3; pp. 381 - 385
• Main Authors: Khot, Umesh N, Mishra, Micky, Yamani, M.Hilal, Smedira, Nicholas G, Paganini, Emil, Yeager, Mike, Buda, Tiffany, McCarthy, Patrick M, Young, James B, Starling, Randall C
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 05.02.2003; Elsevier Science; Elsevier Limited
• Subjects: Adult; Aged; Biological and medical sciences; Cardiology; Contraindications; Creatinine - blood; Diseases of the cardiovascular system; Drug therapy; Female; Heart Transplantation; Heart-Assist Devices; Hemodialysis; Humans; Kidney Diseases - blood; Kidney Diseases - etiology; Kidney Diseases - surgery; Male; Medical sciences; Middle Aged; Mortality; Outcome Assessment (Health Care); Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Severity of Illness Index; Shock, Cardiogenic - blood; Shock, Cardiogenic - complications; Shock, Cardiogenic - surgery; Survival Rate; Time Factors; Transplants & implants; continuous venovenous hemodialysis; VAD; ventricular assist device(s); CVVHD; Kidney disease; Artificial heart; Heart; Human; Heart failure; Intensive cardiocirculatory care; Urinary system disease; Prognosis; Treatment efficiency; Cardiocirculatory support; Cardiovascular disease; Terminal stage; Transplantation; Homotransplantation; Waiting time; Left ventricle; Concomitant disease; Treatment; Heart disease; Surgery; Cardiogenic shock; Renal failure; Complication; Comparative study
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(02)02823-1

This study investigated outcomes in patients with cardiogenic shock and severe renal dysfunction treated with ventricular assist devices (VAD) as a bridge to cardiac transplantation. Previous reports have documented poor survival in patients with cardiogenic shock and severe renal dysfunction treated with VAD. We surveyed 215 consecutive patients who received a VAD from 1992 to 2000 and selected patients who had a serum creatinine ≥3.0 mg/dl at the time of VAD placement. Demographic, laboratory, and clinical outcome data were collected. Eighteen patients met the inclusion criteria. Mean serum creatinine at the time of VAD placement was 4.0 ± 0.7 mg/dl (range 3.0 to 5.2 mg/dl). Seven patients required temporary renal support with continuous venovenous hemodialysis (CVVHD). Eleven patients underwent cardiac transplantation. At six months post-transplantation, mean serum creatinine was 2.0 ± 0.6 mg/dl (range 1.3 to 3.5 mg/dl). None of the transplanted patients required subsequent renal support. Seven patients died with a VAD before transplantation. Three died early (<1 month) after VAD placement, and all three required CVVHD until death. Four patients survived for >1 month after VAD placement; all four had resolution of renal dysfunction with mean serum creatinine of 1.9 ± 1.2 mg/dl (range 0.8 to 3.6 mg/dl) without the need for renal support. Overall 30-day and six-month survival after VAD placement, survival to transplantation, and survival one year post-transplantation were similar to patients without severe renal dysfunction. Contemporary use of VAD leads to resolution of severe renal dysfunction in most cardiogenic shock patients and comparable long-term outcomes to patients without renal dysfunction.