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
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
Affiliations
J. Hunter Mehaffey, MD, MSc
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
Ryan Cantor, PhD
Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Ala
Susan Myers, MS
Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Ala
Nicholas R. Teman, MD
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
John A. Kern, MD
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
Gorav Ailawadi, MD
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va; Department of Cardiothoracic Surgery, University of Michigan, Ann Arbor, Mich
Francis Pagani, MD
Department of Cardiothoracic Surgery, University of Michigan, Ann Arbor, Mich
James Kirklin, MD
Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Ala
Kenan Yount, MD, MBA
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
Leora Yarboro, MD
Division 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 .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.
