Retrospective evaluation of short and long-term effects of left ventricular assist device technique on renal function in patients with end-stage heart failure

Left Ventricular Assist Devices (LVAD) are used as an interventional treatment method for patients with decompensated heart failure who have symptoms of heart failure at rest, despite the maximum medical treatment. The incidence of cardiorenal syndrome due to end organ perfusion disorder is increased in patients with end-stage heart failure. The aim of this study is to retrospectively evaluate the short and long-term effects of LVAD implantation technique on renal function in patients with end-stage heart failure (HF). In our study, 329 patients with LVAD (HeartWare, HeartMate II, HeartMate 3) with end-stage HF were investigated. Biochemical parameters of the patients before and after LVAD implantation were evaluated retrospectively. Basal and follow-up GFR (CKD-Epi) values were calculated. SPSS 22.0 software was used for all statistical analyses. Pearson and Spearman's for correlation analysis, Kaplan-Meier method for survival analysis tests were used, statistical significance was evaluated by log-rank test. Cox regression analysis was performed to determine the independent predictors of mortality. The mean age of the patients was 50.8 ± 13.2, 86% was male, mean basal GFR was 77.6 ± 25.7 ml/min/1.73m2, 29.5% patients had DM, 34.1% had HT. There was a significant increase in mean GFR values of all patients and groups in the first month after LVAD implantation (p <0.01). In patients with basal GFR <60ml / min, there was a significant increase (p <0.001) compared to baseline at 1, 6, 12, 24 months after implantation, and the increase at 36 months was not significant (p = 0.08). During the follow-up period of all patients; 1. year transplantation censored survival was 81.9% (n = 56), 70.3% (n = 82) for 2. year, 62.9% (n = 93) for 3. year, 55.8% for 4. and 5. years (n = 99). The survival rates of all 3 groups according to basal GFR were for 1. year was 87.9% in group 3 (GFR> 90), 76.2% (p=0.03) in group 1 (GFR <60) and 81.9% in group 2 (GFH 60-90). In 27% of patients with low baseline GFR (<60) there was no increase in postoperative GFR, while approximately in 73% of patients GFR was increased. On the other hand, we found that approximately 14% of patients with GFR> 60 had a GFR of <60 on the postoperative 1. month. While comparing first month GFR increased (n = 227) (50.4 ± 2.2 months) and not increased (n = 69) (35.7 ± 3.7 months) groups; for increased group 2-year survival rate was 73%, 3-year was 65%, 4-year was 58% and for not increased group 2- survival rate was 56%, 3-year was 49% and 4-year was 38% (p <0.01). During the follow-up, we found that the most common complications associated with LVAD were cerebrovascular events and complications of pump thrombosis. In patients with LVAD, short- and long-term results are quite good in terms of renal function. Even though GFR was low before, we observed that there was a significant improvement in GFR after LVAD implantation and this improvement continued for the first 3 years.