scholarly journals Outcomes of Moderate-to-Severe Acute Kidney Injury following Left Ventricular Assist Device Implantation

2019 ◽  
Vol 9 (2) ◽  
pp. 100-107 ◽  
Author(s):  
David M. Harmon ◽  
Kristen M. Tecson ◽  
Brian Lima ◽  
Justin D.G. Collier ◽  
Asad F. Shaikh ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Acute Kidney Injury ◽  
Confidence Interval ◽  
Left Ventricular Assist Device ◽  
Odds Ratio ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Background: Although acute kidney injury (AKI) is a common complication following cardiac surgery, less is known about the occurrence and consequences of moderate/severe AKI following left ventricular assist device (LVAD) implantation. Methods: All patients who had an LVAD implanted at our center from 2008 to 2016 were reviewed to determine the incidence of, and risk factors for, moderate/severe (stage 2/3) AKI and to compare postoperative complications and mortality rates between those with and those without moderate/severe AKI. Results: Of 246 patients, 68 (28%) developed moderate/severe AKI. A multivariable logistic regression comprising body mass index and prior sternotomy had fair predictive ability (area under the curve = 0.71). A 1-unit increase in body mass index increased the risk of moderate/severe AKI by 7% (odds ratio = 1.07; 95% confidence interval: 1.03–1.11); a prior sternotomy increased the risk more than 3-fold (odds ratio = 3.4; 95% confidence interval: 1.84–6.43). The group of patients with moderate/severe AKI had higher rates of respiratory failure and death than the group of patients with mild/no AKI. Patients with moderate/severe AKI were at 3.2 (95% confidence interval: 1.2–8.2) times the risk of 30-day mortality compared to those without. Even after adjusting for age and Interagency Registry for Mechanically Assisted Circulatory Support profile, those with moderate/severe AKI had 1.75 (95% confidence interval: 1.03–3.0) times the risk of 1-year mortality compared to those without. Discussion: Risk-stratifying patients prior to LVAD placement in regard to AKI development may be a step toward improving surgical outcomes.

Readmissions after Acute Kidney Injury during Left Ventricular Assist Device Implantation Hospitalization

2020 ◽  
Vol 51 (3) ◽  
pp. 172-181 ◽  
Author(s):  
Carl P. Walther ◽  
Wolfgang C. Winkelmayer ◽  
Anita Deswal ◽  
Jingbo Niu ◽  
Sankar D. Navaneethan
Keyword(s):  
Acute Kidney Injury ◽  
Left Ventricular Assist Device ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Relationship Of ◽  
The Relationship ◽  
Readmission Risk

Background: Acute kidney injury (AKI) frequently complicates hospitalizations for left ventricular assist device (LVAD) implantation. Little is known about the relationship of AKI with subsequent readmissions, and we investigated the relationship of AKI during LVAD implantation hospitalization with all-cause and cause-specific 30-day readmissions. Methods: We used a United States (US) nationwide all-payer administrative database, identifying patients who underwent implantable LVAD placement 2010–2015. Patients were classified into 3 mutually exclusive groups based on presence and severity of AKI during the LVAD placement hospitalization: no AKI, AKI, and AKI requiring dialysis (AKI-D). Outcomes were all-cause and cause-specific 30-day readmissions. Results: Within 30 days after discharge 25.4% of patients were readmitted. Of those without AKI, 23.9% were readmitted, compared to 25.5% of those with AKI and 42.2% of those with AKI-D. Compared to no AKI (adjusted for demographics, index hospitalization and chronic comorbidity factors, and year), odds of 30-day readmission were 2.18 (95% CI 1.37–3.49) times higher for those with AKI-D, whereas those with AKI not requiring dialysis had similar 30-day readmission risk (OR 1.03 [95% CI 0.89–1.20]). Those with AKI-D had higher risk of 30-day readmission for infection (OR 2.02 [95% CI 1.13–3.61]), gastrointestinal (GI) bleed (2.32 [95% CI 1.24–4.34]), and kidney disease (13.9 [95% CI 4.0–48]). There was no increased risk for stroke readmission with AKI or AKI-D. Conclusion: AKI-D was associated with highest ­30-day readmission risk, possibly related to negatively synergistic effects of LVAD, kidney dysfunction, and dialysis related factors on infection and GI bleeding risks. AKI alone was not associated with increased readmission risk.

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.

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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