Abstract 21316: Improved Renal Function With Continuous Flow Left Ventricular Assist Support is Associated With Aortic Valve Opening at 3 Months
Background: Continuous flow (CF) left ventricular assist support (LVAS) improves survival in advanced heart failure (CHF) and is superior to older generation pulsatile flow (PF) LVAS. As CF devices have become standard of care it is important to understand the long term effects of CF, or modulation of CF resulting in some pulsatility, on highly vascular organs such as the kidney and liver. Previous studies report improvement in serum creatinine and bilirubin with LVAS without difference in PF and CF devices. We hypothesized that aortic valve (AV) opening (AVO), as a surrogate of pulsatility in CF, vs AV remaining closed (AVC), may translate to differences in serum creatinine, bilirubin, and BNP with CF LVAS.
Methods: We reviewed records of patients receiving CF LVAS support with the HM II device (Thoratec) as either destination therapy (DT) or as a bridge to transplant (BTT). Patients were clinically evaluated to have NYHA IIIb or IV CHF and deemed to require either BTT or DT LVAS. Left ventricular ejection fraction (LVEF), serum creatinine, bilirubin, AST and BNP was evaluated in the group as a whole and also analyzed by separating into groups with AVO (N=14) and with AVC (N= 20) by echocardiography at 3 months (m).
Results: Overall, LVEF increased (18±2 vs 25±2%, p<0.05), and serum creatinine (1.38± 0.10 vs 1.17±.010 mg/dL, p<0.05) and bilirubin (1.19± 0.11vs 0.75± 0.10mg/dL, p<0.05) decreased. BNP decreased significantly at 3 m. In both AVO (18± 2vs 27± 2%, p<0.05) and AVC (18±2vs 24± %, p<0.05) LVEF increased. Serum creatinine decreased (1.34± 0.12vs 1.11±0.10 mg/dL, p<0.05) in AVO but while trending down in AVC (1.43±0.10 vs 1.22± 0.16mg/dL) did not reach significance. Bilirubin decreased in AVO (1.10± 0.10vs 0.79± 0.11mg/dL, p<0.05) and AVC (1.27±0.13 vs 0.73± 0.12mg/dL, p<0.05). BNP decreased significantly with both AVO and AVC. AST tended to decrease in the overall group, with AVO and AVC.
Conclusions: The present study suggests for the first time that improvement in serum creatinine with CF LVAS may be linked to the degree of pulsatility as measured by AVO. Improvement in LVEF, Bilirubin, and BNP occurred independently of AVO vs AVC. Future studies are required to confirm these findings in larger populations and over extended periods.
- © 2010 by American Heart Association, Inc.