Quader Mohammed A, Goodreau Adam M, Shah Keyur B, Katlaps Gundars, Cooke Richard, Smallfield Melissa C, Tchoukina Inna F, Wolfe Luke G, Kasirajan Vigneshwar
From the *Department of Surgery, Division of Cardiothoracic Surgery, and †Department of Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia.
ASAIO J. 2016 Jan-Feb;62(1):87-91. doi: 10.1097/MAT.0000000000000288.
Heart failure patients requiring total artificial heart (TAH) support often have concomitant renal insufficiency (RI). We sought to quantify renal function recovery in patients supported with TAH at our institution. Renal function data at 30, 90, and 180 days after TAH implantation were analyzed for patients with RI, defined as hemodialysis supported or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m. Between January 2008 and December 2013, 20 of the 46 (43.5%) TAH recipients (age 51 ± 9 years, 85% men) had RI, mean preoperative eGFR of 48 ± 7 ml/min/1.73 m. Renal function recovery was noted at each follow-up interval: increment in eGFR (ml/min/1.73 m) at 30, 90, and 180 days was 21 ± 35 (p = 0.1), 16.5 ± 18 (p = 0.05), and 10 ± 9 (p = 0.1), respectively. Six patients (30%) required preoperative dialysis. Of these, four recovered renal function, one remained on dialysis, and one died. Six patients (30%) required new-onset dialysis. Of these, three recovered renal function and three died. Overall, 75% (15 of 20) of patients' renal function improved with TAH support. Total artificial heart support improved renal function in 75% of patients with pre-existing significant RI, including those who required preoperative dialysis.
需要全人工心脏（TAH）支持的心力衰竭患者常伴有肾功能不全（RI）。我们试图量化在我们机构接受TAH支持的患者的肾功能恢复情况。对TAH植入术后30天、90天和180天的肾功能数据进行分析，这些患者患有RI，定义为接受血液透析支持或估计肾小球滤过率（eGFR）低于60ml/min/1.73m²。在2008年1月至2013年12月期间，46例TAH接受者中有20例（43.5%）患有RI（年龄51±9岁，85%为男性），术前平均eGFR为48±7ml/min/1.73m²。在每个随访间隔均观察到肾功能恢复：30天、90天和180天时eGFR（ml/min/1.73m²）的增加分别为21±35（p=0.1）、16.5±18（p=0.05）和10±9（p=0.1）。6例患者（30%）术前需要透析。其中，4例肾功能恢复，1例继续透析，1例死亡。6例患者（30%）需要开始新的透析。其中，3例肾功能恢复，3例死亡。总体而言，75%（20例中的15例）患者的肾功能在TAH支持下得到改善。全人工心脏支持使75%患有先前严重RI的患者肾功能得到改善，包括那些术前需要透析的患者。
