Anjum Azeen, Kurihara Chitaru, Critsinelis Andre, Kawabori Masashi, Sugiura Tadahisa, Civitello Andrew B, Etheridge Whitson B, Delgado Reynolds M, Simpson Leo, George Joggy K, Nair Ajith P, Frazier O H, Morgan Jeffrey A
Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, 6720 Bertner Ave., Houston, TX, 77030, USA.
Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Cooley 355N, 6770 Bertner Avenue, Houston, TX, 77030, USA.
J Artif Organs. 2018 Sep;21(3):285-292. doi: 10.1007/s10047-018-1047-0. Epub 2018 May 15.
Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly being used to treat advanced, refractory chronic heart failure. Herein, we sought to determine the incidence of postoperative acute kidney injury (AKI) in axial-flow (HeartMate II; HM-II) and centrifugal-flow (HVAD) CF-LVAD recipients, as well as the effect of AKI on mortality. The study cohort comprised 520 patients who received a HM-II (n = 398) or HVAD (n = 122) at our center between November 2003 and March 2016. Their records were reviewed to determine the incidence of RIFLE-defined AKI after LVAD implantation. We compared the perioperative characteristics, postoperative complications, and survival rates of the patients with and without AKI and differentiated the outcomes based on device type (HM-II or HVAD). Seventy-five patients (14.4%) developed AKI postoperatively. Patients with AKI after LVAD implantation had significantly reduced survival compared to patients without AKI (p = 0.01). Cox proportional hazards models showed that AKI was a significant independent predictor of mortality (HR = 1.54, p = 0.03). Preoperative mechanical circulatory support and prolonged cardiopulmonary bypass time were independent predictors of AKI. The incidence of AKI was similar for HM-II and HVAD recipients (p = 0.25). There was no significant difference in AKI rates for the HM-II and HVAD recipients. Developing AKI adversely affected survival.
连续流左心室辅助装置（CF-LVADs）越来越多地用于治疗晚期难治性慢性心力衰竭。在此，我们试图确定轴流（HeartMate II；HM-II）和离心流（HVAD）CF-LVAD接受者术后急性肾损伤（AKI）的发生率，以及AKI对死亡率的影响。研究队列包括2003年11月至2016年3月期间在我们中心接受HM-II（n = 398）或HVAD（n = 122）的520例患者。回顾他们的记录以确定LVAD植入后RIFLE定义的AKI的发生率。我们比较了有和没有AKI的患者的围手术期特征、术后并发症和生存率，并根据装置类型（HM-II或HVAD）区分结果。75例患者（14.4%）术后发生AKI。与没有AKI的患者相比，LVAD植入后发生AKI的患者生存率显著降低（p = 0.01）。Cox比例风险模型显示，AKI是死亡率的显著独立预测因素（HR = 1.54，p = 0.03）。术前机械循环支持和延长的体外循环时间是AKI的独立预测因素。HM-II和HVAD接受者的AKI发生率相似（p = 0.25）。HM-II和HVAD接受者的AKI发生率没有显著差异。发生AKI对生存有不利影响。
