Ricklefs Marcel, Heimeshoff Jan, Hanke Jasmin S, Chatterjee Anamika, Dogan Günes, Shrestha Malakh, Feldmann Christina, Wert Leonhard, Haverich Axel, Schmitto Jan D
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
J Thorac Dis. 2018 Jun;10(Suppl 15):S1737-S1742. doi: 10.21037/jtd.2017.10.03.
End-stage heart failure is associated with severe after-effects such as heart valve insufficiency, cardiac arrhythmias or end-organ dysfunctions. Renal failure or 'cardiorenal syndrome' is a critical end-organ disorder associated with advanced heart failure, which occurs due to low-output failure. Drug therapy or surgical interventions involving left ventricular assist device (LVAD) implantation may impede the progress of heart insufficiency and its after-effects including renal failure. In this study, we investigated the impact of a minimally invasive ventricular assist device implantation through upper hemisternotomy combined with anterolateral thoracotomy on renal function, in patients with perioperative renal failure.
We analyzed data obtained from 103 patients (80 males, 23 females; mean age 53.8±11.7) who underwent LVAD implantation at our clinic within a 15-year interval (2001-2016) and were dialyzed due to renal dysfunction. 90 patients were operated with the conventional LVAD implantation technique (standard approach surgery, SAS) and 13 underwent less invasive approach implantation (less invasive surgery, LIS).
For all patients, data analysis showed significant increase of glomerular filtration rate (GFR) (44.2±56.48 mL/min; 95% CI: 33.81-55.28; P<0.001) along with a significant decrease in the levels of creatinine (-1.08±1.83 mg/dL; 95% CI: 0.75-1.46; P<0.001) and urea (-4.62±13.66 mmol/L; 95% CI: 1.95-7.29; P<0.001). There was a considerable difference in change of renal parameters in patients treated with LIS in comparison to patients who underwent SAS, which was however not statistically significant (GFR: P=0.494; creatinine: P=0.543; urea P=0.918).
LVAD implantation improves kidney function in patients with renal dysfunction. A considerable difference in the change of renal parameters was detected in patients with LIS as compared to SAS, which was not significant possibly due to the limited size of the patient cohort (n=13).
终末期心力衰竭与严重的后遗症相关，如心脏瓣膜功能不全、心律失常或终末器官功能障碍。肾衰竭或“心肾综合征”是一种与晚期心力衰竭相关的严重终末器官疾病，它是由于低心输出量衰竭所致。药物治疗或涉及植入左心室辅助装置（LVAD）的外科干预可能会阻碍心力衰竭及其后遗症（包括肾衰竭）的进展。在本研究中，我们调查了通过上半胸骨切开术联合前外侧开胸术进行微创心室辅助装置植入对围手术期肾衰竭患者肾功能的影响。
我们分析了在15年期间（2001 - 2016年）于我院接受LVAD植入且因肾功能不全接受透析治疗的103例患者（80例男性，23例女性；平均年龄53.8±11.7岁）的数据。90例患者采用传统的LVAD植入技术（标准入路手术，SAS）进行手术，13例接受了侵入性较小的入路植入（微创外科手术，LIS）。
对所有患者的数据分析显示，肾小球滤过率（GFR）显著增加（44.2±56.48 mL/min；95%置信区间：33.81 - 55.28；P<0.001），同时肌酐水平显著降低（-1.08±1.83 mg/dL；95%置信区间：0.75 - 1.46；P<0.001），尿素水平显著降低（-4.62±13.66 mmol/L；95%置信区间：1.95 - 7.29；P<0.001）。与接受SAS的患者相比，接受LIS治疗的患者在肾脏参数变化方面存在相当大的差异，然而差异无统计学意义（GFR：P = 0.494；肌酐：P = 0.543；尿素：P = 0.918）。
LVAD植入可改善肾功能不全患者的肾功能。与SAS相比，LIS患者在肾脏参数变化方面存在相当大的差异，但可能由于患者队列规模有限（n = 13），差异不显著。
