Аcute renal failure in patients with implanted LVAD in the early postoperative period
DOI:
https://doi.org/10.12775/JEHS.2023.47.01.014Keywords
left ventricle assist device (LVAD), anticoagulant targeted therapy (ATT), renal complicationsAbstract
AKI is one of the major complications in the cardiac surgery group of patients in the world. In patients with LVAD in the short postoperative period, the situation with such a complication as AKI is associated with the state of hemodynamics and fluctuations in the parameters of the hemostasis system.
The purpose of this scientific work is to analyze the state of the blood coagulation system and its response to therapy and complications in the early postoperative period in fifty patients with implanted devices for mechanical support of the left ventricle, left ventricle assist device, LVAD, in the Silesian Heart Disease, Poland. Patients were divided into two groups, a control group receiving classical anticoagulation targeted therapy (ATT), which included the most controlled monotherapy with heparin, after reaching the target values of APTT, the addition and transition to monotherapy with warfarin until reaching the target INR and ASA, and the main, research group, who received an alternative ATT consisting of the previous one with the addition of P2Y12-receptor blockers and Xa-factors.
The results showed that the control group of patients with classical anticoagulant targeted therapy had greater mortality associated with AKI than the patients of the study group, and it was also demonstrated that the initially longer duration of surgery and intraoperative polyuria gave a greater percentage of AKI in the postoperative period.
The work was carried out within the framework of a bilateral agreement on scientific cooperation between the Department of Anesthesiology & Intensive Care at the National Medical Academy of Post-Graduate Education Named After P.L. Shupyk and the Silesian Center for Heart Diseases (Poland). This article is part of the analysis of the work on the analysis of the blood coagulation system in patients after implantation of the left ventricular mechanical circulatory support system with the analysis of such postoperative complication as acute kidney failure.
References
Wever-Pinzon O, Drakos SG, Kfoury AG et al. Morbidity and mortality in heart transplant candidates supported with mechanical circulatory support: is reappraisal of the current Circulation. 2013 Jan 29;127(4) pp:452-62.
Akhter SA, Badami A, Murray M, et al. Hospital Readmissions After Continuous-Flow Left Ventricular Assist Device Implantation: Incidence, Causes, and Cost Analysis. Ann Thorac Surg. 2015 Sep;100(3) pp:884-9.
Slaughter MS, Pagani FD, McGee EC, et al. HeartWare Bridge to Transplant ADVANCE Trial Investigators. HeartWare ventricular assist system for bridge to transplant: combined results of the bridge to transplant and continued access protocol trial. J Heart Lung Transplant. 2013 Jul;32(7) pp:675-83.
Stulak JM, Davis ME, Haglund N, et al. Adverse events in contemporary continuous-flow left ventricular assist devices: A multi-institutional comparison shows significant differences. J Thorac Cardiovasc Surg. 2016 Jan;151(1) pp:177-89.
Harvey L, Holley C, Roy SS, et al. Stroke After Left Ventricular Assist Device Implantation: Outcomes in the Continuous-Flow Era. Ann Thorac Surg. 2015;100(2) pp:535-41.
Morgan JA, Brewer RJ, Nemeh HW, et al. Stroke while on long-term left ventricular assist device support: incidence, outcome, and predictors. ASAIO J. 2014 May-Jun;60(3) pp:284-9.
Xia Y, Stern D, Friedmann P, Goldstein D. Preoperative atrial fibrillation may not increase thromboembolic events in left ventricular assist device recipients on midterm follow-up. J Heart Lung Transplant. 2016;35(7) pp:906-12.
Najjar SS, Slaughter MS, Pagani FD, et al. HVAD Bridge to Transplant ADVANCE Trial Investigators. An analysis of pump thrombus events in patients in the HeartWare ADVANCE bridge to transplant and continued access protocol trial. J Heart Lung Transplant. 2014 Jan;33(1) pp:23-34.
Uriel N, Morrison KA, Garan AR, et al. Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices: the Columbia ramp study. J Am Coll Cardiol. 2012 Oct 30; 60 (18) pp:1764-75.
Maltais S, Kilic A, Nathan S, et al. Prevention of HeartMate II Pump Thrombosis Through Clinical Management (PREVENT). J Heart Lung Transplant. 2016;35(4) pp:S161-S162.
Starling RC, Moazami N, Silvestry SC et al. Unexpected abrupt increase in left ventricular assist device thrombosis. N Engl J Med. 2014;370(1) pp:33-40.
Topkara VK, Kondareddy S, Malik F, et al. Infectious complications in patients with left ventricular assist device: etiology and outcomes in the continuous-flow era. Ann Thorac Surg. 2010 Oct;90(4) pp:1270-7.
Daniel W. Ross,1 Gerin R., et al. Left Ventricular Assist Devices and the Kidney. Clin J Am Soc Nephrol 13, 2018 pp: 348–355.
Bethany Roehm, Amanda R. Vest, and Daniel E. Weiner. Left Ventricular Assist Devices, Kidney Disease, and Dialysis. Am J Kidney Dis. 71(2) pp:257-266. 14/12/2017.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 O. Mazurenko, O. Tarabrin
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 198
Number of citations: 0
