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Comparative effects of ventricular assist device and extracorporeal membrane oxygenation on renal function in
Parthak Prodhan1, Adnan T Bhutta1, Jeffrey M Gossett2
1Division of Pediatric Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Division of Pediatric Critical Care, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Insights
Mechanical cardiac support, including ventricular assist devices (VAD) and extracorporeal membrane oxygenation (ECMO), improves renal function in children with heart failure. Early improvement in estimated glomerular filtration rate (eGFR) was observed across support types.
Area of Science:
- Pediatric Cardiology
- Renal Medicine
- Mechanical Circulatory Support
Background:
- Renal function effects of mechanical cardiac support in pediatric end-stage heart failure are not well understood.
- Investigating the impact of ventricular assist device (VAD) and extracorporeal membrane oxygenation (ECMO) on renal function in children is crucial.
Purpose of the Study:
- To evaluate the impact of VAD and ECMO on renal function in pediatric patients with end-stage heart failure.
- To compare renal function changes among patients receiving VAD, prolonged ECMO, or ECMO followed by VAD.
Main Methods:
- Retrospective observational study at a single center.
- Inclusion of pediatric patients with end-stage heart failure on mechanical cardiac support.
- Categorization into VAD, ECMO (>14 days), and ECMO+VAD groups for comparative analysis of renal function.
Main Results:
- Patients in the ECMO group were younger and smaller than VAD and ECMO+VAD groups.
- VAD and ECMO+VAD groups showed improved eGFR until day 7, followed by a decline.
- ECMO group demonstrated sustained eGFR improvement until day 28, with a subsequent decline; initial eGFR improvement was higher in VAD/ECMO+VAD groups within 7 days.
Conclusions:
- Mechanical cardiac support demonstrates early improvement in renal dysfunction in pediatric heart failure patients.
- The type and duration of mechanical support influence the pattern of renal function recovery.
Background:
Effects of mechanical cardiac support on renal function in children with end-stage heart failure are unknown. The objective of this study was to investigate the impact of ventricular assist device (VAD) and extracorporeal membrane oxygenation (ECMO) on renal function in children.
Methods:
We performed a single center retrospective observational study in children with end-stage heart failure supported on pediatric mechanical cardiac support. The patient population was divided into three groups: the VAD group included patients receiving ventricular assist device support; the ECMO group included patients receiving extracorporeal membrane oxygenation membrane support for more than 14 days; and the ECMO+VAD group included patients receiving ECMO followed by VAD support. Comparison of baseline characteristics, duration of mechanical cardiac support, and renal function was made between the three groups.
Results:
During the study period, there were 23 patients in the VAD group, 16 patients in the ECMO+VAD group, and 37 patients in the ECMO group. The patients in the ECMO group were significantly younger and smaller than the patients in the VAD and ECMO+VAD groups. There was a steady improvement in eGFR in the VAD group and the ECMO+VAD group until day 7 after which there was a decline in renal function. In the ECMO group, the improvement in eGFR continued until day 28 after which there was a steady decline in eGFR. Improvement in eGFR in the VAD group and the ECMO+VAD group was much higher than in the ECMO group in the first 7 days.
Conclusions:
On the basis of these data, we demonstrate that renal dysfunction improves early after mechanical cardiac support.
