Changes in End-Organ Function in Patients With Prolonged Continuous-Flow Left Ventricular Assist Device Support

Few studies have evaluated the long-term effects of continuous blood flow with reduced pulsatility on end-organ function.

Between May 2004 and December 2015, 469 patients underwent continuous-flow left ventricular assist device (LVAD) implantation at our center. Our study included 59 (13%) patients who were supported with an LVAD for a minimum of 3 years. We evaluated postoperative renal function and hepatic function at 1 and 6 months, and 1, 2, and 3 years after implantation in those 59 patients.

The patients' mean age was 63 ± 13 years, 81% were male, 53% had an ischemic cause of heart failure, and 68% underwent LVAD implantation as destination therapy. All laboratory determinations showed significant improvements at 1 month after the procedure. Hepatic values remained in a normal range for up to 3 years, although renal function improvement was predominantly transient. One month after implantation, the mean estimated glomerular filtration rate (eGFR) was improved from 58.2 ± 27.9 to 77.7 ± 33.5 mL/min/1.73 m². However, 46 (78%) patients showed a gradual decline in eGFR to only 1.7% above the preoperative value after 3 years (p = 0.67 vs baseline). The risk factors for impaired renal function after long-term support were age 60 years or older, ischemic cause, and late right heart failure.

Continuous-flow LVAD improves renal and hepatic functions in patients with advanced heart failure. However, in most, the initial improvement in renal function is largely transient and returns to baseline after a prolonged support period.