Simplified method of hemofiltration in ventricular assist device patients

Hypervolemia frequently complicates the management of ventricular assist device (VAD) patients as a result of increased intravenous fluid administration and concomitant renal dysfunction. Although acute hemodialysis (AHD) can be used to treat such patients, it requires additional equipment, vascular access cannulations, and personnel. Moreover, hypotension during AHD may occur as a result of rapid shifts in intravascular volume. From January 1987 to March 1988, we treated nine selected VAD patients who had hypervolemia and acute renal failure with a simplified hemofiltration technique. A continuous arteriovenous hemofiltration (CAVH) cartridge was connected from the outflow circuit of a centrifugal blood pump to a large-bore central venous catheter. With CAVH, gradual removal of 272 cc/hour of ultrafiltrate was accomplished for periods up to 241 hours. No episodes of hypotension, thromboembolism, or other deleterious effects occurred. In our series, the CAVH technique was effective in treating hypervolemia in selected VAD patients.