Related Experiment Video
Updated: Dec 20, 2025
Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
Predictors of Renal Failure in Patients Treated With the Total Artificial Heart
Kevin V Desai1, Daniel G Tang2, Mohammed Quader1
1The Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
Insights
High rates of hemodialysis after total artificial heart implantation are linked to increased mortality. Predictors include lower kidney function, coronary artery disease, and need for preoperative oxygenation support.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Critical Care Medicine
Background:
- High incidence of hemodialysis-dependent renal failure post-total artificial heart (TAH) implantation.
- Need to identify preoperative factors predicting hemodialysis requirement after TAH.
Purpose of the Study:
- To determine preoperative predictors of hemodialysis after TAH implantation.
- To assess the association between hemodialysis and mortality risk post-TAH.
Main Methods:
- Retrospective study of 87 patients undergoing TAH implantation (April 2006 - March 2017).
- Logistic regression analysis to identify predictors of postimplantation hemodialysis.
- Follow-up until death or heart transplantation.
Main Results:
- 28% of patients required postimplantation hemodialysis.
- Predictors for hemodialysis included coronary artery disease history (58% vs 29%), preoperative membrane oxygenation (33% vs 4.8%), and lower estimated glomerular filtration rates (eGFR).
- Patients requiring hemodialysis had a significantly higher risk of 1-year mortality (33% vs 5%).
Conclusions:
- Postimplantation hemodialysis is common after TAH and associated with increased mortality.
- Lower baseline eGFR, coronary artery disease, and preoperative membrane oxygenation are key predictors of hemodialysis need.
- Identifying at-risk patients can guide management and improve outcomes after TAH implantation.
Background:
The incidence of hemodialysis (HD)-dependent renal failure after total artificial heart (TAH) implantation is high. We sought to determine the preoperative predictors of HD after TAH implantation.
Methods And Results:
We studied 87 patients after TAH implantation at our institution between April 2006 and March 2017. Baseline clinical data were obtained from the medical records, and patients were followed until death or heart transplantation. We performed logistic regression analysis to identify predictors of HD after TAH implantation. Of the patients, 24 (28%) required postimplantation HD. Those requiring HD were more likely to have histories of coronary artery disease (58% vs 29%; P = 0.01), required preoperative membrane oxygenation (33% vs 4.8%; P = 0.001) and had lower baseline estimated glomerular filtration rates (54 ± 29 vs 67 ± 24 mL/min/1.73m2; P = 0.04). Patients requiring HD were at a higher risk of death on device at 1 year (33% vs 5%, P = 0.001; log rank test: P =0.001, hazard ratio 6.6 [95% CI:1.8-23], P = 0.003).
Conclusions:
The incidence of postimplantation HD is high and is associated with increased likelihood of mortality. Lower baseline estimated glomerular filtration rates, histories of coronary artery disease and preoperative membrane oxygenation support are predictors of postimplantation requirement of HD. These data may help to identify patients at risk for adverse outcomes after TAH implantation.
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:22Heart Failure Drugs: Diuretics
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:22Heart Failure VI: Adjunct Therapies
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:27Heart Failure I: Introduction