Left ventricular assist device implantation in advanced kidney disease

Advanced chronic kidney disease (CKD) is often considered a contraindication to left ventricular assist device (LVAD) implantation, yet limited data exist on outcomes in the era of the HeartMate 3 device.

We retrospectively reviewed 193 patients who underwent HeartMate 3 LVAD implantation at a tertiary care academic medical center between July 2016 and July 2023. Patients were stratified by preoperative estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m² (control, n = 154) vs <30 (advanced kidney disease, n = 39). Outcomes included survival and the need for renal replacement therapy (RRT).

At 30 days post-implantation, survival was lower in advanced kidney disease patients compared with controls (84.6% vs 94.2%, p = 0.04). However, survival at 1 year (79.5% vs 79.9%, p = 0.87) and 2 years (73.9% vs 68.7%, p = 0.60) did not differ significantly. Post-implantation RRT was required in 30.3% of advanced kidney disease patients and 18.2% of controls (p = 0.18).

Although early postoperative mortality is higher, patients with advanced CKD undergoing HeartMate 3 LVAD implantation achieve comparable 1- and 2-year survival to controls. These findings suggest LVAD implantation may be a reasonable option in carefully selected patients with advanced kidney disease.