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Left ventricular assist device implantation in advanced kidney disease

Benjamin N French1, Anudeep S Nakirikanti1, Ian Kusher1

  • 1Emory University School of Medicine, Atlanta, GA.

JHLT Open
|December 1, 2025
PubMed

Insights

Patients with advanced chronic kidney disease (CKD) show lower early survival after HeartMate 3 left ventricular assist device (LVAD) implantation. However, long-term survival at one and two years is comparable to patients without advanced CKD.

Area of Science:

  • Cardiology
  • Nephrology
  • Medical Devices

Background:

  • Advanced chronic kidney disease (CKD) is typically a contraindication for left ventricular assist device (LVAD) implantation.
  • Limited data exist on HeartMate 3 LVAD outcomes in patients with advanced CKD.

Purpose of the Study:

  • To evaluate the outcomes of HeartMate 3 LVAD implantation in patients with advanced CKD.
  • To compare survival and renal replacement therapy (RRT) rates between patients with and without advanced CKD.

Main Methods:

  • Retrospective review of 193 patients who underwent HeartMate 3 LVAD implantation.
  • Stratification of patients based on preoperative estimated glomerular filtration rate (eGFR): ≥30 mL/min/1.73 m² (control) vs. <30 (advanced kidney disease).
  • Analysis of survival and need for RRT post-implantation.

Main Results:

  • Early survival at 30 days was lower in advanced kidney disease patients (84.6%) compared to controls (94.2%, p=0.04).
  • 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 significantly differ.
  • Post-implantation RRT was required in 30.3% of advanced kidney disease patients versus 18.2% of controls (p=0.18).

Conclusions:

  • Despite higher early mortality, advanced CKD patients achieve comparable 1- and 2-year survival after HeartMate 3 LVAD implantation.
  • LVAD implantation may be a viable option for carefully selected advanced CKD patients.
  • Further research is needed to optimize selection criteria and management strategies.
Abstract

Keywords:
Advanced heart failureChronic kidney disease (CKD)HeartMate 3Left ventricular assist device (LVAD)Renal replacement therapy (RRT)Survival outcomes

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