Outcomes of MagLev LVAD Support in Patients Requiring Preoperative Continuous Renal Replacement Therapy

Background/Objectives: Acute Kidney Injury (AKI) requiring continuous renal replacement therapy (CRRT) has historically been a contraindication for left ventricular assist device (LVAD) implantation. However, advancements in magnetically levitated (MagLev) LVADs warrant reevaluation. Methods: A retrospective review of adult LVAD recipients at a tertiary center (2009-2024) was performed. Patients were stratified by preoperative CRRT status and LVAD type. Baseline characteristics and perioperative morbidity, Kaplan-Meier survival estimates, restrictive mean survival time (RMST), and Cox proportional hazards models were assessed. Results: Among 312 MagLev LVAD recipients, 22 (7.1%) required preoperative CRRT. Compared to non-CRRT patients, the CRRT group had higher illness severity (INTERMACS 1 or 2: 95% vs. 71%, p = 0.019). Despite this, preoperative CRRT was not associated with worse mortality within the MagLev cohort at 30 days (9.1% vs. 7.9%), 1 year (18.2% vs. 17.9%), or 2 years (31.8% vs. 20.7%; p = 0.31). RMST at 1 year was also similar (305 vs. 311 days; p = 0.85). In contrast, patients on CRRT receiving non-MagLev devices had significantly worse outcomes, with 30-day, 1-year, and 2-year mortality rates of 57.1%, 71.4%, and 78.6%, respectively. RMST analysis showed a 170-day survival advantage at 1 year for MagLev vs. non-MagLev CRRT patients (p < 0.01). Conclusions: In this single-center cohort, preoperative CRRT was not associated with higher mortality among MagLev LVAD recipients and may challenge traditional contraindications against LVAD therapy. Further investigations using larger cohorts are necessary to further evaluate these findings and delineate patient subgroups that may derive the greatest clinical benefit.