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Continuous‐Flow Left Ventricular Assist Device Therapy in Patients With Preoperative Hepatic Failure: Are We Pushing the Limits Too Far?
Author(s) -
Weymann Alexander,
Patil Nikhil P.,
Sabashnikov Anton,
Mohite Phrashant N.,
Garcia Saez Diana,
Bireta Christian,
Wahlers Thorsten,
Karck Matthias,
Kallenbach Klaus,
Ruhparwar Arjang,
Fatullayev Javid,
Amrani Mohamed,
De Robertis Fabio,
Bahrami Toufan,
Popov AronFrederik,
Simon Andre R.
Publication year - 2015
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12375
Subject(s) - medicine , ventricular assist device , ejection fraction , creatinine , heart failure , bilirubin , cardiology , liver transplantation , surgery , retrospective cohort study , blood urea nitrogen , renal function , transplantation
The purpose of this study was to evaluate the effects and outcome of continuous‐flow left ventricular assist device (cf‐ LVAD ) therapy in patients with preoperative acute hepatic failure. The study design was a retrospective review of prospectively collected data. Included were 42 patients who underwent cf‐ LVAD implantation (64.3% HeartMate II , 35.7% HeartWare ) between J uly 2007 and M ay 2013 with preoperative hepatic failure defined as elevation of greater than or equal to two liver function parameters above twice the upper normal range. Mean patient age was 35 ± 12.5 years, comprising 23.8% females. Dilated cardiomyopathy was present in 92.9% of patients (left ventricular ejection fraction 17.3 ± 5.9%). Mean support duration was 511 ± 512 days (range: 2–1996 days). Mean preoperative laboratory parameters for blood urea nitrogen, serum creatinine, total bilirubin, and alanine aminotransferase were 9.5 ± 5.4 mg/dL, 110.3 ± 42.8 μmol/ L , 51.7 ± 38.3 mmol/ L , and 242.1 ± 268.6 U / L , respectively. All parameters decreased significantly 1 month postoperatively. The mean preoperative modified Model for Endstage Liver Disease excluding international normalized ratio score was 16.03 ± 5.57, which improved significantly after cf‐ LVAD implantation to 10.62 ± 5.66 ( P < 0.001) at 7 days and 5.83 ± 4.98 ( P < 0.001) at 30 days postoperatively. One‐year and 5‐year survival was 75.9 and 48.1%, respectively. 21.4% of the patients underwent LVAD explantation for myocardial recovery, 16.7% were successfully transplanted, and 7.1% underwent LVAD exchange for device failure over the follow‐up period. Patients with preexisting acute hepatic failure are reasonable candidates for cf‐ LVAD implantation, with excellent rates of recovery and survival, suggesting that cf‐ LVAD therapy should not be denied to patients merely on grounds of “preoperative elevated liver enzymes/hepatopathy.”