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ASAIO CARDIAC ABSTRACT

PREOPERATIVE HEPATIC INSUFFICIENCY CORRELATES WITH LONGER INTENSIVE CARE UNIT (ICU) STAYS AND LOWER BRIDGE TO TRANSPLANT RATES FOLLOWING LEFT VENTRICULAR ASSIST DEVICE (LVAD) INSERTION

Dang, N C1; Topkara, V K1; Kim, B T1; OZ, M C1; Naka, Y1

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PURPOSE: The presence of multi-organ dysfunction adversely affects the prognosis of patients with congestive heart failure and may signal the need for placement of an LVAD. This study seeks to determine the extent to which preoperative renal and hepatic insufficiency affects outcomes following LVAD. METHODS: 173 patients underwent Heartmate LVAD insertion over 7 years. Preoperative blood urea nitrogen (BUN) and creatinine (Cr) represented renal function, and total protein (TP), albumin, total bilirubin (TB), direct bilirubin (DB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) represented liver function. Values were categorized into “low” or “high” relative to the normal range of our hospital's patient population. RESULTS: TP ≥6.7 and Albumin ≥4.1 correlated with lower bridge rates (65.71YO vs. 88.00%, p=0.005; 70.40% vs. 89.28%, p=0.040). Patients with AST >38 had longer ICU stays and lower bridge rates (19.73+/−23.93 vs. 13.28+/−12.13 days, p = 0.043; 63.09% vs. 88.57%, piO.001). Those with ALT >41 had longer ICU stays (19.1 +/−20.12 vs. 13.23 +/−1 3.47 days, p = 0.032). BUN, Cr, TB, DB, and ALP had no effect on outcomes. None of the parameters affected the development of renal failure or infection, or post-transplant survival. CONCLUSIONS Hepatic insufficiency correlates with longer ICU stay and lower bridge rate following LVAD insertion. Assessment of liver function and nutritional status might be implemented when evaluating patients for LVAD implantation.

Copyright © 2004 by the American Society for Artificial Internal Organs