Universität zu Köln

Weymann, Alexander, Patil, Nikhil P., Sabashnikov, Anton ORCID: 0000-0002-6289-1035, Mohite, Phrashant N., Saez, Diana Garcia, Bireta, Christian, Wahlers, Thorsten, Karck, Matthias, Kallenbach, Klaus, Ruhparwar, Arjang, Fatullayev, Javid, Amrani, Mohamed, De Robertis, Fabio, Bahrami, Toufan, Popov, Aron-Frederik ORCID: 0000-0003-4226-3004 and Simon, Andre R. (2015). Continuous-Flow Left Ventricular Assist Device Therapy in Patients With Preoperative Hepatic Failure: Are We Pushing the Limits Too Far? Artif. Organs, 39 (4). S. 336 - 343. HOBOKEN: WILEY. ISSN 1525-1594

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Abstract

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 July 2007 and May 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 mu mol/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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Weymann, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Patil, Nikhil P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sabashnikov, Anton UNSPECIFIED orcid.org/0000-0002-6289-1035 UNSPECIFIED Mohite, Phrashant N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Saez, Diana Garcia UNSPECIFIED UNSPECIFIED UNSPECIFIED Bireta, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Karck, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Kallenbach, Klaus UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruhparwar, Arjang UNSPECIFIED UNSPECIFIED UNSPECIFIED Fatullayev, Javid UNSPECIFIED UNSPECIFIED UNSPECIFIED Amrani, Mohamed UNSPECIFIED UNSPECIFIED UNSPECIFIED De Robertis, Fabio UNSPECIFIED UNSPECIFIED UNSPECIFIED Bahrami, Toufan UNSPECIFIED UNSPECIFIED UNSPECIFIED Popov, Aron-Frederik UNSPECIFIED orcid.org/0000-0003-4226-3004 UNSPECIFIED Simon, Andre R. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-403962
DOI:	10.1111/aor.12375
Journal or Publication Title:	Artif. Organs
Volume:	39
Number:	4
Page Range:	S. 336 - 343
Date:	2015
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1525-1594
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LIVER-DISEASE SCORE; HEART-FAILURE; ADVERSE EVENTS; MELD-XI; MODEL; IMPLANTATION; PREDICTOR; MORTALITY; SURVIVAL; OUTCOMES Multiple languages Engineering, Biomedical; Transplantation Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/40396