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:
CreatorsEmailORCIDORCID Put Code
Weymann, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Patil, Nikhil P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sabashnikov, AntonUNSPECIFIEDorcid.org/0000-0002-6289-1035UNSPECIFIED
Mohite, Phrashant N.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Saez, Diana GarciaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bireta, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wahlers, ThorstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Karck, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kallenbach, KlausUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ruhparwar, ArjangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fatullayev, JavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Amrani, MohamedUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
De Robertis, FabioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bahrami, ToufanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Popov, Aron-FrederikUNSPECIFIEDorcid.org/0000-0003-4226-3004UNSPECIFIED
Simon, Andre R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-408858
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:
KeywordsLanguage
LIVER-DISEASE SCORE; HEART-FAILURE; ADVERSE EVENTS; MELD-XI; MODEL; IMPLANTATION; PREDICTOR; MORTALITY; SURVIVAL; OUTCOMESMultiple languages
Engineering, Biomedical; TransplantationMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/40885

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