The influence of preoperative dialysis on survival after continuous-flow left ventricular assist device implantation

Interact Cardiovasc Thorac Surg. 2022 Feb 21;34(3):470-477. doi: 10.1093/icvts/ivab357.


Objectives: Dialysis is considered a contraindication to continuous-flow left ventricular assist device (CF-LVAD) implantation. We evaluated clinical outcomes and survival in carefully selected, low-risk patients with renal failure who required dialysis before CF-LVAD implantation.

Methods: We extracted medical record data of patients who underwent CF-LVAD placement at our centre between 1 January 2006 and 31 August 2017, with 2 clinical scenarios: those who required long-term (>14 days) dialysis and those who required short-term (≤14 days) dialysis immediately before implantation. Demographic, clinical and intraoperative characteristics and survival outcomes were assessed.

Results: Of 621 patients who underwent CF-LVAD implantation during the study period, 31 underwent dialysis beforehand. Of these, 17 required long-term dialysis (13 haemodialysis, 4 peritoneal dialysis), and 14 underwent short-term haemodialysis. Compared with the long-term dialysis patients, the short-term dialysis patients were more likely to be Interagency Registry for Mechanically Assisted Circulatory Support profile 1-2 (92.9% vs 70.6%; P < 0.001), to have needed preoperative mechanical circulatory support (78.6% vs 70.6%; P < 0.01) and to have higher in-hospital mortality (85.7% vs 29.4%; P = 0.01). Patients stable on long-term dialysis had acceptable overall survival and markedly better 6-month and 1-year survival than those with short-term dialysis before implantation (64.7% vs 14.3% and 58.8% vs 7.1%, respectively; P < 0.001).

Conclusions: Carefully selected patients who are stable on long-term dialysis have acceptable survival rates after CF-LVAD implantation. Patients with acute renal failure had much poorer outcomes than those with chronic end-stage renal disease.

Keywords: End-stage renal disease; Haemodialysis; Heart failure; Left ventricular assist device.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Heart Failure* / diagnosis
  • Heart Failure* / therapy
  • Heart-Assist Devices* / adverse effects
  • Humans
  • Renal Dialysis / adverse effects
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome