HeartMate II left ventricular assist device implantation in patients with advanced hepatic dysfunction.

Autor: Demirozu ZT; Department of Cardiopulmonary Transplantation, Texas Heart Institute, Houston, Texas; Center for Cardiac Support, Texas Heart Institute, Houston, Texas., Hernandez R, Mallidi HR, Singh SK, Radovancevic R, Segura AM, Etheridge WB, Cohn WE, Frazier OH
Jazyk: angličtina
Zdroj: Journal of cardiac surgery [J Card Surg] 2014 May; Vol. 29 (3), pp. 419-23. Date of Electronic Publication: 2014 Mar 19.
DOI: 10.1111/jocs.12318
Abstrakt: Background: We sought to determine the outcomes for patients with advanced hepatic dysfunction undergoing HeartMate II left ventricular assist device (LVAD) implantation.
Methods: Between November 1, 2003 and December 1, 2012, we implanted the HeartMate II continuous-flow LVAD in 338 patients, either for bridging to heart transplantation or for destination therapy. Twenty-three of these patients (19 men and 4 women; mean age, 47 ± 16 years) had advanced hepatic dysfunction, as characterized by alanine aminotransferase (ALT) or aspartate transaminase (AST) levels five times normal; serum total bilirubin levels three times normal; and/or necessity for a liver biopsy before or during device implantation. Of this group, 17 patients received the LVAD as a bridge to transplantation, and six patients received it for destination therapy.
Results: Nine of the 23 patients required either a transjugular or a core liver biopsy during LVAD implantation. Three patients died within the first postoperative month; the 20 surviving patients had significant improvements in their hepatic parameters. The ALT decreased from 238 ± 296 to 27 ± 13 U/L (p = 0.022), AST decreased from 209 ± 199 to 29 ± 8 U/L (p = 0.009), and total bilirubin level decreased from 6.9 ± 6.0 to 0.6 ± 0.1 mg/dL (p = 0.044). The serum albumin level increased from 3.2 ± 0.6 to 4.3 ± 0.3 g/dL (p = 0.003), and creatinine clearance increased from 77.6 ± 35.2 to 110.2 ± 35.7 mL/min/1.73 m2 (p = 0.101).
Conclusion: Continuous-flow LVAD support may significantly improve hepatic function, allowing patients with poor preimplant liver function to become better candidates for heart transplantation.
(© 2014 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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