Abstract
A 55-year-old man, who previously underwent surgical ventricular restoration and mitral valve surgery, was referred to our department for management of refractory heart and multiple organ failure. At the time of admission to our hospital, he could not be registered as a candidate for heart transplantation because of severe renal failure with a serum creatinine level of 4.6 mg/dl. We considered that he was a marginal candidate for heart transplantation; thus, it was essential to understand the etiology of renal failure and estimate whether it was reversible. Cardiac catheterization revealed poor hemodynamic function with a systemic pressure of 107/60 mmHg, cardiac index of 2.5 l/min/m2, and pulmonary artery pressure of 63/27 mmHg, despite intense medical treatment. Contrary to biochemical examination findings of blood, renal biopsy findings showed no significant glomerular abnormality. Furthermore, the severity of tubular atrophy and interstitial fibrosis in the cortex was mild. These pathological findings suggested that the renal dysfunction in this case was possibly attributable to a hemodynamic factor. His symptoms gradually deteriorated despite an increasing dose of inotropic support; thus, we planned implantation of a Jarvik 2000 axial-flow pump (Jarvik Heart Inc., New York, NY, USA) as a bridge to eligibility, and informed consent was obtained. Because of a tight adhesion on the anterior wall, we placed the device on the lateral wall of the left ventricle, making sure not to direct the pump at the septum. Postoperatively, the implantable left ventricular assist device provided relief from heart failure symptoms as well as recovery of renal function, with serum the creatinine level at 1.2 mg/dl, which allowed the patient to become an appropriate candidate for heart transplantation. At an 18-month follow-up examination, his status was uneventful, and he is now at home awaiting heart transplantation.
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Hillege HL, Nitsch D, Pfeffer MA, Swedberg K, McMurray JJ, Yusuf S, Granger CB, Michelson EL, Ostergren J, Cornel JH, de Zeeuw D, Pocock S, van Veldhuisen DJ, et al. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation. 2006;113:671–8.
Haj-Yahia S, Birks EJ, Rogers P, Bowles C, Hipkins M, George R, Amrani M, Petrou M, Pepper J, Dreyfus G, Khaghani A. Midterm experience with the Jarvik 2000 axial flow left ventricular assist device. J Thorac Cardiovasc Surg. 2007;134:199–203.
Frazier OH, Delgado RM. Mechanical circulatory support for advanced heart failure: where does it stand in 2003? Circulation. 2003;108:3064–8.
Deng MC, Edwards LB, Hertz MI, Rowe AW, Keck BM, Kormos R, Naftel DC, Kirklin JK. Mechanical Circulatory Support Device Database of the International Society for Heart and Lung Transplantation: second annual report 2004. J Heart Lung Transplant. 2004;23:1027–34.
Copeland JG, Smith RG, Arabia FA, Nolan PE, Sethi GK, Tsau PH, McClellan D, Slepian MJ, CardioWest Total Artificial Heart Investigators, et al. Cardiac replacement with a total artificial heart as a bridge to transplantation. N Engl J Med. 2004;351:859–67.
Frazier OH, Myers TJ, Gregoric ID, Khan T, Delgado R, Croitoru M, Miller K, Jarvik R, Westaby S. Initial clinical experience with the Jarvik 2000 implantable axial-flow left ventricular assist system. Circulation. 2002;105:2855–60.
James KB, McCarthy PM, Jaalouk S, Bravo EL, Betkowski A, Thomas JD, Nakatani S, Fouad-Tarazi FM. Plasma volume and its regulatory factors in congestive heart failure after implantation of long-term left ventricular assist devices. Circulation. 1996;93:1515–9.
Maschio G, Alberti D, Janin G, Locatelli F, Mann JF, Motolese M, Ponticelli C, Ritz E, Zucchelli P. Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N Engl J Med. 1996;334:939–45.
Sugiura T, Wada A. Resistive index predicts renal prognosis in chronic kidney disease. Nephrol Dial Transplant. 2009;24:2780–5.
Sandner SE, Zimpfer D, Zrunek P, Rajek A, Schima H, Dunkler D, Grimm M, Wolner E, Wieselthaler GM. Renal function and outcome after continuous flow left ventricular assist device implantation. Ann Thorac Surg. 2009;87:1072–8.
Butler J, Geisberg C, Howser R, Portner PM, Rogers JG, Deng MC, Pierson RN 3rd. Relationship between renal function and left ventricular assist device use. Ann Thorac Surg. 2006;81:1745–51.
Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Ford CE, Shulman NB, Stamler J. Blood pressure and end-stage renal disease in men. N Engl J Med. 1996;334:13–8.
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This study is supported by the Health and Labour Sciences Research Grants, Research on intractable diseases.
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Kainuma, S., Sakaguchi, T., Saito, S. et al. Implantation of a Jarvik 2000 left ventricular assist device as a bridge to eligibility for refractory heart failure with renal dysfunction. J Artif Organs 15, 83–86 (2012). https://doi.org/10.1007/s10047-011-0602-8
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DOI: https://doi.org/10.1007/s10047-011-0602-8