- 作者：Umesh N. Khot ; Micky Mishra ; M. Hilal Yamani ; Nicholas G. Smedira ; Emil Paganini ; Mike Yeager ; Tiffany Buda ; Patrick M. McCarthy ; James B. Young ; R ; all C. Starling
- 关键词：AHA/ACC ; Conference Proceedings ; myocardial infarction ; acute ; diagnosis ; treatment
- 刊名：Journal of the American College of Cardiology
- 出版年：2003
- 出版时间：5 February 2003
- 年：2003
- 卷：41
- 期：3
- 页码：381-385
- 全文大小：157 K
Background
Previous reports have documented poor survival in patients with cardiogenic shock and severe renal dysfunction treated with VAD.name=""toc3"">
Methods
We surveyed 215 consecutive patients who received a VAD from 1992 to 2000 and selected patients who had a serum creatinine ≥3.0 mg/dl at the time of VAD placement. Demographic, laboratory, and clinical outcome data were collected.name=""toc4"">
Results
Eighteen patients met the inclusion criteria. Mean serum creatinine at the time of VAD placement was 4.0 ± 0.7 mg/dl (range 3.0 to 5.2 mg/dl). Seven patients required temporary renal support with continuous venovenous hemodialysis (CVVHD). Eleven patients underwent cardiac transplantation. At six months post-transplantation, mean serum creatinine was 2.0 ± 0.6 mg/dl (range 1.3 to 3.5 mg/dl). None of the transplanted patients required subsequent renal support. Seven patients died with a VAD before transplantation. Three died early (<1 month) after VAD placement, and all three required CVVHD until death. Four patients survived for >1 month after VAD placement; all four had resolution of renal dysfunction with mean serum creatinine of 1.9 ± 1.2 mg/dl (range 0.8 to 3.6 mg/dl) without the need for renal support. Overall 30-day and six-month survival after VAD placement, survival to transplantation, and survival one year post-transplantation were similar to patients without severe renal dysfunction.name=""toc5"">
Conclusions
Contemporary use of VAD leads to resolution of severe renal dysfunction in most cardiogenic shock patients and comparable long-term outcomes to patients without renal dysfunction.