Author + information
- Tal Hasin, MD and
- Sudhir Kushwaha, MD⁎ ()
- ↵⁎Mayo Clinic, Cardiovascular Diseases, 200 First Street, SW, Rochester, Minnesota 55905
We thank Drs. Rajagopalan and Hoopes for their letter discussing our recent publication (1), and agree with their main observations. They chose to highlight the adverse outcomes of patients succumbing to renal failure after left ventricular assist device (LVAD) implantation and the current limitations of administering long-term renal support for patients assisted with such a device. In our experience, a minority of patients experience an unfavorable post-operative course, including end organ dysfunction. This can be reversible at times; however, renal damage may persist despite general clinical improvement. Unfortunately, it remains difficult to predict which patients will have this complicated post-operative course. Currently used predictors include careful assessment of right ventricular function as well as various risk scores, some of which are outdated or not validated for the current population (2). In our current publication, we advocate that temporary end organ improvement under monitored treatment may be a novel way for predicting post-operative outcomes.
Accurate prediction of outcomes in all patients is not feasible; therefore, we agree with the authors on the need to be prepared for the option of renal replacement, if needed. We have also encountered difficulties with reluctance of some dialysis centers to treat patients on LVAD support. Continued education and understanding is needed to improve the treatment of this rapidly growing patient population.
- American College of Cardiology Foundation