RENAL FAILURE IN PATIENTS WITH IMPLANTED LVAD IN EARLY POSTOPERATIVE PERIOD AND AFTER
DOI:
https://doi.org/10.32782/2411-9164.22.1-5Keywords:
left ventricle assist device (LVAD), anticoagulant targeted therapy (ATT), renal failure, acute kidney injury (AKI), chronic kidney diseases (CKD)Abstract
Introduction. Diseases of the cardiovascular system occupy a leading place in the statistics of morbidity and mortality of the population not only in Ukraine, but throughout the world as a result of heart failure. Cardiovascular insufficiency of varying degrees, in turn, as well as cardio-renal syndrome cause renal failure, which is one of the main complications in the group of cardiac surgery patients in the world. LVAD, as a result of the development of radical treatment of heart failure, is sometimes the only treatment option for this category of patients in the form of city therapy or targeted therapy. But in patients with implanted LVAD in the short and long postoperative period, the situation with such a complication as renal failure, which is associated with destabilization of hemodynamics, fluctuations in the parameters of the hemostasis system, etc.The purpose of this scientific work is to analyze the state of the excretory renal system in 50 patients with implanted LVAD with various targeted anticoagulant maintenance therapy and its correction with complications in the early postoperative period treated at the Silesian Heart Disease Center, Poland. There were two groups of patients to investigate the state of the coagulation system and its response on correction, the control group receiving classical anticoagulation targeted therapy (ATT), which included the most controlled heparin monotherapy, after reaching the target APTT values, addition and switch to warfarin monotherapy before reaching the INR and ASA goal, and the main, research group that received an alternative ATT, consisting of the previous one with the addition of P2Y12-receptor blockers and Xa-factors. The results of the article are analytics of correlation between renal complications in the perioperative period in both groups of patients and the final results of persistent renal failure in these patients and their impact on further treatment and prognosis of their state of health.The results showed that the control group of patients with classical anticoagulant targeted therapy had a greater mortality associated with renal failure than the patients of the study group, and it was also demonstrated that initially greater duration of surgery and intraoperative polyuria gave a greater percentage of the first new acute kidney complications in the postoperative period and more results of permanent kidney diseases after the study period.
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