Kidney Week

Abstract: FR-PO657

Full Vessel and Empty Chambers: Volume Management in a Patient with Total Artificial Heart

Session Information

• Trainee Case Reports - IV
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Andrievskaya, Maria, Henry Ford Hospital, Detroit, Michigan, United States

Maria Andrievskaya,

• Frinak, Stanley, Henry Ford Hospital, Detroit, Michigan, United States

Stanley Frinak,

• Yee, Jerry, Henry Ford Hospital, Detroit, Michigan, United States

Jerry Yee,

• Uduman, Junior, Henry Ford Hospital, Detroit, Michigan, United States

Junior Uduman,

Introduction

Total Artificial Heart (TAH) is a pulsatile device that is FDA approved as a bridge to transplant among individuals with biventricular failure. Renal failure requiring renal replacement therapy (RRT) is seen in 15 to 20% of these patients. Given the mechanical constraints of these devices, volume management in dialysis dependent patients is challenging as they are prone to deleterious effects of volume overload and contraction. We describe the use of blood volume monitor as a tool to guide ultrafiltration management in a patient with TAH.

Case Description

A 50 year-old male with non-ischemic cardiomyopathy was admitted with decompensated biventricular failure and acute kidney injury (AKI) requiring RRT. He was evaluated for advanced heart failure therapies. His hospital course was prolonged with multiple cardiac and medical complications warranting percutaneous cardiac support devices. He was eventually listed for heart-kidney transplantation and underwent TAH implantation as a bridge to transplant. The ventricular chambers of the TAH have limited pre-load capability, thus 6 to 7 days a week of dialysis therapy has been a requirement to avoid volume overload. Similarly, excess ultrafiltration can also lead to unstable hemodynamics. Four months post-operatively the patient remained on a step-down inpatient unit, without invasive hemodynamic monitoring capabilities, while awaiting organ transplantation. It was difficult to maintain an adequate fluid balance without additional hemodynamic monitoring. In addition to fill volumes reported on the patient’s TAH monitor, (Companion 2 Driver- SynCardia) blood volume monitoring with the Crit-line III^TM was utilized for real time fluid management. Each dialysis treatment was 3-3.5 hours duration with ultrafiltration of 2-3 liters per session. The average blood volume change was between -7 to 8%, allowing safe ultrafiltration without untoward hemodynamic instability.

Discussion

A clinical trial for TAH as destination therapy is currently underway and more widespread adoption of TAH is likely. Understanding the mechanics and hemodynamic effects of TAH is important for nephrologists caring for dialysis dependent patients. This index case describes the feasibility and utility of employing a blood volume monitor to assist in safe volume management.