Microcirculatory alterations and renal outcome following Heart Mate II and 3 Left Ventricular Assist Device implantations

AKI (Acute Kidney Injury) arises often after LVAD (Left Ventricular Assist Device) implantation. More severe AKI is associated with higher mortality. Sublingual microcirculation could aid to predict severe AKI following LVAD implantation. The aim of this study is to examine pre- and postoperative sublingual microcirculation to early predict severe AKI. Patients and methods We analysed all patients undergoing LVAD implantation with available sublingual microcirculation (N = 30; 27% with an HeartMate II and 73% with HeartMate 3 device) between 2015 and 2017. Bedside microscopy with Cytocam-IDF to monitor sublingual microcirculation involved before and after LVAD implantation. The definition of AKI was as proposed by Kidney Disease Improving Global Outcome (KDIGO). Results Of 30 patients, mean age 56 ± 14 years and 93% males, 23 (77%) showed mild to severe AKI. One way ANOVA paired test of microcirculatory parameters total vessel density (TVD), functional capillary density (FCD), portion of the perfused vessels (PPV), red blood cell velocity (RBCv) and tissue red blood cell perfusion (tRBCp) shown highly association with mild to severe AKI (respectively pre- and post LVAD with p = 0,0466; p = 0,0472; p = 0.027 and = 0.0051). Furthermore, early mortality following LVAD is highly associated with development of severe AKI (p = 0.002). Conclusion Sublingual microcirculation is promising predictor for mild to severe AKI following LVAD implantation. Microcirculatory monitoring may provide an easy bedside tool to predict renal outcome following LVAD implantation.