Considerations for long-term dialysis access in patients with left ventricular assist devices.

OBJECTIVE: Renal dysfunction, requiring renal replacement therapy (RRT) is commonly encountered in patients with left ventricular assist devices (LVAD). Continuous flow LVAD (CFLVAD) is the most widely used device. Non-pulsatile blood flow begets special hemodynamic changes. This poses a unique challenge in choosing a long-term dialysis access for patients with CFLVAD where life expectancy is limited.

METHODS: Sixty-one year old man with an implanted CFLVAD and renal dysfunction receiving intermittent RRT through a non-tunneled dialysis catheter had progressed to dialysis dependent renal failure. He was referred to us for a permanent hemodialysis access.

RESULTS: The patient underwent a successful right brachio-brachial arterio-venous graft (AVG) placement. The graft was successfully cannulated for hemodialysis on postoperative day 15. On regular follow-up at 18 months the graft was still functional.

CONCLUSIONS: Dialysis access for patients on LVAD is an exceptional management problem owing to both altered physiology and guarded overall prognosis. We recommend the use of AVG as a convenient and durable option- facilitating early cannulation and expediting freedom from indwelling catheters that may lead to catastrophic consequences. This should limit the need for secondary interventions, hospitalization and cost, thus improving quality of life.