Effect of Preoperative Albumin Levels on Outcomes in Patients Undergoing Left Ventricular Device Implantation.
A single institution retrospectively reviewed the correlation of preoperative serum albumin level with outcomes after LVAD implantation from 2006 to 2014. A lower albumin level was associated with a significant increase in postop renal failure and prolonged hospitalization, but not overall short-term and long-term survival.
We have always known that prolonged CPB causes protein breakdown usually by laying down of a protein layer on filters, oxygenator membranes and even tubing. We have always given 25% albumin to older patients and patients who had been on bypass for a length of time. Extrapolating that to VAD’s is just common sense. Back in 1978 when Denton Cooley implanted a VAD into a patient who had emergent MVR-AVR and later on, a renal transplant/cardiac transplant, the surgical team had difficulties maintaining normal albumin levels and it seemed that a constant IV dose of either 25% albumin or normal albumin was given knowing that Na++ could cause problems with the patients impaired renal function. Needless to say, even in 1978, albumin was considered to be a planned therapy for those undergoing long term ECMO/VAD and it still is today.