Are All Patients Equal in Response to Intra-Aortic Balloon Counterpulsation?

Abstract

Purpose: Patients supported with left ventricle assist device (LVAD) are at high risk for both bleeding and thrombotic events. In a recent study of a subset of patients enrolled in the IMAGE trial showed significantly decreased activity of 2 platelets activation genes (PF4, C6orf25) and 2 hematopoietic genes (WDR40A, MARCH8) during the first year after transplantation. This study aims to report changes in the GEP of patients supported by LVADs, before and after device implantation. Methods: In this prospective study consecutive patients undergoing LVAD implantation were considered for enrolment. Patients required device exchange, temporary mechanical circulatory support, INTERMACS1, and septic shock were excluded. Blood work including GEP (Allomap® and its genes subset), von Willebrand factor were taken one week prior to LVAD implantation and 1, 3 and 6 months after device implantation. Results: 21 patients, with mean age 54.2±13.7, 72.7% were male were enrolled into the study. There wasn't significant difference in the total GEP score before and after 1 month post implantation (31.7±6.42 vs 32.8±4.63, p= 0.63). Similarly, no significant differences were detected in the platelets regulating genes PF4 (24.9±0.75 vs 25.2±0.87, p= 0.40) and C6orf25 (26.2±1.43 vs 25.9±1.24, p= 0.84). There was no change in the hematopoietic genes WDR40 (27.6±1.27 vs 27.4±1.47, p= 0.75) and MARCH8 levels (28.6±1.08 vs 28.5±1.24, p= 0.88) at 1 month. 90% of the patients developed acquired vonWillebrand disease type 2A 1 month following device implantation.Purpose: Beginning January 2009 to present, all NYHA class IV, and all INTERMACS II patients referred for surgical therapy, had heart transplantation only in presence of LVAD contra indications (severe pulmonary hypertension, apical thrombus, aortic valve incompetence, non compliance) Therefore, all LVAD implanted were classified as destination therapy. Results are here reviewed. Methods: January 2009 to October 2015 90 NYHA class IV pts. (60% males vs 40% females, affected either by DCMP, 45%, or by IHD ,50%, or other, 5%, aged 25 to 73 years, mean 49 y.), had either heart transplant (G 1, 55 pts.) or Heart Mate II type LVAD implanted, (35 pts. ,G2 pts.) Entire population was followed up from 1 to 60 mos. Results: 1 mo. survival was 93% in G1 vs. 96 % in G2, while 60 mos. survival was in G1.69% vs 82% in G2, p.v.:n.s. One mo freedom from RVF was 69% in G1 vs. 79 % in G2, p.v.: n.s. 60 mos freedom from hospital readmission (25% in G1vs. 32% in G2), from infections (G1: 40%, vs. G2 34%), and from renal failure (G1: 52%, vs. G2 82%,) were not significant. Otherwise, freedom from neoplasia (G1: 76%, vs. G2 100 %, from bleeding G1: 89%, vs. G2 25%, 12 mos. and survival on the waiting list gone from 35% in 2009 to 49% i 2015 had .p.v.: < 0.005. Conclusion: Although our experience is still limited, better controlled mortality on the waiting list and acceptable results in terms of survival, and of freedom from main complications seems to indicate that use of LVAD as destination therapy shoul...