End-organ function during chronic nonpulsatile circulation

Saito, Satoshi; Westaby, Stephen; Piggot, D; Dudnikov, S.; Robson, D.; Catarino, Pedro; Clelland, Colin; Nojiri, Chisato

doi:10.1016/s0003-4975(02)03846-8

Cited by 106 publications

(54 citation statements)

References 9 publications

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“…Similar to the study by Kihara et al, 14 there were no differences in BUN, creatinine, total bilirubin, or liver transaminases between the 2 groups. 15 Finally, in a similar study with a different device, Saito et al 16 found no change in liver and renal function in 6 sheep.…”

Section: Discussionmentioning

confidence: 89%

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Renal and Hepatic Function Improve in Advanced Heart Failure Patients During Continuous-Flow Support With the HeartMate II Left Ventricular Assist Device

et al. 2009

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Background-The effects of continuous blood flow and reduced pulsatility on major organ function have not been studied in detail. Methods and Results-We evaluated renal (creatinine and blood urea nitrogen) and hepatic (aspartate transaminase, alanine transaminase, and total bilirubin) function in 309 (235 male, 74 female) advanced heart failure patients who had been supported with the HeartMate II continuous-flow left ventricular assist device for bridge to transplantation. To determine whether patients with impaired renal and hepatic function improve over time with continuous-flow left ventricular assist device support or whether there are any detrimental effects in patients with normal organ function, we divided patients into those with above-normal and normal laboratory values before implantation and measured blood chemistry over time during left ventricular assist device support. There were significant improvements over 6 months in all parameters in the above-normal groups, with values in the normal groups remaining in the normal range over time.Mean blood urea nitrogen and serum creatinine in the above-normal groups decreased significantly from 37Ϯ14 to 23Ϯ10 mg/dL (PϽ0.0001) and from 1.8Ϯ0.4 to 1.4Ϯ0.8 mg/dL (PϽ0.01), respectively. There were decreases in aspartate transaminase and alanine transaminase in the above-normal groups from 121Ϯ206 and 171Ϯ348 to 36Ϯ19 and 31Ϯ22 IU (PϽ0.001), respectively. Total bilirubin for the above-normal group was 2.1Ϯ0.9 mg/dL at baseline; after an acute increase at week 1, it decreased to 0.9Ϯ0.5 mg/dL by 6 months (PϽ0.0001). Both renal and liver values from patients in the normal groups remained normal during support with the left ventricular assist device. Conclusions-The HeartMate II continuous-flow left ventricular assist device improves renal and hepatic function in advanced heart failure patients who are being bridged to transplantation, without evidence of detrimental effects from reduced pulsatility over a 6-month time period. Clinical Trial Registration Information-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00121472.

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Section: Discussionmentioning

confidence: 89%

“…There also was a trend toward increased hypertrophy with lower flow rates. In contrast, Saito et al 15 implanted pumps into 9 sheep (6 controls) and found that the histology of the kidney, liver, and brain were unchanged compared with controls. They did find that the thickness of the medial layer of the ascending aorta was diminished.…”

Section: Discussionmentioning

confidence: 98%

Renal and Hepatic Function Improve in Advanced Heart Failure Patients During Continuous-Flow Support With the HeartMate II Left Ventricular Assist Device

et al. 2009

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“…In one study, plasma renin activity increased significantly after LVAD insertion, possibly as an adaptive response to a lack of pulse pressure (39). In another study, there was increased immunohistochemical staining of angiotensin II receptors and angiotensin converting enzyme in the endothelial and inflammatory cells infiltrating the peri-arterial and cortical interstitial areas of the animals (41).…”

Section: Continuous Blood Flow and Renal Functionmentioning

confidence: 95%

“…Implantation of continuous-flow LVADs into animals demonstrate stable renal function for periods as long as 340 days postimplantation but there is also evidence of renal arterial smooth muscle cell hyperplasia, peri-arterial inflammatory cell infiltration, and interstitial nephritis (36)(37)(38)(39)(40). In one study, plasma renin activity increased significantly after LVAD insertion, possibly as an adaptive response to a lack of pulse pressure (39).…”

Section: Continuous Blood Flow and Renal Functionmentioning

confidence: 97%

Renal Failure in Patients with Left Ventricular Assist Devices

Patel

Adeseun

Ahmed

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryImplantable left ventricular assist devices (LVADs) are increasingly being used as a bridge to transplantation or as destination therapy in patients with end stage heart failure refractory to conventional medical therapy. A significant number of these patients have associated renal dysfunction before LVAD implantation, which may improve after LVAD placement due to enhanced perfusion. Other patients develop AKI after implantation. LVAD recipients who develop AKI requiring renal replacement therapy in the hospital or who ultimately require longterm outpatient hemodialysis therapy present management challenges with respect to hemodynamics, volume, and dialysis access. This review discusses the mechanics of a continuous-flow LVAD (the HeartMate II), the effects of continuous blood flow on the kidney, renal outcomes of patients after LVAD implantation, dialysis modality selection, vascular access, hemodynamic monitoring during the dialytic procedure, and other issues relevant to caring for these patients.

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“…In the kidneys, short-term results seem to favor the use of pulsatile flow 22 , while long-term continuous flow obtains better renal perfusion than short-term usage and is not technically inferior to pulsatile flow 23 . Studies conducted on the liver show that pulsatile flow sustains total hepatic blood flow more effectively than continuous flow, due to the specific preservation of hepatic arterial and portal venous blood flow (attributed to prevention of hepatic arterial vasoconstriction) 24 .…”

Section: Figurementioning

confidence: 96%

Development of a physiologic ex vivo vessel perfusion system.

Buller

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system integrated with a mock adult circulatory system was design to study the impact of VAD-generated flow patterns on vascular function. Methods:The benefits of a mock circulatory loop and an ex vivo perfusion system were combined by designing and integrating a vessel perfusion chamber to an adult-sized mock circulatory loop as a parallel flow branch distal to VAD outflow. Testing was conducted using a mock over several physiologic conditions (normal, heart failure, and hypertension) and at various levels of VAD flow. The system was integrated into an incubator to allow for control of pH and temperature in future studies and fitted with a vessel for feasibility testing. Data was collected using a custom Labview program and analyzed using the HEART program, an automated beat-to-beat cardiovascular analysis program based in The system was found to be sufficient for future testing with bovine carotid arteries and extended perfusion times (>24 hours). Conclusions:This study resulted in an ex vivo vessel perfusion system that can successfully expose bovine carotid arteries to physiologic and VAD-specific hemodynamic waveforms. The ability to combine the mock ventricle with clinically implanted VADs makes this system both unique and clinically relevant for studying the effects of continuous versus pulsatile flow on the peripheral vasculature.

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End-organ function during chronic nonpulsatile circulation

Cited by 106 publications

References 9 publications

Renal and Hepatic Function Improve in Advanced Heart Failure Patients During Continuous-Flow Support With the HeartMate II Left Ventricular Assist Device

Renal and Hepatic Function Improve in Advanced Heart Failure Patients During Continuous-Flow Support With the HeartMate II Left Ventricular Assist Device

Renal Failure in Patients with Left Ventricular Assist Devices

Development of a physiologic ex vivo vessel perfusion system.

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