Inflammatory Response after Implantation of a Left Ventricular Assist Device: Comparison between the Axial Flow MicroMed DeBakey VAD and the Pulsatile Novacor Device

Abstract

The implantation of a ventricular assist device (VAD) is associated with a stimulation of the inflammatory system. We compared changes in the inflammatory response after implantation of a pulsatile Novacor left (L) VAD and the axial flow MicroMed DeBakey VAD. Six consecutive patients after implantation of a Novacor LVAD (NC) and six patients after implantation of a MicroMed DeBakey VAD (MD) were included in the investigation. Patients received LVADs for medically non treatable end-stage heart failure. Tumor necrosis factor alpha (TNF), C3a, C5a, interleukin 6 (IL-6), and neutrophil elastase were measured twice a week over a period of 3 months after implantation of the device. All tests were performed with an enzyme-linked immunosorbent assay. There was no significant difference in the clinical course of the two groups. All inflammatory parameters were elevated in both groups during the entire period of the investigation. There was no difference in TNF, polynuclear leukocyte elastase, or C3a levels between the two groups; however, IL-6 (NC: 23.6+/-37.6 pg/ml vs. MD: 63+/-114 pg/ml, p < 0.001) and C5a (NC: 708+/-352 microg/L vs. MD: 1,745+/-1,305 microg/L, p < 0.001) were increased significantly more in patients following implantation of the axial flow MicroMed DeBakey VAD. Compared with the pulsatile Novacor device, the implantation of the axial flow MicroMed DeBakey LVAD seems to be associated with an increased stimulation of one part of the inflammatory system. Further investigations are necessary for evaluation of the pathophysiologic mechanism and clinical implications of these findings.

Cavo-pulmonary anastomosis associated with left ventricular in comparison with biventricular circulatory support in acute heart failure

“…Functional evaluation methods, such as echocardiography, have their effective in assessing cardiac function in pigs proven in the literature and would be useful in this protocol [22]. In addition to these methods, it has recently been demonstrated that pulsatile flow pumps are as effective as the continuous flow pumps in relation to hemodynamic performance, but with less activation of part of the inflammatory system [23]. Another factor of great importance was the direct measurement of PAP, through which it would be possible to calculate pulmonary vascular resistance, which may have influenced the proper functioning of the cavopulmonary shunt.…”

Preoperative Prediction of Aortic Insufficiency During Ventricular Assist Device Treatment

“…56) Loebe, et al revealed that a PF LVAD was associated with less stimulation of the systemic inflammatory system as compared with a CF device. 57) Accordingly, intermittent LV unloading may correlate positively to successful LVRR. We have also demonstrated in a clinical setting that PF LVAD had an advantage over CF pumps in terms of LVRR.…”

Attenuation in Peripheral Endothelial Function After Continuous Flow Left Ventricular Assist Device Therapy Is Associated With Cardiovascular Adverse Events

“…Stimulation of inflammatory cascade after CF-LVAD implantation in HF patients has been reported in several previous studies. 44, 45 Major causes of this activation of inflammation cascade may include exposure of blood to the artificial surface of CF-LVAD, triggering a foreign body reaction and altered rheologic conditions with different velocities of blood flow, and blood stasis in the CF-LVAD recipient heart. Inflammation is associated with reduced basal and stimulated NO release from the arterial endothelial cells through various mechanisms, 46 and could possibly be the mechanism responsible for the present results.…”