Left Ventricular Assist Device–Induced Coagulation and Platelet Activation and Effect of the Current Anticoagulant Therapy Regimen

Ashbrook, Michael; Walenga, Jeanine M.; Schwartz, Jeffrey; Heroux, A.; Jeske, Walter; Escalante, Vicki; Bakhos, Mamdouh

doi:10.1177/1076029612464900

Cited by 14 publications

(3 citation statements)

References 20 publications

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“…Regarding implanted-patients with HM-II or HM-III, we also observed a normal VWF propeptide/VWF:Ag ratio as previously described after LVAD implantation. 22…”

Section: Resultsmentioning

confidence: 99%

Bioprosthetic Total Artificial Heart in Autoregulated Mode Is Biologically Hemocompatible: Insights for Multimers of von Willebrand Factor

Poitier

Chocron

Peronino

et al. 2022

ATVB

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Background: Carmat bioprosthetic total artificial heart (Aeson; A-TAH) is a pulsatile and autoregulated device. The aim of this study is to evaluate level of hemolysis potential acquired von Willebrand syndrome after A-TAH implantation. Methods: We examined the presence of hemolysis and acquired von Willebrand syndrome in adult patients receiving A-TAH support (n=10) during their whole clinical follow-up in comparison with control subjects and adult patients receiving Heartmate II or Heartmate III support. We also performed a fluid structure interaction model coupled with computational fluid dynamics simulation to evaluate the A-TAH resulting shear stress and its distribution in the blood volume. Results: The cumulative duration of A-TAH support was 2087 days. A-TAH implantation did not affect plasma free hemoglobin over time, and there was no association between plasma free hemoglobin and cardiac output or beat rate. For VWF (von Willebrand factor) evaluation, A-TAH implantation did not modify multimers profile of VWF in contrast to Heartmate II and Heartmate III. Furthermore, fluid structure interaction coupled with computational fluid dynamics showed a gradually increase of blood damage according to increase of cardiac output ( P <0.01), however, the blood volume fraction that endured significant shear stresses was always inferior to 0.03% of the volume for both ventricles in all regimens tested. An inverse association between cardiac output, beat rate, and high-molecular weight multimers ratio was found. Conclusions: We demonstrated that A-TAH does not cause hemolysis or AWVS. However, relationship between HMWM and cardiac output depending flow confirms relevance of VWF as a biological sensor of blood flow, even in normal range.

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“…Regarding implanted-patients with HM-II or HM-III, we also observed a normal VWF propeptide/VWF:Ag ratio as previously described after LVAD implantation. 22…”

Section: Resultsmentioning

confidence: 99%

Bioprosthetic Total Artificial Heart in Autoregulated Mode Is Biologically Hemocompatible: Insights for Multimers of von Willebrand Factor

Poitier

Chocron

Peronino

et al. 2022

ATVB

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“…16 Similar lack of platelet biomarker expression was also observed in patients supported with the HeartMate II LVAD – independent of length of LVAD support, patient age, or antiplatelet regiment. 17, 18 …”

Section: Platelet Activation and Lvadsmentioning

confidence: 99%

Bleeding and thrombosis in chronic ventricular assist device therapy

Koliopoulou

McKellar

Rondina

et al. 2016

Current Opinion in Cardiology

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Purpose of review LVADs have markedly improved the survival for patients with advanced heart failure but are plagued with significant morbidity, including pump thrombosis and bleeding. Better understanding of the platelet, and their role in the balance of bleeding and thrombosis, stands to impact the frequency and treatment of these significant complications. Recent findings In patients with LVADs, there is little consistency linking traditional biomarkers of platelet activation and clinical events. A number of innovative methods of assessing platelet functionality, including shedding of platelet receptors and formation of microparticle complexes as well as measuring mitochondrial membrane potentials, exist and appear to be clinically relevant. Acquired von Willebrand syndrome, while not explaining all bleeding events, is a central feature of mechanical support and offers a target for innovative therapies Summary Although the platelet is only one component of impacting thrombosis and bleeding in patients supported with LVADs, it plays a central role in mediating these two opposing forces. Innovations in both understanding platelet physiology as well as manipulating genomic and receptor interactions for an individual patient will be critical if we are to decrease these serious adverse events in the future.

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“…Once MAC is initiated, blood is constantly exposed to device artificial surfaces and blood cells experience non-physiological shear stress (NPSS) from the pump. The high-speed impeller rotation of a rotary pump generates high NPSS in certain regions, such as blade-tip gap and the impeller passage, which is often above 100 Pascal (Pa) and sometimes higher than 600 Pa. 9 It is well known that NPSS causes damage to blood cells and plasma proteins, including hemolysis, 10 platelet activation and receptor shedding, [11][12][13] degradation of von Willebrand factor (vWF), 14,15 and deleterious alterations of leukocytes. 16,17 One in vitro study even suggested that leukocytes were more vulnerable to mechanical trauma than red blood cells (RBCs).…”

Section: Introductionmentioning

confidence: 99%

Neutrophil dysfunction due to continuous mechanical shear exposure in mechanically assisted circulation in vitro

et al. 2021

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Objective: Leukocytes play an important role in the body's immune system. The aim of this study was to assess alterations in neutrophil phenotype and function in pump-assisted circulation in vitro. Methods:Human blood was circulated for four hours in three circulatory flow loops with a CentriMag blood pump operated at a flow of 4.5 L/min at three rotational speeds (2100, 2800, and 4000 rpm), against three pressure heads (75, 150, and 350 mm Hg), respectively. Blood samples were collected hourly for analyses of neutrophil activation state (Mac-1, CD62L, CD162), neutrophil reactive oxygen species (ROS) production, apoptosis, and neutrophil phagocytosis. Results: Activated neutrophils indicated by both Mac-1 expression and decreased surface expression of CD62L and CD162 receptors increased with time in three loops. The highest level of neutrophil activation was observed in the loop with the highest rotational speed. Platelet-neutrophil aggregates (PNAs) progressively increased in two loops with lower rotational speeds. PNAs peaked at one hour after circulation and decreased subsequently in the loop with the highest rotational speed. Neutrophil ROS production dramatically increased at one hour after circulation and decreased subsequently in all three loops with similar levels and trends. Apoptotic neutrophils increased with time in all three loops. Neutrophil phagocytosis capacity in three loops initially elevated at one hour after circulation and decreased subsequently. Apoptosis and altered phagocytosis were dependent on rotational speed. Conclusions:Our study revealed that the pump-assisted circulation induced neutrophil activation, apoptosis, and functional impairment. The alterations were strongly associated with pump operating condition and duration.

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Left Ventricular Assist Device–Induced Coagulation and Platelet Activation and Effect of the Current Anticoagulant Therapy Regimen

Cited by 14 publications

References 20 publications

Bioprosthetic Total Artificial Heart in Autoregulated Mode Is Biologically Hemocompatible: Insights for Multimers of von Willebrand Factor

Bioprosthetic Total Artificial Heart in Autoregulated Mode Is Biologically Hemocompatible: Insights for Multimers of von Willebrand Factor

Bleeding and thrombosis in chronic ventricular assist device therapy

Neutrophil dysfunction due to continuous mechanical shear exposure in mechanically assisted circulation in vitro

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