Time Course of Cytokine Release and Complement Activation After Implantation of the HeartMate Left Ventricular Assist Device

Corry, David C.; DeLucia, Alphonse; Zhu, Hong; Radcliffe, Robert R.; Brevetti, Gregory R.; El-khatib, Hazem; Vance, Sara; Moyer, Bruce R.; Cotts, William; Richenbacher, Wayne E.

doi:10.1097/00002480-199809000-00005

Cited by 29 publications

(21 citation statements)

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“…We [14] have previously shown that some patients under mechanical circulatory support develop a drop in systemic vascular resistances in the absence of obvious infection which might be related to an ongoing systemic inflammatory response syndrome (SIRS). Indeed, patients undergoing MCS present a SIRS [15] which appears to be more pronounced at least initially, than that observed in patients undergoing conventional cardiac procedures under cardiopulmonary bypass [16]. The immediate postoperative SIRS observed in MCS recipients is the result of a complex interaction between patient-related variables (cardiogenic shock, end-stage heart failure), acute blood-biomaterial interactions on the cardiopulmonary bypass and mechanical circulatory assist device surfaces, and a multitude of biomaterialindependent variables (anesthesia, surgical procedures, hypothermia, non-pulsatile perfusion during cardiopulmonary bypass, ischemia-reperfusion injury, drugs, and blood products) [15].…”

Section: Discussionmentioning

confidence: 96%

Impact of preoperative hemodynamic support on early outcome in patients assisted with paracorporeal Thoratec® ventricular assist device

Kirsch

Vermès

Radu

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Background: Mechanical circulatory support has become a well-established procedure for some patients with cardiogenic shock. However, patient selection and timing of implantation remains critical. This retrospective study was undertaken to identify preoperative predictors of survival in ICU of patients requiring mechanical circulatory support. Methods: Between 1996 and 2006, 71 patients (61 men, 10 women, aged 41.6 AE 12.2 years) with primary cardiogenic shock were assisted using the paracorporeal Thoratec W VAD. Twenty-seven (38%) patients needed preoperative mechanical ventilation. Preoperative IV hemodynamic drug support included dobutamine in 63 (89%), vasopressors (adrenaline, noradrenaline or dopamine !5 mg/kg min) in 47 (66%), and intraaortic balloon counter-pulsation in 22 (31%) patients. Mean preoperative blood creatinine and total bilirubin levels were 162.2 AE 72.4 mmol/l and 36.4 AE 53.9 mmol/l, respectively. Results: Fifty-six (79%) patients required biventricular and 15 (21%) left ventricular support. Patients were assisted for a mean duration of 73.1 AE 93.6 days (extremes, 1-480 days). Twenty-five patients (35%) died while on support. Among these, 18 patients (25%) never recovered sufficiently to allow dismissal from ICU, and died after a mean of 15.4 AE 14.3 days. Logistic regression identified preoperative IV adrenaline as sole predictor for ICU death (OR, 5.48; 95% CI,, p = 0.012). Conclusions: The need for preoperative IV adrenaline therapy appeared to be the sole independent risk factor for death in ICU in patients assisted with the Thoratec W paracorporeal VAD. This suggests that, besides hemodynamic and metabolic consequences of cardiogenic shock, preoperative activation of the inflammatory cascade could influence the prognosis of patients undergoing mechanical circulatory support. #

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Section: Discussionmentioning

confidence: 96%

Impact of preoperative hemodynamic support on early outcome in patients assisted with paracorporeal Thoratec® ventricular assist device

Kirsch

Vermès

Radu

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…Studies of myocardial tissue from explanted hearts with device support described recovery of gene expression, 6,13 regression of cellular hypertrophy, [2][3][4] and improvement in calcium cycling, 5,6 in vitro contractile function, 1,14 ␤-receptor density and myocyte oxygenation, 1,15 as well as decreased deposition of cytokines such as TNF-␣, 7 interleukin-6, 16 interleukin-8, 16,17 and complement C3a. 17 There have been conflicting reports on the impact of device support on the extracellular matrix, with some studies reporting an increase 18,19 and others a decrease in collagen deposition. 4,11,20 Many studies were performed in the absence of clinical correlation, but in the few studies in which clinical parameters were analyzed, the cellular improvement was more impressive than the clinical impact.…”

Section: Recoverymentioning

confidence: 99%

Cardiac Improvement During Mechanical Circulatory Support

et al. 2007

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Background-Myocardial recovery after left ventricular assist device (LVAD) support has been reported. The LVAD Working Group Recovery Study was a prospective multicenter trial to assess the incidence of myocardial recovery in patients bridged to cardiac transplantation. Methods and Results-After LVAD implantation, patients were evaluated with the use of rest echocardiograms with partial LVAD support and cardiopulmonary exercise testing. Dobutamine echocardiography with hemodynamic measurements was performed in those patients with left ventricular ejection fraction Ͼ40% during resting studies.Histological analysis was performed on myocardial samples taken at LVAD implantation and explantation. Sixty-seven LVAD patients with heart failure participated in the study. 001).Tissue analysis revealed significant reductions in myocyte size, collagen content, and cardiac tumor necrosis factor-␣. Six subjects (9%) underwent LVAD explantation for recovery. Conclusions-Cardiac function improves significantly after device implantation. Although cellular recovery and improvement in ventricular function are observed, the degree of clinical recovery is insufficient for device explantation in most patients with chronic heart failure.

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“…22 These global structural changes are associated with beneficial changes that are demonstrable at the cellular and molecular levels. A number of investigators have demonstrated consistent reductions in myocyte size and fibrosis, [23][24][25] attenuation of elevated neurohormones, 26,27 normalization of proteins that regulate calcium flux, 28 and improvements in circulating 29 and cardiac markers of inflammation. 30 It is not known whether support with a continuous-type flow device results in similar degrees of structural or cellular changes in failing myocardium.…”

mentioning

confidence: 97%

Cellular and Hemodynamics Responses of Failing Myocardium to Continuous Flow Mechanical Circulatory Support Using the DeBakey-Noon Left Ventricular Assist Device: a Comparative Analysis With Pulsatile-Type Devices

Thohan

Stetson

Nagueh

et al. 2005

The Journal of Heart and Lung Transplantation

115

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Time Course of Cytokine Release and Complement Activation After Implantation of the HeartMate Left Ventricular Assist Device

Cited by 29 publications

References 0 publications

Impact of preoperative hemodynamic support on early outcome in patients assisted with paracorporeal Thoratec® ventricular assist device

Impact of preoperative hemodynamic support on early outcome in patients assisted with paracorporeal Thoratec® ventricular assist device

Cardiac Improvement During Mechanical Circulatory Support

Cellular and Hemodynamics Responses of Failing Myocardium to Continuous Flow Mechanical Circulatory Support Using the DeBakey-Noon Left Ventricular Assist Device: a Comparative Analysis With Pulsatile-Type Devices

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