Arterial wall histology in chronic pulsatile-flow and continuous-flow device circulatory support

BACKGROUND Continuous-flow (CF) ventricular assist devices (VAD) are an established option for treatment of end-stage heart failure. However, the effect of long-term CF with lack of peripheral arterial wall motions on blood pressure regulation and end-organ arterial wall sclerosis, especially in the...

Full description

Saved in:

Bibliographic Details
Published in:	The Journal of heart and lung transplantation Vol. 31; no. 11; pp. 1171 - 1176
Main Authors:	Potapov, Evgenij V., MD, PhD, Dranishnikov, Nikolay, MD, Morawietz, Lars, MD, PhD, Stepanenko, Alexander, MD, Rezai, Sajjad, Blechschmidt, Cristiane, MD, Lehmkuhl, Hans B., MD, PhD, Weng, Yuguo, MD, PhD, Pasic, Miralem, MD, PhD, Hübler, Michael, MD, Hetzer, Roland, MD, PhD, Krabatsch, Thomas, MD, PhD
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-11-2012 Elsevier
Subjects:	Adult Aged arterial wall Biological and medical sciences Biomechanical Phenomena - physiology Blood Pressure - physiology Cardiology. Vascular system Cerebral Arteries - pathology Cerebral Arteries - physiopathology continuous flow Coronary Vessels - pathology Coronary Vessels - physiopathology Female Fibrosis Follow-Up Studies Heart Failure - physiopathology Heart Failure - therapy Heart-Assist Devices - classification Hepatic Artery - pathology Hepatic Artery - physiopathology Humans Hyperplasia long-term support Longitudinal Studies Male Medical sciences Middle Aged Necrosis pathology pulsatile flow Renal Artery - pathology Renal Artery - physiopathology Retrospective Studies Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Time Factors Ventricular assist device long-term support continuous flow pathology arterial wall pulsatile flow Ventricular assist device Chronic Pulsatile Support Continuous Device Histology Circulatory system Cardiology Vascular wall Phlebology
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	BACKGROUND Continuous-flow (CF) ventricular assist devices (VAD) are an established option for treatment of end-stage heart failure. However, the effect of long-term CF with lack of peripheral arterial wall motions on blood pressure regulation and end-organ arterial wall sclerosis, especially in the case of long-term support (>3 years), remains unclear. METHODS Tissue samples obtained at autopsy from liver, kidney, coronary arteries, and brain from 27 VAD recipients supported for >180 days between 2000 and 2010 were histologically examined to assess vascular alterations, including perivascular infiltrate, intravascular infiltrate, wall thickness, thrombosis, endothelial cell swelling, vessel wall necrosis, and peri-vascular fibrosis. Pulsatile-flow (PF) devices had been inserted in 9 patients and CF devices had been inserted in 16. The pathologist was blinded to the group distribution. Demographic, pharmacologic, and clinical data were retrospectively analyzed before surgery and during the follow-up period of up to 24 months. RESULTS Median duration of support was 467 days (range, 235–1,588 days) in the PF group and 263 days (range, 182–942 days) in the CF group. Demographic and clinical data before and after surgery were similar. Amiodarone was more often used during follow-up in CF group than in the PF group (61% vs 10%, p =0.009). Throughout the follow-up period, mean arterial pressure did not differ between recipients of the 2 pump types, nor did systolic and diastolic pressure, except at 2 weeks after VAD implantation, when systolic blood pressure was higher ( p =0.05) and diastolic lower ( p =0.03) in the PF group. Histologic studies did not identify any relevant differences in arterial wall characteristics between the 2 groups. CONCLUSION Long-term mechanical circulatory support with CF devices does not adversely influence arterial wall properties of the end-organ vasculature.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1053-2498 1557-3117
DOI:	10.1016/j.healun.2012.08.013