title: 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.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Loebe
authors.forename: A
authors.initials: A
authors.lastname: Koster
authors.forename: S
authors.initials: S
authors.lastname: Sänger
authors.forename: E V
authors.initials: EV
authors.lastname: Potapov
authors.forename: H
authors.initials: H
authors.lastname: Kuppe
authors.forename: G P
authors.initials: GP
authors.lastname: Noon
authors.forename: R
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000328:Adult; D001777:Blood Coagulation / Q000276:immunology; D003167:Complement Activation; D015926:Complement C3a / Q000378:metabolism; D015936:Complement C5a / Q000378:metabolism; D005260:Female; D006333:Heart Failure / Q000276:immunology / Q000601:surgery* / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D019272:Leukocyte Elastase / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D011673:Pulsatile Flow; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D015926:Complement C3a; D015936:Complement C5a; D019272:Leukocyte Elastase