Transitory immunologic response after implantation of the DeBakey VAD continuous-axial-flow pump.
BACKGROUND
The development of local and systemic infection is a significant risk factor associated with implantation of a ventricular assist device. The immunologic consequence of continuous-flow rotary blood pumps is not known.


METHODS
Six male adult patients (mean age 47 plus minus 10.3) with end-stage left heart failure received a DeBakey VAD axial-flow pump for use as a bridge to transplantation. (Four patients underwent transplantation after a mean 115 plus minus 14 days; 2 patients are still waiting for the allograft.)


RESULTS
We prospectively monitored T-cell populations and apoptosis-specific aberrant T-cell activation via CD95 triggering and annexin V binding to lymphocytes, identifying T cells undergoing early phases of apoptosis, within the first 10 weeks. Moreover, soluble death-inducing receptors soluble CD95 and soluble tumor necrosis factor-R1 were evaluated by enzyme-linked immunosorbent assay.


CONCLUSIONS
Patients bridged to transplantation by a nonpulsatile ventricular assist device demonstrated an initial pronounced apoptosis-specific immune alteration by increased annexin V binding to CD3 T cells and death-inducing receptors soluble CD95/tumor necrosis factor-R1 (all P <.001). All parameters normalized after 7 weeks to baseline. No blood-borne sepsis was detected, as defined by blood culture, within the first 10 weeks of the cohort study. These results indicate a biphasic immunologic response in patients with end-stage heart failure treated with nonpulsatile ventricular assist devices.
Ankersmit
Hendrik Jan
HJ
Department of Surgery, General Hospital Vienna University, Währinger Gürtel 18-20, 1090 Vienna, Austria. hjankersmit@hotmail.com
Wieselthaler
G
G
Moser
B
B
Gerlitz
S
S
Roth
G
G
Boltz-Nitulescu
G
G
Wolner
E
E
D000328:Adult; D017304:Annexin A5 / Q000276:immunology; D017209:Apoptosis / Q000276:immunology; D004867:Equipment Design; D006333:Heart Failure / Q000276:immunology* / Q000628:therapy; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007111:Immunity, Cellular; D016130:Immunophenotyping; D008213:Lymphocyte Activation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013601:T-Lymphocytes / Q000276:immunology*; D019014:fas Receptor / Q000276:immunology
D017304:Annexin A5; D019014:fas Receptor