title: Transitory immunologic response after implantation of the DeBakey VAD continuous-axial-flow pump.
abstract: 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.
authors.affiliation: Department of Surgery, General Hospital Vienna University, Währinger Gürtel 18-20, 1090 Vienna, Austria. hjankersmit@hotmail.com
authors.forename: Hendrik Jan
authors.initials: HJ
authors.lastname: Ankersmit
authors.forename: G
authors.initials: G
authors.lastname: Wieselthaler
authors.forename: B
authors.initials: B
authors.lastname: Moser
authors.forename: S
authors.initials: S
authors.lastname: Gerlitz
authors.forename: G
authors.initials: G
authors.lastname: Roth
authors.forename: G
authors.initials: G
authors.lastname: Boltz-Nitulescu
authors.forename: E
authors.initials: E
authors.lastname: Wolner
mesh_terms: 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
chemical_list: D017304:Annexin A5; D019014:fas Receptor