title: Arterial wall histology in chronic pulsatile-flow and continuous-flow device circulatory support.
abstract: 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.
  
  
  CONCLUSIONS
  Long-term mechanical circulatory support with CF devices does not adversely influence arterial wall properties of the end-organ vasculature.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin. potapov@dhzb.de
authors.forename: Evgenij V
authors.initials: EV
authors.lastname: Potapov
authors.forename: Nikolay
authors.initials: N
authors.lastname: Dranishnikov
authors.forename: Lars
authors.initials: L
authors.lastname: Morawietz
authors.forename: Alexander
authors.initials: A
authors.lastname: Stepanenko
authors.forename: Sajjad
authors.initials: S
authors.lastname: Rezai
authors.forename: Cristiane
authors.initials: C
authors.lastname: Blechschmidt
authors.forename: Hans B
authors.initials: HB
authors.lastname: Lehmkuhl
authors.forename: Yuguo
authors.initials: Y
authors.lastname: Weng
authors.forename: Miralem
authors.initials: M
authors.lastname: Pasic
authors.forename: Michael
authors.initials: M
authors.lastname: Hübler
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Thomas
authors.initials: T
authors.lastname: Krabatsch
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002536:Cerebral Arteries / Q000473:pathology* / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000145:classification*; D006499:Hepatic Artery / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D006965:Hyperplasia; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012077:Renal Artery / Q000473:pathology* / Q000503:physiopathology; D012189:Retrospective Studies; D013997:Time Factors