title: Temporal leukocyte numbers and granulocyte activation in pulsatile and rotary ventricular assist device patients.
abstract: Individual ventricular assist device (VAD) design may affect leukocytes and impact immunity. Few studies have presented leukocyte and infection profiles in VAD patients over the course of the implant period. CD11b (MAC-1) expression on granulocytes is an indicator of activation during inflammation, mediating extravasation and the release of reactive oxygen species in tissue. No reported studies have presented MAC-1 expression on circulating granulocytes in VAD patients. Fifty-six patients implanted at a single center with a HeartMate II (HMII; n = 32), HeartWare (HW; n = 12), or Thoratec pneumatic VAD (PVAD; n = 12) between 1999 and 2011 were followed for 120 days of support. The leukocyte profiles and infectious events of all patients were evaluated; additionally, a subset had MAC-1 expression on circulating granulocytes was measured (HMII n = 9; HW n = 7; PVAD n = 4). All groups exhibited a significant peak in leukocyte numbers at postoperative day (POD) 14 while simultaneously experiencing a significant decrease in hematocrit. HMII patients exhibited a 3.2-fold increase in granulocyte MAC-1 expression at POD 14, and the temporal trend over the implant period differed from that experienced by HW patients. Further, HW patients experienced significantly fewer infection events. Alterations in leukocyte profiles and granulocyte activation experienced by VAD patients appear to be device-specific. Elevations in leukocyte activation may be related to an increased risk for infection, although the specific relationship between these phenomena in this patient group is not known.
authors.affiliation: Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Woolley
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Teuteberg
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.forename: Jay K
authors.initials: JK
authors.lastname: Bhama
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Lockard
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kormos
authors.forename: William R
authors.initials: WR
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006098:Granulocytes / Q000276:immunology* / Q000378:metabolism; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006400:Hematocrit; D006801:Humans; D007958:Leukocyte Count; D007962:Leukocytes / Q000276:immunology* / Q000378:metabolism; D016177:Macrophage-1 Antigen / Q000097:blood; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D016459:Prosthesis-Related Infections / Q000097:blood / Q000175:diagnosis / Q000276:immunology; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000097:blood / Q000175:diagnosis / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D016177:Macrophage-1 Antigen
keywords: Artificial organs; Circulatory assist devices; Immunology; Inflammatory cells; Left ventricular assist devices; Neutrophils; Systemic inflammation