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J Thorac Cardiovasc Surg 2002;123:557-561
© 2002 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology (CSP) |
From the Departments of Surgery,a Immunodermatology,b and Experimental Pathology,c General Hospital Vienna University, Wien, Austria.
This paper was supported by the Boltzmann Institut für Herzchirurgische Forschung and grant 8920, Austrian National Bank.
Received for publication May 31, 2001; revisions requested July 9, 2001; revisions received July 16, 2001; accepted for publication Aug 15, 2001. Address for reprints: Hendrik Jan Ankersmit, MD, Department of Surgery, General Hospital Vienna University, Währinger Gürtel 18-20, 1090 Wien, Austria (E-mail: hjankersmit{at}hotmail.com).
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 ± 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 ± 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.
Conclusion: 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.
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