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J Thorac Cardiovasc Surg 2008;135:1372-1379
© 2008 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Association of device surface and biomaterials with immunologic sensitization after mechanical support

^a Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York, NY
^b Department of Medicine, Division of Cardiology, College of Physicians and Surgeons of Columbia University, New York, NY

Received for publication April 25, 2007; revisions received November 7, 2007; accepted for publication November 13, 2007.

^_* Address for reprints: Isaac George, MD, Department of Surgery, 630 W 168th St, P&S Building, Rm 17-415, New York, NY 10032. (Email: isaacgeorge{at}hotmail.com).

Objective: Biomaterials and textured surfaces in early pulsatile left ventricular assist devices (HeartMate I; Thoratec Corporation, Pleasanton, Calif) may increase immunologic risk through allosensitization. We hypothesized that axial-flow devices without biologic membranes or textured surfaces (HeartMate II; Thoratec; and DeBakey; MicroMed Cardiovascular, Inc, Houston, Tex) would cause less allosensitization than devices with such membranes and surfaces.

Methods: HeartMate II and DeBakey (n = 24) and HeartMate I (n = 36) devices were implanted from 1999 to 2006 in patients with severe heart failure cohort-matched for age, etiology, and support duration. Serum samples reacting with more than 10% of the HLA reference panel were considered positive for anti-HLA antibodies. Endomyocardial biopsy samples were collected after transplant.

Results: There were no significant cohort differences in age, etiology, sex, blood transfusion, or support duration. Anti-HLA antibodies were not detected at implantation of either HeartMate II and DeBakey or HeartMate I devices; however, significant increases in anti-HLA antibodies were present within 1 and 3 months of support with HeartMate I but not HeartMate II and DeBakey devices. Overall, fewer patients with HeartMate II and DeBakey devices demonstrated positive anti-HLA antibodies during support (8% vs 28%, P = .02), and fewer episodes of acute rejection per patient were seen within the first 9 posttransplant months(0.31 vs 0.69, P = .052). Long-term posttransplant survival was not different between groups.

Conclusion: Hemodynamic support with HeartMate II and DeBakey devices produced less allosensitization than did HeartMate I devices. Device selection may improve clinical outcomes for high-risk patients.