Howard FRAZIER, Kamuran KADIPAŞAOĞLU, Mehmet Hakan AKAY, Kanber Öcal KARABAY, Egemen TÜZÜN, Dan TAMEZ

Hematological, biochemical and end-organ effects of the Levitronix centrifugal left ventricular assist device in a bovine model

Amaç: Bu çalışmada, Levitronix CentriMag® sol ventrikül destek cihazının kısa dönem (30 gün) hematolojik, biyokimyasal ve son-organ etkileri büyükbaş hayvan modelinde incelendi. Çalışma planı: Üç danaya kardiyopulmoner bypass kullanılmadan Levitronix CentriMag® pompası implante edildi. Pompalar 5 litre/dakika sabit hızda çalıştırıldı. Pompa işlevleri ve hemodinamiye ait veriler çalışma sonlanana kadar bir saatlik aralıklarla sürekli olarak monitörize edildi. Hematolojik ve biyokimyasal testler (karaciğer ve böbrek fonksiyonları) ameliyat öncesi (bazal) ve sonrası dönemde çalışma boyunca günlük olarak ölçüldü. Çalışma sonlandırıldıktan sonra son-organların (beyin, kalp, karaciğer, böbrek, dalak ve akciğer) histopatolojik değerlendirmesi yapıldı. Bulgular: Bütün deneklerde çalışmada hedeflenen bitiş gününe komplikasyon ve cihazla ilgili sorun olmadan ulaşıldı. Pompalar, giriş ve çıkış kanüllerinde trombüs saptanmadı. Hematolojik testler çalışma süresi boyunca normal sınırlar içersindeydi. Beyaz kan hücre sayısında görülen yükselme ve hematokrit, hemoglobin ve kırmızı kan hücre sayısında görülen düşüşler kısa süreliydi; bu değerler ameliyatın ilk haftası içinde normale döndü. Cerrahinin ilk üç günü içinde kreatin kinaz ve serum glutamik oksaloasetik transaminaz düzeylerinde geçici artış görüldü. Diğer biyokimyasal parametreler normal sınırlar içinde seyretti. Organların postmortem incelemesinde iskemi veya infarktüse ait bulgu saptanmadı. Sonuç: Levitronix CentriMag® sol ventrikül destek cihazının kısa dönem kullanımı ile hematolojik ve biyokimyasal verilerde ve son-organ fonksiyonlarında bozulma olmamaktadır.

Levitronix sentrifugal sol ventrikül destek cihazının dana modelinde hematolojik, biyokimyasal ve son-organ etkileri

Background: The purpose of this study was to evaluate the short-term (30 days) hematological, biochemical, and end-organ effects of the Levitronix CentriMag® left ventricular assist system (LVAS) in a bovine model. Methods: Three calves underwent Levitronix CentriMag® LVAS implantation without the use of cardiopulmonary bypass. The pump was operated with a fixed flow rate of 5 L/min. Data related to pump function and hemodynamics were collected continuously at 1-hour intervals until study termination. Hematologic and biochemical (liver and kidney function) tests were performed preoperatively (baseline) and daily throughout the study period. Histopathologic examination of the end-organs (brain, heart, liver, kidney, spleen, and lungs) was performed after the study termination. Results: The planned date of termination (30 days) was reached in all the animals without complication and device failure. The pumps, inflow and outflow cannulae were free of thrombus. Hematological tests were within normal limits during the study period. Elevations observed in the levels of white blood cell count, and decreases in hematocrit, hemoglobin, and red blood cell count were of short duration; these parameters returned to normal within one week of surgery. Creatine kinase and serum glutamic oxaloacetic transaminase levels showed transient increases within the first three days of surgery. Other biochemical parameters were within normal limits. Postmortem examination of the explanted organs revealed no evidence for ischemia or infarction. Conclusion: Hematological, biochemical, and end-organ functions were not adversely affected by short-term Levitronix CentriMag® LVAS support.

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1. Westaby S, Katsumata T, Houel R, Evans R, Pigott D, Frazier OH, et al. Jarvik 2000 heart: potential for bridge to myocyte recovery. Circulation 1998;98:1568-74.
2. Jurmann MJ, Siniawski H, Erb M, Drews T, Hetzer R. Initial experience with miniature axial flow ventricular assist devices for postcardiotomy heart failure. Ann Thorac Surg 2004;77:1642-7.
3. Samuels LE, Holmes EC, Thomas MP, Entwistle JC 3rd, Morris RJ, Narula J, et al. Management of acute cardiac failure with mechanical assist: experience with the ABIOMED BVS 5000. Ann Thorac Surg 2001;71(3 Suppl):S67-72.
4. Frazier OH, Delgado RM 3rd, Scroggins N, Odegaard P, Kar B. Mechanical bridging to improvement in severe acute "non ischemic, nonmyocarditis" heart failure. Congest Heart Fail 2004; 10:109-13.
5. Frazier OH, Shah NA, Myers TJ, Robertson KD, Gregoric ID, Delgado R. Use of the Flowmaker (Jarvik 2000) left ventriculer assist device for destination therapy and bridging to transplantation. Cardiology 2004; 101:111-6.
6. Frazier OH, Myers TJ, Gregoric ID, Khan T, Delgado R, Croitoru M, et al. Initial clinical experience with the Jarvik 2000 implantable axial-flow left ventricular assist system. Circulation 2002; 105:2855-60.
7. Hetzer R, Weng Y, Potapov EV, Pasic M, Drews T, Jurmann M, et al. First experiences with a novel magnetically suspended axial flow left ventricular assist device. Eur J Cardiothorac Surg 2004;25:964-70.
8. Nojiri C, Kijima T, Maekawa J, Horiuchi K, Kido T, Sugiyama T, et al. Development status of Terumo implantable left ventricular assist system. Artif Organs 2001 ;25:411-3.
9. Merhige ME, Smalling RW, Cassidy D, Barrett R, Wise G, Short J, et al. Effect of the hemopump left ventricular assist device on regional myocardial perfusion and function. Reduction of ischemia during coronary occlusion. Circulation 1989;80(5 Pt 2):ini58-66.
10. Sezai A, Shiono M, Orime Y, Nakata K, Hata M, Iida M, et al. Major organ function under mechanical support: comparative studies of pulsatile and nonpulsatile circulation. Artif Organs 1999;23:280-5.
11. Richenbacher WE, Naka Y, Raines EP, Frazier OH, Couper GS, Pagani FD, et al. Surgical management of patients in the REMATCH trial. Ann Thorac Surg 2003;75(6 Suppl):S86-92.
12. Mesana TG. Rotary blood pumps for cardiac assistance: a "must"? Artif Organs 2004;28:218-25.
13. Noon GP, Ball JW Jr, Papaconstantinou HT. Clinical experience with BioMedicus centrifugal ventricular support in 172 patients. Artif Organs 1995;19:756-60.
14. Nojiri C, Kijima T, Maekawa J, Horiuchi K, Kido T, Sugiyama T, et al. Recent progress in the development of Terumo implantable left ventricular assist system. ASAIO J 1999;45:199-203.
15. Nojiri C, Kijima T, Maekawa J, Horiuchi K, Kido T, Sugiyama T, et al. Terumo implantable left ventricular assist system: results of long-term animal study. ASAIO J 2000;46:117-22.
16. Myers TJ, Robertson K, Pool T, Shah N, Gregoric I, Frazier OH. Continuous flow pumps and total artificial hearts: management issues. Ann Thorac Surg 2003;75(6 Suppl):S79-85.
17. Chatterjee S, Williams NN, Ohara ML, Twomey C, Morris JB, Acker MA. Diaphragmatic hernias associated with ventricular assist devices and heart transplantation. Ann Thorac Surg 2004;77:2111-4.
18. Saito S, Westaby S, Piggott D, Katsumata T, Dudnikov S, Robson D, et al. Reliable long-term non-pulsatile circulatory support without anticoagulation. Eur J Cardiothorac Surg 2001; 19:678-83.
19. Saito S, Westaby S, Piggot D, Dudnikov S, Robson D, Catarino PA, et al. End-organ function during chronic nonpulsatile circulation. Ann Thorac Surg 2002;74:1080-5.