Left ventricular assist devices (LVAD) have revolutionized the field of mechanical circulatory support because this technology has been shown to extend life and improve outcomes in patients with advanced heart failure. It has turned out that many LVAD patients become immunologically activated because of serum antibodies directed against human leukocyte antigens (HLA). 1,2 Srivastava et al. 3 have recently described high rates of false-positive hepatitis C antibody tests in LVAD patients, thereby supporting the observation of broad immunologic reactions in these patients. However, there is a lack of information whether such immunologic reaction is limited to a certain laboratory test and whether such an effect is observed temporarily or consistently.In our center, LVAD surgery is performed since more than 20 years with more than 350 cases. We reviewed those patients who had an LVAD (HeartWare or HeartMate II) implanted between September 2011 and September 2013 (n = 37) with regard to hepatitis C (HCV) serology, which was controlled on demand during follow-ups. HCV was tested by ADVIA Centaur XP Anti-HCV Test, Siemens Healthcare Diagnostics, Germany. This test engages the HCV coding antigen c200 and NS5 as well as a synthetic HCV coding core peptide c22 and provides a specificity of 99.9%. In case of positive results, the blood was further analyzed by Anti-HCV Line Immunoblot DeciScan HCV PLUS, Bio-Rad, Germany, as confirmatory test. This immunoblot comprises analysis for the proteins NS3, NS4, C1, and C2.In six patients (five patients with HeartMate II and one patient with HeartWare LVAD), we found positive screening tests for HCV after postoperative intervals of up to 12 months. All these patients were negative for HCV in confirmatory immunoblot testing. Remarkably, on longitudinal analysis, the screening test did not prove to reveal consistent positive results but usually turned to become negative again.Our report is in line with the work of Srivastava et al. 3 and further points out that false-positive hepatitis C reaction and negative confirmatory analyses are not only limited to the tests reported earlier. 3 Even more remarkable, such an immunologic reaction is not constantly found but has the tendency to vanish, leaving the interesting question of immunologic processes initiated by LVAD therapy. However, as already pointed out by Srivastava et al., 3 hepatitis C testing should be carefully performed with regard to decision making toward heart transplantation.
A minority of patients on left ventricular assist devices (LVADs) display myocardial recovery raising the question of device explantation. We report a series of seven LVAD patients with nonischemic cardiomyopathy allowing explantation of the VAD. In case of four patients we overview follow-up periods of 4 to 10 years. Remarkably, in three cases device explantation was considered beyond 1 year of LVAD support. Explantation was finally performed after 20 months and more on the device. In light of the scarcity of donor organs we conclude that patients on LVAD support should be evaluated for possible weaning from the device on a regular basis.
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