A novel link between G6PD deficiency and hemolysis in patients with continuous-flow left ventricular assist devices

Alhosaini, Hassan; Jensen, Brian C.; Chang, Patricia P.; Sheridan, Brett C.; Katz, Jason N.

doi:10.1016/j.healun.2013.10.028

Cited by 6 publications

(1 citation statement)

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“…However, many other factors, such as oxidative stress, medications, and infections contribute to the process of hemolysis. 4,33,34) NO is continuously synthesized in the endothelium and has many functions, such as the regulation of homeostatic vascular functions through vasodilation and inhibition of platelet activation and thrombosis. 35,36) Elevated fHb, as it appears in hemolysis conditions, increases the scavenging of NO and enhances its consumption, resulting in several cellular dysfunctions, such as vasoconstriction, platelet activation and systemic and pulmonary hypertension, in patients with hemolytic disorders.…”

Section: Discussionmentioning

confidence: 99%

Sildenafil Reduces the Risk of Thromboembolic Events in HeartMate II Patients with Low-Level Hemolysis and Significantly Improves the Pulmonary Circulation

Zayat¹,

Ahmad²,

Stoppe³

et al. 2018

Int. Heart J.

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Low-level hemolysis (LLH) after left ventricular assist device implantation contributes to thromboembolic events (TE). Free plasma hemoglobin (fHb) scavenges nitric oxide (NO), which causes endothelial dysfunction and activates platelets. fHb also interacts with von Willebrand factor (vWF). We hypothesized that improved hemodynamic and enhanced NO signaling in HeartMate II (HMII) patients with LLH taking the phosphodiesterase-5 inhibitor sildenafil may reduce the risk of TE. From 2011 to 2015, 83 patients underwent HMII implantation. Patients with LLH as defined by elevated lactate dehydrogenase (400 < LDH ! 700 U/L) at hospital discharge were identified. Patients were categorized into 4 groups: 1) LLH + sildenafil, 2) LLH no sildenafil, 3) no LLH + sildenafil, and 4) no LLH no sildenafil. Adverse event-free survival was compared between the groups. Thirty-four patients (40.9%) were discharged with LLH and 22 (64.7%) of them took sildenafil. LDH and fHb remained significantly elevated in both LLH groups compared to the no LLH patients (P < 0.0001). Overall incidence of pump thrombosis (PT) was 4.8% and of ischemic stroke (IS) was 8.4%. HMII patients with LLH not on sildenafil had higher risk of TE (hazard ratio (HR): 14.4, 95%-CI: 1.8-117.1, P = 0.001). vWF activity and bleeding incidence did not differ between the LLH and no LLH patients. Mean pulmonary artery pressure and pulmonary vascular resistance decreased significantly in HMII taking sildenafil (P < 0.0001) while cardiac index increased (P < 0.0001). Sildenafil treatment among HMII patients with LLH reduced the risk of thromboembolic events and significantly improved and decompressed the pulmonary circulation during HMII support.

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