Arterial wall histology in chronic pulsatile-flow and continuous-flow device circulatory support

Potapov, Evgenij; Dranishnikov, N.; Morawietz, Lars; Stepanenko, Alexander; Rezai, Sajjad; Blechschmidt, Cristiane; Lehmkuhl, H.; Weng, Yuguo; Pašić, Miralem; Hübler, Michael; Hetzer, Roland; Krabatsch, Thomas

doi:10.1016/j.healun.2012.08.013

Cited by 33 publications

(16 citation statements)

References 18 publications

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“…2 The duration of CF-LVAD support was similar in our study, but we focused on alterations within the aorta-the arterial vessel that is normally exposed to the greatest magnitude of pulsatility from left ventricular contraction. It is unknown if distal arterial vessels may be susceptible to the changes we observed in the aorta if exposed to nonpulsatile flow for a longer period of time.…”

Section: Discussionmentioning

confidence: 95%

Changes in Aortic Wall Structure, Composition, and Stiffness With Continuous-Flow Left Ventricular Assist Devices

Ambardekar

Hunter

Babu

et al. 2015

Circ: Heart Failure

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Background— The effects of nonpulsatile flow on the aorta are unknown. Our aim was to examine the structure of the aorta from patients with continuous-flow left ventricular assist devices (LVADs) and directly measure aortic wall composition and stiffness. Methods and Results— Age-matched aortic wall samples were collected from consecutive patients with heart failure (HF) at the time of transplantation and compared with nonfailing donor hearts. An unbiased stereological approach was used to quantify aortic morphometry and composition, and biomechanical testing was performed to determine the stress–strain relationship of the vessel. Data were obtained from 4 patients without a left ventricular assist device (HF group: mean age, 58.3±8.0 years), 7 patients with a continuous-flow LVAD (HF+LVAD group: mean, 57.7±5.6 years), and 3 nonfailing donors (mean, 53.3±12.9 years). Compared with HF, the aortic walls from HF+LVAD had an increase in wall thickness, collagen, and smooth muscle content accompanied by a reduction in elastin and mucinous ground-substance content. Stress–strain curves from the aortas revealed increased vessel stiffness in HF+LVAD compared with HF and nonfailing. The physiological modulus of the aorta progressively stiffened from 74.3±5.5 kPa in the nonfailing to 134.4±35.0 kPa in the HF to 201.7±36.4kPa in the HF+LVAD groups ( P <0.001). Conclusions— Among continuous-flow LVAD patients without aortic valve opening, there are changes in the structure and composition of the aorta as well as an increase in aortic wall stiffness compared with age-matched HF patients and nonfailing donors. Further studies examining the role of nonpulsatile blood flow on aortic function and the potential resultant systemic sequelae are needed.

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Section: Discussionmentioning

confidence: 95%

Changes in Aortic Wall Structure, Composition, and Stiffness With Continuous-Flow Left Ventricular Assist Devices

Ambardekar

Hunter

Babu

et al. 2015

Circ: Heart Failure

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“…We found no changes in the thickness of the aortic intima or media relating to duration of CF-LVAD support, in agreement with some of them. 23, 25 A recent aortic wall histology study from Colorado, however, reported that heart failure patients supported with CF-LVAD had increased aortic wall thickness, when compared with heart failure patients without CF-LVAD and non-failing donors. 24 Further study is needed to resolve the controversial result between the clinical and histological findings, and it is necessary to prove whether clinical signs of progressive aortic dilatation are related to aortic wall thinning or to other mechanisms such as derangement of cell structures in the medial layer.…”

Section: Aortic Wall Histologymentioning

confidence: 99%

Aortic Valve Pathology in Patients Supported by Continuous-Flow Left Ventricular Assist Device

Saito

Wassilew

Gorodetski

et al. 2016

Circ J

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“…While one autopsy study found no histological changes in various vascular beds between CF-and PF-VAD patients, 48 another revealed an increase in medial degeneration, smooth muscle cell depletion, elastic fiber fragmentation, and medial fibrosis in the aorta in CF-VAD patients. 49 Clinical studies are limited but suggestive of worsening endothelial function with CF-LVADs utilizing flow-mediated vasodilation 50 and reactive hyperemia index.…”

Section: Endothelial Functionmentioning

confidence: 92%

“…1 Though autopsy studies did not show significant histological changes in the brain arterial circulation in CF-LVAD patients compared to PF patients, 29 functional alterations cannot be ruled out. Women have a higher incidence of neurological complications, 30 raising the possibility of a hormonal impact on arterial biology in the presence of CF.…”

Section: Cerebral Functionmentioning

confidence: 95%

Physiological Impact of Continuous Flow on End-Organ Function: Clinical Implications in the Current Era of Left Ventricular Assist Devices

Bhimaraj¹,

Uribe²,

Suarez

2015

Methodist DeBakey Cardiovascular Journal

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Arterial wall histology in chronic pulsatile-flow and continuous-flow device circulatory support

Cited by 33 publications

References 18 publications

Changes in Aortic Wall Structure, Composition, and Stiffness With Continuous-Flow Left Ventricular Assist Devices

Changes in Aortic Wall Structure, Composition, and Stiffness With Continuous-Flow Left Ventricular Assist Devices

Aortic Valve Pathology in Patients Supported by Continuous-Flow Left Ventricular Assist Device

Physiological Impact of Continuous Flow on End-Organ Function: Clinical Implications in the Current Era of Left Ventricular Assist Devices

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