Lack of Sensitization and Equivalent Post-transplant Outcomes With the Novacor Left Ventricular Assist Device

Allosensitization in bridge to transplant Novacor left ventricular assist device patients: analysis of long-term outcomes with regard to acute rejection and chronic allograft vasculopathy☆

“…In our experience, our unselected LVAD bridge -to transplant patients had an excellent 81% survival rate to transplantation, a rate that compares favorably to recent published series where rates from 49% to 66.7% were reported [10,21].…”

“…With the use of coronary angiography, CAV is usually classified as absent, mild, moderate, or severe according to the amount of stenosis in the most severely affected vessel. In this study, our definition of significant CAV was a lesion greater than 50% of a proximal or mid portion of one major coronary graft vessel [10,19,20]. In order to precisely determine the date of occurrence of graft vasculopathy, all angiographies were serially reviewed and compared with each patient's prior exam.…”

“…Left ventricular assist devices, due to their specific physical properties, their blood-contacting surface and the frequent need for blood product support [3,4], have been shown to be responsible for allosensitization through upregulation of the immune system and an increased antibody production [5,6], though its true impact on transplantation outcome is still a matter of debate [7][8][9][10][11][12][13]. Allosensitization can translate into an increase in cellular and/or humoral immunity [5,6], putting the transplant recipient at risk for both acute and chronic rejection.…”

Allosensitization and the Ventricular Assist Device: Dual Evolution of Technology

“…Another group [16] undertook a propensity matched study of 231 patients who received either the HeartMate I (n=166) or Novacor (n=55) device. In contrast to Baran [15], this group observed no differential rate of sensitization in a much larger patient population. However, they did report a general rapid, but small increase in PRA in the immediate post-VAD implantation period that decreased over time.…”

“…The early reports compared the pulsatile pumps with one another. Baran [15] assessed sensitization in a series of 23 patients who received the Novacor (Worldheart, Ottawa) device prior to transplant as opposed to the HeartMate for which previous high PRA had been reported. They note that the HeartMate I was made of textured titanium that develops a neointimal lining that averts the need for systemic anti-coagulation.…”