Red blood cell mechanical fragility as potential metric for assessing blood damage caused by implantable durable ventricular assist devices: Comparison of two types of centrifugal flow left ventricular assist devices

Tarasev, Michael; Chakraborty, Sumita; Light, Lucia; Alfano, K.; Pagani, Francis D.

doi:10.1016/j.ppedcard.2020.101198

Cited by 2 publications

(5 citation statements)

References 55 publications

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“…As the causes of blood damage are likely to be different in these two cases, the outcome of such damage is likely to manifest in different hemolytic and sub-hemolytic RBC. Similar to the observations made previously 35 , these results show the importance of selecting and optimizing in vitro applied stress configurations to the nature of the blood damage and outcomes being predicted. This highlights the need for the results based on any single stress application regime or assay method to be interpreted with caution, as they would be unlikely to represent the whole picture.…”

Section: Discussionsupporting

confidence: 85%

“…In another case, elevated hemolytic biomarkers were associated with an unrelated clinical condition, in that case an atypical hemolytic uremic syndrome 54 . We also previously reported higher post-surgery hemolysis with HM3 as compared to HVAD; however, a strong correlation of such hemolysis with cardiopulmonary bypass time suggested that it is likely the procedure and not the device itself that is the proximal cause of the difference 35 .…”

Section: Discussionmentioning

confidence: 78%

“…All implants for both devices were performed through a median sternotomy incision with cardiopulmonary bypass. (Additional details on the operating procedure, as well as a comparison of performance between the two device types in this study, was reported previously 35 .) Mean age was 54±15 years, with 11 subjects having blood type A (55%), and 8 blood type O.…”

Section: Methodsmentioning

confidence: 99%

“…This follows a previous article on this study, which was focused more on the differences in performance between the two devices. 35…”

Section: Introductionmentioning

confidence: 99%

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Red Blood Cell Mechanical Fragility as a Potential Predictor of Long-Term Hemolysis from Ventricular Assist Devices

Tarasev

Chakraborty²,

Alfano

et al. 2022

MRAJ

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Introduction: Recent improvement in design and performance of Left Ventricular Assist Devices facilitate their use for destination therapy. The shear stresses in such devices can damage patients’ red blood cells (RBC), leading to increased hemolysis, which has been associated with pump thrombosis and patient mortality. Here we report an investigation assessing RBC mechanical fragility as a potential metric of blood damage and its potential utility in monitoring LVAD performance. Methods: Twenty subjects were recruited from the Center for Circulatory Support at the University of Michigan. Thirteen were implanted with the HeartWare HVAD (Medtronic, Inc.) and 7 with HeartMate 3® LVAD (HM3; Abbott Labs). Blood samples were obtained before surgery and at 1 hour, 24 hours, 1 week and 4 weeks after. Hemolysis biomarkers, total lactate dehydrogenase (LDH) and LDH isoenzymes, bilirubin, haptoglobin, and serum hemoglobin were determined through standard clinical tests. Mechanical fragility, as a metric of sub-hemolytic RBC damage, was determined using electromagnetically driven bead milling in a tube with a cylindrical bead, combined with non-invasive spectrophotometric analysis of induced hemolysis upon selected durations of the stress application. Certain variations of the stressing regime were employed for comparison. Results: RBC mechanical fragility, as assessed through some of the stress application regimes, was correlated with certain hemolysis metrics like bilirubin, LDH, and LDH1. Specifically, a subset of pre-surgery RBC mechanical fragility markers were strongly correlated with bilirubin levels measured 1 day, 1 week, and 1 month (though not immediately) after the surgery. While such correlation with unconjugated bilirubin declined in significance over time, the correlation to conjugated bilirubin reached significance at 1 month. Mechanical fragility values determined in albumin-supplemented medium at 1-day post-surgery, showed strong correlation to total LDH and LDH1 at 1-month post-surgery (p < 0.01, R2 up to 0.45), with the correlation with LDH1 stronger than with total LDH. Conclusions: These data demonstrate the potential for some RBC mechanical fragility metrics as predictive prognostic biomarkers for hemolysis induced by implantable circulatory support systems. With appropriate tailoring of testing parameters to best suit the application, mechanical fragility assays could help facilitate the transition to greater utilization of ventricular assist devices.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 78%

Section: Methodsmentioning

confidence: 99%

“…This follows a previous article on this study, which was focused more on the differences in performance between the two devices. 35…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Red Blood Cell Mechanical Fragility as a Potential Predictor of Long-Term Hemolysis from Ventricular Assist Devices

Tarasev

Chakraborty²,

Alfano

et al. 2022

MRAJ

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show abstract

“…In this case, long-term mechanical support involves prolonged contact and collision of blood cells with foreign surfaces, as well as very high mechanical loads caused by the rotation of the pump rotor. 1 Despite the high resistance of erythrocytes to mechanical shear stress, prolonged exposure to the pumps circulatory assist causes cellular changes that are similar to the physiological changes that occur in aging erythrocytes during normal circulation, but they occur at an accelerated pace. Such changes lead to thinning of cell membranes, loss of phospholipids, increased membrane permeability, and leakage of lactate dehydrogenase (LDH), hemoglobin, which causes hemolysis.…”

Section: Introductionmentioning

confidence: 99%

The influence of the disk pump of assisted circulation of the left ventricular bypass on hemolytic blood parameters

Olegovna,

Mikhailovich,

Idelevich

2024

MOJAP

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Over the past two decades, rotary circulation pumps have been effectively used to treat patients suffering from chronic heart failure (CHF). However, prolonged contact of blood cells with a foreign surface of the pump can cause hemolysis, thrombosis, bleeding and other disorders. A possible solution to reduce the level of blood cells damage may be the introduction into clinical practice the pumps for maintaining blood circulation with a lower rotor speed - 2000-3000 rpm The purpose of this study was to study the effect of a developed by us disk pump for auxiliary circulation of the left ventricular bypass on hemolytic blood parameters. Methods: A study of the effect of a disk pump of auxiliary blood circulation on human donor blood parameters was conducted using a special simulation stand (n=6) and experiments on laboratory animals (n=3). Results: In studies on donated blood, the level of free hemoglobin (FreeHb) was 0.03±0.1 g/l for 4 hours of the experiment. In animal studies, in the first two days after implantation of the pump, an increase in FreeHb was observed in the range from 0.01±0 to 0.05±0.1 g/l. Further, from the third day to the end of observation, fluctuations in FreeHb in the blood were in the range of 0.03–0.04 g/l. During the same period (1-3 days), there was a significant decrease in hematocrit (Hct), which was restored to background values by the 4th day. The concentrations of sodium, calcium, chlorine ions and blood pH remained virtually unchanged throughout the experiment, and the concentration of potassium tended to increase by the 5th-7th day. Conclusion: The developed prototype of a disc-type auxiliary blood circulation pump for left ventricular bypass did not cause significant hemolytic, electrolyte and acid-base disorders in the blood during 240 minutes of experiment on the stand (in vitro) and during 7 days in an in vivo experiment. It allows to recommend this type of pump for short-term use as a promising heart replacement like a “bridge” to organ transplantation or for unloading the heart in patients with CHF.

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Red blood cell mechanical fragility as potential metric for assessing blood damage caused by implantable durable ventricular assist devices: Comparison of two types of centrifugal flow left ventricular assist devices

Cited by 2 publications

References 55 publications

Red Blood Cell Mechanical Fragility as a Potential Predictor of Long-Term Hemolysis from Ventricular Assist Devices

Red Blood Cell Mechanical Fragility as a Potential Predictor of Long-Term Hemolysis from Ventricular Assist Devices

The influence of the disk pump of assisted circulation of the left ventricular bypass on hemolytic blood parameters

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