Löffler Christoph, Straub Andreas, Bassler Nicole, Pernice Katharina, Beyersdorf Friedhelm, Bode Christoph, Siegenthaler Michael P, Peter Karlheinz
Department of Cardiology and Angiology, University Hospital, Albert-Ludwigs-University, Freiburg, Germany.
J Thorac Cardiovasc Surg. 2009 Mar;137(3):736-41. doi: 10.1016/j.jtcvs.2008.09.019.
The Jarvik 2000 (Jarvik Heart, Inc, New York, NY) is a thumb-sized high-speed impeller pump that is used as a ventricular assist device in patients with terminal heart failure. Because the Jarvik 2000 is designed for long-term use, it is a central question whether the mechanical forces inside the pump affect blood components. This study evaluated the potential association of the high rotational speed of the Jarvik 2000 with platelet activation, which may result in thromboembolic events.
The study group comprised patients with terminal heart failure who were supported with the Jarvik 2000. All were men and received 100 mg aspirin daily. In 8 patients, soluble platelet activation markers (P-selectin and sCD40L), platelet counts, and hemolysis markers (haptoglobin and lactate dehydrogenase levels) were determined. In 5 patients, P-selectin expression and platelet receptor glycoprotein IIb/IIIa activation were determined with flow cytometry and compared with a control group of 5 healthy men. Platelet activation was measured at various rotational device speeds.
After Jarvik 2000 implantation, increased hemolysis was observed, but platelet activation markers and platelet counts were not affected. Increased rotational speed (8000 to 12,000 rpm) of the device also did not result in increased platelet activation.
The Jarvik 2000 was not associated with detectable platelet activation, despite high rotational impeller speeds.
Jarvik 2000（纽约州纽约市Jarvik Heart公司）是一种拇指大小的高速叶轮泵，用作终末期心力衰竭患者的心室辅助装置。由于Jarvik 2000设计用于长期使用，泵内的机械力是否会影响血液成分是一个核心问题。本研究评估了Jarvik 2000的高转速与血小板活化之间的潜在关联，血小板活化可能导致血栓栓塞事件。
研究组包括接受Jarvik 2000支持的终末期心力衰竭患者。所有患者均为男性，每天服用100 mg阿司匹林。测定了8例患者的可溶性血小板活化标志物（P-选择素和可溶性CD40配体）、血小板计数和溶血标志物（触珠蛋白和乳酸脱氢酶水平）。对5例患者采用流式细胞术测定P-选择素表达和血小板受体糖蛋白IIb/IIIa活化情况，并与5名健康男性组成的对照组进行比较。在不同的装置转速下测量血小板活化情况。
植入Jarvik 2000后，观察到溶血增加，但血小板活化标志物和血小板计数未受影响。装置转速增加（8000至12,000转/分钟）也未导致血小板活化增加。
尽管叶轮转速很高，但Jarvik 2000与可检测到的血小板活化无关。
