Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin.
J Heart Lung Transplant. 2012 Nov;31(11):1171-6. doi: 10.1016/j.healun.2012.08.013. Epub 2012 Sep 18.
Continuous-flow (CF) ventricular assist devices (VAD) are an established option for treatment of end-stage heart failure. However, the effect of long-term CF with lack of peripheral arterial wall motions on blood pressure regulation and end-organ arterial wall sclerosis, especially in the case of long-term support (> 3 years), remains unclear.
Tissue samples obtained at autopsy from liver, kidney, coronary arteries, and brain from 27 VAD recipients supported for > 180 days between 2000 and 2010 were histologically examined to assess vascular alterations, including perivascular infiltrate, intravascular infiltrate, wall thickness, thrombosis, endothelial cell swelling, vessel wall necrosis, and peri-vascular fibrosis. Pulsatile-flow (PF) devices had been inserted in 9 patients and CF devices had been inserted in 16. The pathologist was blinded to the group distribution. Demographic, pharmacologic, and clinical data were retrospectively analyzed before surgery and during the follow-up period of up to 24 months.
Median duration of support was 467 days (range, 235-1,588 days) in the PF group and 263 days (range, 182-942 days) in the CF group. Demographic and clinical data before and after surgery were similar. Amiodarone was more often used during follow-up in CF group than in the PF group (61% vs 10%, p = 0.009). Throughout the follow-up period, mean arterial pressure did not differ between recipients of the 2 pump types, nor did systolic and diastolic pressure, except at 2 weeks after VAD implantation, when systolic blood pressure was higher (p = 0.05) and diastolic lower (p = 0.03) in the PF group. Histologic studies did not identify any relevant differences in arterial wall characteristics between the 2 groups.
Long-term mechanical circulatory support with CF devices does not adversely influence arterial wall properties of the end-organ vasculature.
连续流（CF）心室辅助装置（VAD）是治疗终末期心力衰竭的一种成熟选择。然而，长期缺乏外周动脉壁运动的 CF 对血压调节和终末器官动脉壁硬化的影响尚不清楚，特别是在长期支持（>3 年）的情况下。
对 2000 年至 2010 年间接受>180 天支持的 27 例 VAD 受者的肝、肾、冠状动脉和脑组织样本进行组织学检查，以评估血管改变，包括血管周围浸润、血管内浸润、壁厚度、血栓形成、内皮细胞肿胀、血管壁坏死和血管周围纤维化。9 例患者植入搏动流（PF）装置，16 例患者植入 CF 装置。病理学家对分组分布情况不知情。回顾性分析手术前和随访期间长达 24 个月的人口统计学、药理学和临床数据。
PF 组的中位支持时间为 467 天（范围，235-1588 天），CF 组为 263 天（范围，182-942 天）。手术前后的人口统计学和临床数据相似。CF 组在随访期间更常使用胺碘酮（61%比 10%，p=0.009）。在整个随访期间，两种泵类型的受者之间平均动脉压没有差异，收缩压和舒张压也没有差异，但在 VAD 植入后 2 周，收缩压更高（p=0.05），舒张压更低（p=0.03），PF 组。组织学研究未发现两种类型的动脉壁特征之间存在任何相关差异。
长期使用 CF 装置进行机械循环支持不会对终末器官血管的动脉壁特性产生不利影响。
