Loebe M, Gorman K, Burger R, Gage J E, Harke C, Hetzer R
Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Berlin, Germany.
ASAIO J. 1998 Sep-Oct;44(5):M340-6. doi: 10.1097/00002480-199809000-00004.
Contact of blood with artificial surfaces activates pro-inflammatory responses and the complement cascade. This may have broad implications on the post implantation fate of patients needing mechanical circulatory support. Therefore, we investigated the course and prognostic value of complement factors C3a and C5a in 66 patients supported with pulsatile ventricular assist devices. All patients were in severe cardiogenic shock, i.e., catecholamine dependent and in the intensive care unit, before implementation of mechanical circulatory support. Isolated left ventricular support (Novacor [Oakland, CA] or Thermo Cardiosystems, Inc. [TCI; Woburn, MA]) was used in 28 patients, and biventricular support (Berlin Heart [Mediport, Berlin, Germany]) in 38 patients. Before initiation of mechanical circulatory support, no statistically significant differences in C3a or C5a between surviving and nonsurviving patients with left ventricular assist devices (LVADs) were found. Patients with biventricular assist devices (BVADs) had significantly higher C3a (804 +/- 364 ng/L) levels than patients with LVADs (536 +/- 204 ng/L, p = 0.02) before mechanical circulatory support. Only C5a, only in the BVAD group, was able to predict patients' post implantation course before implantation of a ventricular assist device (p = 0.02). Three weeks after initiation of mechanical circulatory support, complement factors remained increased in all groups. There was no difference, however, in complement activation between patients with LVADs and those with BVADs. Patients not reaching transplantation had significantly higher C3a levels at this point than those successfully supported (p = 0.007). The degree of complement activation mainly depends on the severity of cardiogenic shock before initiation of mechanical circulatory support, and not on the device used. Patients with extremely high levels of complement activation before implantation of the device could be saved with BVAD rather than LVAD support. Patients who continued to have highly elevated complement levels 3 weeks after initiation of mechanical circulatory support had unfavorable prognoses. Complement activation indicates the severity of cardiogenic shock before implementation of mechanical circulatory support and the degree of recovery from secondary organ dysfunction while on the device. It is fairly independent of the system used for mechanical circulatory support, and therefore can be applied to predict patients' post implantation course and outcome.
血液与人工表面接触会激活促炎反应和补体级联反应。这可能对需要机械循环支持的患者植入后的预后产生广泛影响。因此，我们调查了66例使用搏动性心室辅助装置的患者中补体因子C3a和C5a的变化过程及其预后价值。所有患者在实施机械循环支持前均处于严重心源性休克状态，即依赖儿茶酚胺且在重症监护病房。28例患者使用了孤立左心室支持装置（Novacor[加利福尼亚州奥克兰]或热控心血管系统公司[TCI；马萨诸塞州沃本]），38例患者使用了双心室支持装置（柏林心脏[德国柏林Mediport]）。在开始机械循环支持前，使用左心室辅助装置（LVAD）的存活患者和非存活患者之间，C3a或C5a无统计学显著差异。在机械循环支持前，使用双心室辅助装置（BVAD）的患者C3a水平（804±364 ng/L）显著高于使用LVAD的患者（536±204 ng/L，p = 0.02）。仅在BVAD组中，C5a能够在植入心室辅助装置前预测患者的植入后病程（p = 0.02）。机械循环支持开始三周后，所有组的补体因子仍升高。然而，使用LVAD的患者和使用BVAD的患者之间在补体激活方面没有差异。此时未达到移植标准的患者C3a水平显著高于成功获得支持治疗的患者（p = 0.007）。补体激活程度主要取决于开始机械循环支持前的心源性休克严重程度，而非所使用的装置。在植入装置前补体激活水平极高的患者，使用BVAD而非LVAD支持可能挽救生命。在机械循环支持开始三周后补体水平持续高度升高的患者预后不良。补体激活表明在实施机械循环支持前的心源性休克严重程度以及在使用装置期间继发器官功能障碍的恢复程度。它与用于机械循环支持的系统相当独立，因此可用于预测患者植入后的病程和结局。
