Abstract 17545: Effect of Long-Term Circulatory Support on Arterial Wall: Comparison of Histological Findings in Pulsatile and Continuous Flow Blood Pump Recipients

Abstract

Background. Continuous flow (CF) ventricular assist devices (VAD) are an established option for treatment of end-stage heart failure. However, the impact of long-term continuous flow 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 (over 3 years), remains unclear. Methods: Samples of arterial wall (liver, kidney, coronary and cerebral arteries) from a total of 33 autopsies of VAD recipients treated between September 2000 and July 2009 were examined for perivascular infiltrate index, intravascular infiltrate index, wall thickness, thrombosis, entdothelial cell swelling, vessel wall necrosis and perivascular fibrosis. In ten patients (group P) pulsatile devices, and in 23 patients CF devices had been inserted (group CF). The pathologist was blinded to the group distribution. Additionally, clinical course and follow-up data were retrospectively analyzed. Results: Median duration of support in group P was 432 days (range 177-1588 days) and in group CF 351 days (range 182-942 days). There were no differences in doses of ACE-inhibitors, beta-blockers, aldactone and diuretics. During follow-up amiodaron was more often used in the CF group than the P group (61% vs. 10%, p=0.009). Throughout the follow-up period mean arterial pressure did not differ between recipients of the two pump types. Diastolic blood pressure in CF device recipients was lower after 3 months of support only (figure). Histological studies did not recognize any relevant differences in arterial wall characteristics between the two groups. Conclusion: Chronic mechanical circulatory support for up to 4 years with CF devices does not adversely influence arterial wall properties of the end-organ vasculature.