Transistory immunologic response after implantation of Debakey VAD continous-axial-flow-pump

Abstract

Background: The development of local systemic infection is a significant risk factor associated with ventricular assist device (VAD) implantation. The immunological consequences of continous-flow rotary blood pumps is not known. Methods: 6 male adult patients (mean age 47 /10.3) suffering from end-stage left heart failure were implanted with DeBakey VAD axial-flow pump for the use as bridge to tranplantation ( 4 patients were transplanted after a mean 115 /14 days, 2 patients are still waiting for the allograft). We prospectively monitored T-cell populations and apoptosis specific aberrant T-cell activation via CD95 triggering and annexin V binding to lymphocytes (FACS analysis), identifying T cells undergoing early phases of apoptosis, within the first 10 weeks. Moreover soluble death inducing receptors (DIR) sCD95, sTNF-R1 were evaluated by ELISA. Results: Patients bridged by non-pulsatile VAD to transplantation demonstrate a initial pronounced apoptosis specific immunealteration as demonstrated by increased annexin V binding to CD3 positive T cells (prior implantation 18 /8.5 %, 4th week 41.4 /9.3%, 7th week 10.8 /3%) and DIR sCD95 (1.32 /0.21ng, 7.6 /4.2ng, 0.9 /0.7ng), sTNF-R1 (1.5 /0.23ng, 10 /6.9ng, 2.1 /0.8ng) (all p 0.001). All parameters normalized after 7 weeks to baseline. No blood born sepsis was detected, as defined by blood culture, within the first 10 weeks of the study cohort. Conclusions: These results indicate a biphasic immunologic response in patients suffering of end-stage heart failure patients treated with non-pulsatile ventricular assist devices.