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Nascimbene A, Bark D, Smadja DM. Hemocompatibility and biophysical interface of left ventricular assist devices and total artificial hearts. Blood 2024; 143:661-672. [PMID: 37890145 PMCID: PMC10900168 DOI: 10.1182/blood.2022018096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
ABSTRACT Over the past 2 decades, there has been a significant increase in the utilization of long-term mechanical circulatory support (MCS) for the treatment of cardiac failure. Left ventricular assist devices (LVADs) and total artificial hearts (TAHs) have been developed in parallel to serve as bridge-to-transplant and destination therapy solutions. Despite the distinct hemodynamic characteristics introduced by LVADs and TAHs, a comparative evaluation of these devices regarding potential complications in supported patients, has not been undertaken. Such a study could provide valuable insights into the complications associated with these devices. Although MCS has shown substantial clinical benefits, significant complications related to hemocompatibility persist, including thrombosis, recurrent bleeding, and cerebrovascular accidents. This review focuses on the current understanding of hemostasis, specifically thrombotic and bleeding complications, and explores the influence of different shear stress regimens in long-term MCS. Furthermore, the role of endothelial cells in protecting against hemocompatibility-related complications of MCS is discussed. We also compared the diverse mechanisms contributing to the occurrence of hemocompatibility-related complications in currently used LVADs and TAHs. By applying the existing knowledge, we present, for the first time, a comprehensive comparison between long-term MCS options.
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Affiliation(s)
- Angelo Nascimbene
- Advanced Cardiopulmonary Therapies and Transplantation, University of Texas, Houston, TX
| | - David Bark
- Division of Hematology and Oncology, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO
| | - David M. Smadja
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department, Assistance Publique–Hôpitaux de Paris, Georges Pompidou European Hospital, Paris, France
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Poitier B, Chocron R, Peronino C, Philippe A, Pya Y, Rivet N, Richez U, Bekbossynova M, Gendron N, Grimmé M, Bories MC, Brichet J, Capel A, Rancic J, Vedie B, Roussel JC, Jannot AS, Jansen P, Carpentier A, Ivak P, Latremouille C, Netuka I, Smadja DM. Bioprosthetic Total Artificial Heart in Autoregulated Mode Is Biologically Hemocompatible: Insights for Multimers of von Willebrand Factor. Arterioscler Thromb Vasc Biol 2022; 42:470-480. [PMID: 35139659 DOI: 10.1161/atvbaha.121.316833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Carmat bioprosthetic total artificial heart (Aeson; A-TAH) is a pulsatile and autoregulated device. The aim of this study is to evaluate level of hemolysis potential acquired von Willebrand syndrome after A-TAH implantation. METHODS We examined the presence of hemolysis and acquired von Willebrand syndrome in adult patients receiving A-TAH support (n=10) during their whole clinical follow-up in comparison with control subjects and adult patients receiving Heartmate II or Heartmate III support. We also performed a fluid structure interaction model coupled with computational fluid dynamics simulation to evaluate the A-TAH resulting shear stress and its distribution in the blood volume. RESULTS The cumulative duration of A-TAH support was 2087 days. A-TAH implantation did not affect plasma free hemoglobin over time, and there was no association between plasma free hemoglobin and cardiac output or beat rate. For VWF (von Willebrand factor) evaluation, A-TAH implantation did not modify multimers profile of VWF in contrast to Heartmate II and Heartmate III. Furthermore, fluid structure interaction coupled with computational fluid dynamics showed a gradually increase of blood damage according to increase of cardiac output (P<0.01), however, the blood volume fraction that endured significant shear stresses was always inferior to 0.03% of the volume for both ventricles in all regimens tested. An inverse association between cardiac output, beat rate, and high-molecular weight multimers ratio was found. CONCLUSIONS We demonstrated that A-TAH does not cause hemolysis or AWVS. However, relationship between HMWM and cardiac output depending flow confirms relevance of VWF as a biological sensor of blood flow, even in normal range.
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Affiliation(s)
- Bastien Poitier
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France (B.P., A.C., C.L.).,Cardiac Surgery Department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (B.P., A.C., C.L.).,Carmat SAS, Velizy-Villacoublay, France (B.P., U.R., M.G., A.C., P.J.)
| | - Richard Chocron
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Emergency department, AP-HP, Georges Pompidou European Hospital, France (R.C.)
| | - Christophe Peronino
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | - Aurélien Philippe
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | - Yuri Pya
- National Research Cardiac, Surgery Center, Nur-Sultan, Kazakhstan (Y.P., M.B.)
| | - Nadia Rivet
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | - Ulysse Richez
- Carmat SAS, Velizy-Villacoublay, France (B.P., U.R., M.G., A.C., P.J.).,Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | | | - Nicolas Gendron
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | - Marc Grimmé
- Carmat SAS, Velizy-Villacoublay, France (B.P., U.R., M.G., A.C., P.J.)
| | - Marie Cécile Bories
- Université de Paris, Cardiac Surgery Department, AP-HP, Georges Pompidou European Hospital, France (M.C.B.)
| | - Julie Brichet
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | - Antoine Capel
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France (B.P., A.C., C.L.).,Cardiac Surgery Department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (B.P., A.C., C.L.)
| | - Jeanne Rancic
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | - Benoit Vedie
- AP-HP, Biochemistry Department, Georges Pompidou European Hospital, France (B.V.)
| | - Jean Christian Roussel
- Cardiac and thoracic Surgery Department, CHU de Nantes, hôpital Nord Laënnec, boulevard Jacques-Monod, France (J.C.R.)
| | - Anne-Sophie Jannot
- Department of Bioinformatics, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (A.-S.J.)
| | | | - Alain Carpentier
- Carmat SAS, Velizy-Villacoublay, France (B.P., U.R., M.G., A.C., P.J.)
| | - Peter Ivak
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.I., I.N.)
| | - Christian Latremouille
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France (B.P., A.C., C.L.).,Cardiac Surgery Department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (B.P., A.C., C.L.)
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.I., I.N.)
| | - David M Smadja
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
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Dlouha D, Ivak P, Netuka I, Benesova S, Tucanova Z, Hubacek JA. An Integrative Study of Aortic mRNA/miRNA Longitudinal Changes in Long-Term LVAD Support. Int J Mol Sci 2021; 22:ijms22147414. [PMID: 34299034 PMCID: PMC8303892 DOI: 10.3390/ijms22147414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/27/2021] [Accepted: 07/07/2021] [Indexed: 12/16/2022] Open
Abstract
Studying the long-term impact of continuous-flow left ventricular assist device (CF-LVAD) offers an opportunity for a complex understanding of the pathophysiology of vascular changes in aortic tissue in response to a nonphysiological blood flow pattern. Our study aimed to analyze aortic mRNA/miRNA expression changes in response to long-term LVAD support. Paired aortic samples obtained at the time of LVAD implantation and at the time of heart transplantation were examined for mRNA/miRNA profiling. The number of differentially expressed genes (Pcorr < 0.05) shared between samples before and after LVAD support was 277. The whole miRNome profile revealed 69 differentially expressed miRNAs (Pcorr < 0.05). Gene ontology (GO) analysis identified that LVAD predominantly influenced genes involved in the extracellular matrix and collagen fibril organization. Integrated mRNA/miRNA analysis revealed that potential targets of miRNAs dysregulated in explanted samples are mainly involved in GO biological process terms related to dendritic spine organization, neuron projection organization, and cell junction assembly and organization. We found differentially expressed genes participating in vascular tissue engineering as a consequence of LVAD duration. Changes in aortic miRNA levels demonstrated an effect on molecular processes involved in angiogenesis.
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Affiliation(s)
- Dana Dlouha
- Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic;
- Correspondence: ; Tel.: +420-261-362-229
| | - Peter Ivak
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic; (P.I.); (I.N.); (Z.T.)
- Department of Physiology, 3rd Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
- Second Department of Surgery, Department of Cardiovascular Surgery, 1st Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic; (P.I.); (I.N.); (Z.T.)
- Second Department of Surgery, Department of Cardiovascular Surgery, 1st Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Sarka Benesova
- Laboratory of Informatics and Chemistry, Faculty of Chemical Technology, University of Chemistry and Technology, 166 28 Prague, Czech Republic;
- Laboratory of Gene Expression, Institute of Biotechnology CAS, BIOCEV, 252 50 Vestec, Czech Republic
| | - Zuzana Tucanova
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic; (P.I.); (I.N.); (Z.T.)
| | - Jaroslav A. Hubacek
- Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic;
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
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