Reduced continuous-flow left ventricular assist device speed does not decrease von Willebrand factor degradation Jooeun Kang, BA, David M. Zhang, David.

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Presentation transcript:

Reduced continuous-flow left ventricular assist device speed does not decrease von Willebrand factor degradation Jooeun Kang, BA, David M. Zhang, David J. Restle, BSE, Faouzi Kallel, PhD, Michael A. Acker, MD, Pavan Atluri, MD, Carlo R. Bartoli, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 151, Issue 6, Pages 1747-1754.e1 (June 2016) DOI: 10.1016/j.jtcvs.2016.01.031 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, The LVAD mock circulatory loop. B, Schematic of the LVAD mock circulatory loop. LVAD, Left ventricular assist device. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1747-1754.e1DOI: (10.1016/j.jtcvs.2016.01.031) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Paired blood samples from a single patient before and after HeartMate II continuous-flow LVAD implantation demonstrated reduced large vWF multimers and increased small vWF multimers (agarose blot), as well as significantly increased vWF degradation fragments (polyacrylamide blot). *Immmunoblots in Figures 2-5 represent duplicate samples studied with 2 different methods: (1) agarose gel electrophoresis to resolve high-molecular-weight vWF multimers, and (2) polyacrylamide gel electrophoresis to resolve small vWF degradation fragments. LVAD, Left ventricular assist device; vWF, von Willebrand factor. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1747-1754.e1DOI: (10.1016/j.jtcvs.2016.01.031) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Human blood circulated through a HeartMate II mock circulatory loop at 11,400 rpm demonstrated significant vWF degradation. Compared with 10,000 and 8600 rpm, vWF degradation was not statistically different. LVAD, Left ventricular assist device; vWF, von Willebrand factor. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1747-1754.e1DOI: (10.1016/j.jtcvs.2016.01.031) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Human blood circulated through a HeartMate II mock circulatory loop at 10,000 rpm demonstrated significant vWF degradation. Compared with 11,400 and 8600 rpm, vWF degradation was not statistically different. LVAD, Left ventricular assist device; vWF, von Willebrand factor. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1747-1754.e1DOI: (10.1016/j.jtcvs.2016.01.031) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Human blood circulated through a HeartMate II mock circulatory loop at 8600 rpm demonstrated significant vWF degradation. Compared with 11,400 and 10,000 rpm, vWF degradation was not statistically different. LVAD, Left ventricular assist device; vWF, von Willebrand factor. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1747-1754.e1DOI: (10.1016/j.jtcvs.2016.01.031) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 The total fold change for vWF degradation across all vWF degradation fragments in LVAD patients and in an LVAD mock circulatory loop with whole human blood during different rpm conditions. Fold change was significantly elevated between baseline and each group. Fold change was not significantly different across groups. LVAD, Left ventricular assist device; vWF, von Willebrand factor. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1747-1754.e1DOI: (10.1016/j.jtcvs.2016.01.031) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 The relationship between HeartMate II speed and wall shear stress is shown at different rpms. The instantaneous shear stress at a single location between the impellar and pump housing was modeled by computational fluid modeling. Reduced LVAD speed produced a modest decrease in shear stress. However, speeds within the clinical operational range did not approach physiologic levels of shear stress. Thoratec Corporation independently generated and provided these data prior to this study. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1747-1754.e1DOI: (10.1016/j.jtcvs.2016.01.031) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Jooeun Kang, BA, and Carlo R. Bartoli, MD, PhD The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1747-1754.e1DOI: (10.1016/j.jtcvs.2016.01.031) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions