Effect of Long-Term Circulatory Support on Arterial Wall: Comparison of Histological Findings in Pulsatile and Continuous Flow Blood Pump Recipients: 2018

Introduction: 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 27 VAD recipients supported for >180 days between 2000 and 2010 were examined for perivascular infiltrate, intravascular infiltrate, wall thickness, thrombosis, endothelial cell swelling, vessel wall necrosis and perivascular fibrosis. In nine patients pulsatile devices (group P), and in 16 patients CF devices had been inserted (group CF). The pathologist was blinded to the group distribution. Demographic, pharmacological and clinical data were retrospectively analyzed before surgery and during the follow -up period of up to 24 months. Results: Median duration of support was in group P 467 days (range 235-1588 days) and in group CF 263 days (range 182-942 days). There were no differences in demographic and clinical data before and after surgery. 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; nor did systolic and diastolic pressure, except at the time point of 2 weeks after VAD implantation (systolic blood pressure was higher (p=0.05) and diastolic lower (p=0.03) in group P). 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.