PMID- 31760240
OWN - NLM
STAT- MEDLINE
DCOM- 20200325
LR  - 20200325
IS  - 1879-1336 (Electronic)
IS  - 1054-8807 (Linking)
VI  - 44
DP  - 2020 Jan-Feb
TI  - In vivo tissue reaction within the outflow conduit in patients supported by 
      HeartWare HVAD.
PG  - 107156
LID - S1054-8807(19)30321-7 [pii]
LID - 10.1016/j.carpath.2019.107156 [doi]
AB  - AIM: The frequency, extent, and nature of tissue ingrowth within the 
      continuous-flow left ventricular assist device (cf-LVAD) outflow conduit has not 
      been systematically assessed. We sought to characterize conduit histopathology at 
      explantation in a cohort of patients with HeartWare ventricular assist device 
      (HVAD) and assess the effect on pump performance. METHODS: Patients undergoing 
      routine histopathological assessment of a HeartWare HVAD removed at 
      transplantation or autopsy were assessed. Outflow conduits were examined 
      macroscopically, and visible tissue was sectioned for microscopic evaluation. In 
      patients who had undergone prior contrast-enhanced computerized tomography (CT) 
      with HVAD in situ, the outflow conduit was measured at the aortic anastomosis and 
      5 cm proximal to the anastomosis, in the axial and sagittal planes. All patients 
      had their pump flow, flow pulsatility, current, and speed determined from log 
      files examined at 1, 3, 6, 9, and 12 months after LVAD implantation. RESULTS: 
      Twenty-five consecutive patients were assessed (24 LVAD, 1 biventricular assist 
      device (BiVAD)). Of the 26 outflow grafts assessed, there was evidence of tissue 
      ingrowth reaction in 24 (92%) grafts. The most common site was the distal 
      anastomosis (18/24, 75%), with the graft body involved in 14 of 24 (58%) grafts. 
      Microscopic evaluation revealed acute inflammatory infiltrate in 4 of 24 grafts 
      (17%), chronic inflammatory infiltrate in 14 of 24 (58%), neointima formation in 
      18 of 24 (75%) and fibrosis in 18 of 24 (75%) grafts. The median depth of tissue 
      was 1 mm (range, 0-2 mm). The mean conduit diameter was 9.5 +/- 0.6 mm at the 
      aortic anastomosis compared with 11.1 +/- 0.5 mm 5 cm proximal to the anastomosis 
      (p < 0.0001). In patients with unchanged pump speed one month after implantation, 
      analysis of log files revealed a significant (5.8 +/- 8.6%) decrease in pump flow 
      (4.65 +/- 0.86 vs 4.38 +/- 0.92 L/min, p = 0.01) and flow pulsatility (5.00 +/- 1.10 vs 
      4.16 +/- 1.05 L/min, p = 0.006). CONCLUSIONS: There is evidence of tissue formation 
      within the HVAD outflow conduit in the vast majority of patients, most commonly 
      located at the aortic anastomosis. This is associated with significantly 
      decreased pump flow over time.
CI  - Crown Copyright (c) 2019. Published by Elsevier Inc. All rights reserved.
FAU - Jain, P
AU  - Jain P
AD  - Cardiology Department, St Vincent's Hospital, Sydney, Australia; University of 
      New South Wales, Sydney, Australia.
FAU - Robson, D
AU  - Robson D
AD  - Cardiology Department, St Vincent's Hospital, Sydney, Australia.
FAU - Shehab, S
AU  - Shehab S
AD  - Victor Chang Cardiac Research Institute, Sydney, Australia.
FAU - Muthiah, K
AU  - Muthiah K
AD  - Cardiology Department, St Vincent's Hospital, Sydney, Australia; Victor Chang 
      Cardiac Research Institute, Sydney, Australia.
FAU - Jansz, P
AU  - Jansz P
AD  - Cardiology Department, St Vincent's Hospital, Sydney, Australia.
FAU - Qiu, M R
AU  - Qiu MR
AD  - Anatomical Pathology Department, St Vincent's Hospital, Sydney, Australia.
FAU - Barrett, W
AU  - Barrett W
AD  - Anatomical Pathology Department, St Vincent's Hospital, Sydney, Australia.
FAU - Sivasubramaniam, V
AU  - Sivasubramaniam V
AD  - Anatomical Pathology Department, St Vincent's Hospital, Sydney, Australia.
FAU - Kumaradevan, N
AU  - Kumaradevan N
AD  - Anatomical Pathology Department, St Vincent's Hospital, Sydney, Australia.
FAU - Macdonald, P S
AU  - Macdonald PS
AD  - Cardiology Department, St Vincent's Hospital, Sydney, Australia; University of 
      New South Wales, Sydney, Australia; Victor Chang Cardiac Research Institute, 
      Sydney, Australia.
FAU - Hayward, C S
AU  - Hayward CS
AD  - Cardiology Department, St Vincent's Hospital, Sydney, Australia; University of 
      New South Wales, Sydney, Australia; Victor Chang Cardiac Research Institute, 
      Sydney, Australia. Electronic address: cshayward@stvincents.com.au.
LA  - eng
PT  - Journal Article
DEP - 20191010
PL  - United States
TA  - Cardiovasc Pathol
JT  - Cardiovascular pathology : the official journal of the Society for Cardiovascular 
      Pathology
JID - 9212060
SB  - IM
MH  - Autopsy
MH  - Device Removal
MH  - Female
MH  - Foreign-Body Reaction/*etiology/pathology
MH  - Heart Failure/pathology/physiopathology/*therapy
MH  - *Heart-Assist Devices
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardium/*pathology
MH  - Prosthesis Design
MH  - Prosthesis Implantation/*adverse effects/*instrumentation
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Ventricular Function, Left
OTO - NOTNLM
OT  - Continuous-flow left ventricular assist device
OT  - Foreign body
OT  - Outflow conduit
OT  - Pump flow
OT  - Tissue reaction
EDAT- 2019/11/25 06:00
MHDA- 2020/03/26 06:00
CRDT- 2019/11/25 06:00
PHST- 2019/08/01 00:00 [received]
PHST- 2019/09/23 00:00 [revised]
PHST- 2019/09/24 00:00 [accepted]
PHST- 2019/11/25 06:00 [pubmed]
PHST- 2020/03/26 06:00 [medline]
PHST- 2019/11/25 06:00 [entrez]
AID - S1054-8807(19)30321-7 [pii]
AID - 10.1016/j.carpath.2019.107156 [doi]
PST - ppublish
SO  - Cardiovasc Pathol. 2020 Jan-Feb;44:107156. doi: 10.1016/j.carpath.2019.107156. 
      Epub 2019 Oct 10.