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DOI: 10.1055/s-2005-922365
Effect of pulsatile and nonpulsatile left ventricular assist devices on the neuroendocrine system
Introduction: Congestive heart failure can be associated with an activation of the neuroendocrine system usually reversible under medical treatment. The aim of the present study was to examine the reversibility of neuroendocrine activation under mechanical left ventricular support.
Methods: We prospectively studied 20 patients undergoing LVAD implantation. Ten patients were treated with the nonpulsatile INCOR-LVAD (Berlin Heart©) and ten Patients received the pulsatile EXCOR-LVAD (Berlin Heart©). Patients were included after being taken off inotropic medications and mechanical ventilation. Blood samples for renin (PRA), aldosteron, ADH, adrenalin, noradrenalin, sodium and potassium were taken over a period of ten weeks once a week.
Results: Although there was no significant difference in mean blood pressure (INCOR: 70±10mmHg; EXCOR: 73±10mmHg), PRA was substantially elevated in patient with non-pulsatile LV support (INCOR: 94.68±33.97µU/ml; EXCOR: 17.06±15.94µU/ml; p<0.05). Plasma aldosteron levels as well as adrenalin levels were also significantly higher in patients supported with the nonpulsatile LVAD (Adrenalin: INCOR: 64.4±10 pg/ml; EXCOR: 41.6±9.3µg/ml, p<0.05; Aldosteron: INCOR: 73.4±9.6µg/ml; EXCOR: 20.6±4.6µg/ml, p<0.05). There were no statistically significant differences between the two groups with regard to plasma ADH and noradrenalin levels.
Discussion: Our data suggest that the activation of the neuroendocrine system observed in chronic heart failure is reversible under mechanical ventricular support. However pulsatile ventricular assist devices seem to be more potent in reducing plasma levels of vasoconstrictors.