Details

Autor(en) / Beteiligte

• Mankad, Anit K., MD
• Tang, Daniel G., MD
• Clark, William B., MD, MS
• Flattery, Maureen, NP
• Harton, Suzanne, NP
• Katlaps, Gundars J., MD
• Stribling, Warren K., MD
• Cooke, Richard H., MD
• Hess, Michael L., MD
• Kasirajan, Vigneshwar, MD
• Shah, Keyur B., MD

Titel

Persistent Anemia After Implantation of the Total Artificial Heart

Ist Teil von

• Journal of cardiac failure, 2012-06, Vol.18 (6), p.433-438

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2012

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Background The total artificial heart (TAH) replaces the heart with 2 pneumatic pumps and 4 tilting disk mechanical valves. It was hypothesized that patients receiving TAH support have persistent hemolysis that resolves after heart transplantation (HT). Methods and Results Hematocrit (HCT) was compared in patients on TAH to left ventricular assist device (LVAD) support for bridge to HT. Data were compared with t tests. The TAH (n = 36; mean age 47 ± 13 years) and LVAD patients (n = 14; mean age 53 ± 12 years) were supported for a median of 83 (interquartile range [IQR] 43–115) and 106 days (IQR 84–134), respectively. Hematocrit was similar between the TAH and LVAD patients (34 ± 6% vs 37 ± 5%; P  = .07) at baseline. After placement, TAH patients had lower HCT at 2 (20 ± 2% vs 24 ± 3%), 4 (22 ± 3% vs 26 ± 3%), 6 (22 ± 4% vs 30 ± 4%), and 8 weeks (23 ± 4% vs 33 ± 5%; P < .001 for all). There were no differences in HCT at 1 (30 ± 4% vs 29 ± 7%; P  = .42) and 3 months (35 ± 7% vs 35 ± 4%; P  = .98) after removal of the devices for HT. TAH patients had undetectable haptoglobin in 96% of assessments, increased lactate dehydrogenase (1,128 ± 384 units/L), and detectable plasma free hemoglobin in 40% of measurements (21 ± 15 mg/dL). High sensitivity C-reactive protein (52 ± 50 mg/dL) was elevated, and reticulocyte production index was decreased (1.6 ± 0.6). Conclusions Patients implanted with a TAH have persistent anemia that resolves only after HT. The association of hemolysis, ineffective erythropoiesis, and inflammation with the TAH warrants further study.