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Implantation of a bioprosthetic total artificial heart induces a profile of acquired hemocompatibility with recellularization of its blood-contacting membranes
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214
Archives of Cardiovascular Diseases Supplements (2017) 9, 212-215
Abstract 498 – Figure- Correlations between right ventricular to right atrium gradient and pulmonary arterial resistances assessed by transthoracic echocardiography and right heart catheterization
498 TRANSTHORACIC ECHOCARDIOGRAPHY TO QUANTIFY PULMONARY VASCULAR RESISTANCE IN PATIENTS WITH SYSTEMIC SCLEROSIS S. Billet* (1), T. Chollet (1), P. Fournier (1), L. Tétu (2), G. Prévot (2), M. Galinier (1), D. Carrié (1), G. Pugnet (2), O. Lairez (1) (1) Département de Cardiologie, CHU RANGUEIL, Toulouse Cedex 9 – (2) Département de Pneumologie, Hopital LARREY, Toulouse, France *Corresponding author: [email protected] Background One of the major causes of systemic sclerosis (SSc)-related death is pulmonary arterial hypertension, which develops in 12–15% of patients with SSc and accounts for 30-40% of deaths. Consequently, monitoring of pulmonary arterial pressure (PAP) and resistances is essential in patients with SSc. Abbas formula performed by transthoracic echocardiography (TTE) was reported as a good tool to quantify pulmonary vascular resistances (PVR). Aim Explore the accuracy of TTE and Abbas formula to quantify PVR in patients with SSc. Methods and Results Thirty-two patients with SSc explored within the same day protocol were retrospectively included. Measures of TTE and Abbas formula were compared to right heart catheterization (RHC) measures. There were 13 (41%) male. The mean age was 64±12 years. Mean and systolic PAP were 31±9 and 53±16 mmHg. There was a good correlation between right ventricle to right atrium gradient pressure assessed by TTE and RHC (R=0.620, P<0.001). RVP assessed by Abbas formula (2.6±1.0 wood units) were well correlated with RVP assessed by RHC (4.8±2.3; R=0.446, P=0.013). Conclusion Abbas formula is a good tool to detect PVR in patients with SSc.
Plateforme imagerie, Faculté de Pharmacie and Inserm UMR-S 1144, Paris – (6) Cardiovascular surgery Department, University Hospital of Strasbourg, Strasbourg – (7) UMR 1064, INSERM, Nantes, France; Faculté de Médecine, Nantes – (8) CHRU Lille and University Hospital, Inserm UMR-S 1176, Lille, France – (9) Department of Cell Research and Immunology, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israël – (10) University Hospital Guillaume and René Laennec, Nantes – (11) Carmat, Velisy – (12) CARMAT – (13) Cardiac Surgery, AP-HP, Paris, France *Corresponding author: [email protected] Background Biocompatibility has been the major challenge to the expansion of Mechanical Circulatory Assist devices, as a therapy for end-stage heart disease. This report focuses on studies conducted during the recently concluded Pilot Study of the Carmat Total Artificial Heart, a novel device incorporating bioprosthetic blood-contacting surfaces. Methods Three patients were studied, with implant times of 74, 270 and 254 days respectively. Biocompatibility investigations included hematological, biochemical and histological methodologies. The anticoagulation management strategy comprised initial unfractionated heparin followed by low molecular weight heparin and aspirin, from postoperative day 2. Results No signs of hemolysis, acquired von Willebrand syndrome or immunogenicity were detected in any patient. An increased D-dimer level in all patients was observed during months 1 to 4. Temporary suspension of heparin anticoagulation resulted in thrombocytopenia and increased fibrin monomer, reversed by resuming anticoagulation with heparin. There were no clinical neurological events and no evidence of thrombo-embolism at autopsy, apart from a small temporal infarction in patient #3, related to aspirin withdrawal during the last month of support. All explanted devices were free from thrombus. Histological analysis and electron microscopy of the bioprosthetic membranes revealed a fibrin network, stabilized as a fibrin cap, incorporating endothelial cells with tight junctions. Conclusions The Carmat Total Artificial Heart is the first long-term mechanical support device to employ bioprosthetic membranes. These results suggest that improved hemocompatibility could be associated with the ongoing formation of a endothelial lining on the bioprosthetic membranes, providing the prospect for a fully hemocompatible device, by analogy to bioprosthetic heart valves.
The author hereby declares no conflict of interest
121 Implantation of a bioprosthetic total artificial heart induces a profile of acquired hemocompatibility with recellularization of its bloodcontacting membranes
The author hereby declares no conflict of interest
D. Smadja* (1-2), C. Latremouille (1), B. Saubamea (1), B. Cholley (1), E. Boissier (3), M. Kindo (4), JP. Soulillou (5), J. Trochu (3), S. Susen (6), E. Epailly (4), N. Gendron (2), V. Karavani (7), S. Leviatan (7), E. Van Belle (6), P. Bizouarn (8), P. Bruneval (1), A. Capel (9), P. Jansen (10), JC. Roussel (8), A. Carpentier (11-1) (1) Université Paris Descartes – (2) Hématologie, AP-HP – (3) Inserm UMR-S1140, Paris – (4) Institut du thorax CHU de Nantes, Nantes – (5)
© Elsevier Masson SAS. All rights reserved.
214
Archives of Cardiovascular Diseases Supplements (2017) 9, 212-215
Abstract 498 – Figure- Correlations between right ventricular to right atrium gradient and pulmonary arterial resistances assessed by transthoracic echocardiography and right heart catheterization
498 TRANSTHORACIC ECHOCARDIOGRAPHY TO QUANTIFY PULMONARY VASCULAR RESISTANCE IN PATIENTS WITH SYSTEMIC SCLEROSIS S. Billet* (1), T. Chollet (1), P. Fournier (1), L. Tétu (2), G. Prévot (2), M. Galinier (1), D. Carrié (1), G. Pugnet (2), O. Lairez (1) (1) Département de Cardiologie, CHU RANGUEIL, Toulouse Cedex 9 – (2) Département de Pneumologie, Hopital LARREY, Toulouse, France *Corresponding author: [email protected] Background One of the major causes of systemic sclerosis (SSc)-related death is pulmonary arterial hypertension, which develops in 12–15% of patients with SSc and accounts for 30-40% of deaths. Consequently, monitoring of pulmonary arterial pressure (PAP) and resistances is essential in patients with SSc. Abbas formula performed by transthoracic echocardiography (TTE) was reported as a good tool to quantify pulmonary vascular resistances (PVR). Aim Explore the accuracy of TTE and Abbas formula to quantify PVR in patients with SSc. Methods and Results Thirty-two patients with SSc explored within the same day protocol were retrospectively included. Measures of TTE and Abbas formula were compared to right heart catheterization (RHC) measures. There were 13 (41%) male. The mean age was 64±12 years. Mean and systolic PAP were 31±9 and 53±16 mmHg. There was a good correlation between right ventricle to right atrium gradient pressure assessed by TTE and RHC (R=0.620, P<0.001). RVP assessed by Abbas formula (2.6±1.0 wood units) were well correlated with RVP assessed by RHC (4.8±2.3; R=0.446, P=0.013). Conclusion Abbas formula is a good tool to detect PVR in patients with SSc.
Plateforme imagerie, Faculté de Pharmacie and Inserm UMR-S 1144, Paris – (6) Cardiovascular surgery Department, University Hospital of Strasbourg, Strasbourg – (7) UMR 1064, INSERM, Nantes, France; Faculté de Médecine, Nantes – (8) CHRU Lille and University Hospital, Inserm UMR-S 1176, Lille, France – (9) Department of Cell Research and Immunology, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israël – (10) University Hospital Guillaume and René Laennec, Nantes – (11) Carmat, Velisy – (12) CARMAT – (13) Cardiac Surgery, AP-HP, Paris, France *Corresponding author: [email protected] Background Biocompatibility has been the major challenge to the expansion of Mechanical Circulatory Assist devices, as a therapy for end-stage heart disease. This report focuses on studies conducted during the recently concluded Pilot Study of the Carmat Total Artificial Heart, a novel device incorporating bioprosthetic blood-contacting surfaces. Methods Three patients were studied, with implant times of 74, 270 and 254 days respectively. Biocompatibility investigations included hematological, biochemical and histological methodologies. The anticoagulation management strategy comprised initial unfractionated heparin followed by low molecular weight heparin and aspirin, from postoperative day 2. Results No signs of hemolysis, acquired von Willebrand syndrome or immunogenicity were detected in any patient. An increased D-dimer level in all patients was observed during months 1 to 4. Temporary suspension of heparin anticoagulation resulted in thrombocytopenia and increased fibrin monomer, reversed by resuming anticoagulation with heparin. There were no clinical neurological events and no evidence of thrombo-embolism at autopsy, apart from a small temporal infarction in patient #3, related to aspirin withdrawal during the last month of support. All explanted devices were free from thrombus. Histological analysis and electron microscopy of the bioprosthetic membranes revealed a fibrin network, stabilized as a fibrin cap, incorporating endothelial cells with tight junctions. Conclusions The Carmat Total Artificial Heart is the first long-term mechanical support device to employ bioprosthetic membranes. These results suggest that improved hemocompatibility could be associated with the ongoing formation of a endothelial lining on the bioprosthetic membranes, providing the prospect for a fully hemocompatible device, by analogy to bioprosthetic heart valves.
The author hereby declares no conflict of interest
121 Implantation of a bioprosthetic total artificial heart induces a profile of acquired hemocompatibility with recellularization of its bloodcontacting membranes
The author hereby declares no conflict of interest
D. Smadja* (1-2), C. Latremouille (1), B. Saubamea (1), B. Cholley (1), E. Boissier (3), M. Kindo (4), JP. Soulillou (5), J. Trochu (3), S. Susen (6), E. Epailly (4), N. Gendron (2), V. Karavani (7), S. Leviatan (7), E. Van Belle (6), P. Bizouarn (8), P. Bruneval (1), A. Capel (9), P. Jansen (10), JC. Roussel (8), A. Carpentier (11-1) (1) Université Paris Descartes – (2) Hématologie, AP-HP – (3) Inserm UMR-S1140, Paris – (4) Institut du thorax CHU de Nantes, Nantes – (5)
© Elsevier Masson SAS. All rights reserved.