Key result
LVAD implantation was associated with impaired platelet aggregation and increased proinflammatory platelet-leukocyte binding compared to CABG/AVR, with less pronounced changes in HeartMate 3.
Why the study?
Blood flow through LVADs may induce platelet activation and dysfunction, which cause coagulation disturbances and form proinflammatory platelet-neutrophil conjugates.
Does LVAD implantation cause greater platelet dysfunction and proinflammatory platelet-neutrophil interaction compared to standard cardiac surgery (CABG/AVR)?
Cohort (n=23)
Does LVAD implantation cause greater platelet dysfunction and proinflammatory platelet-neutrophil interaction compared to standard cardiac surgery (CABG/AVR)?
LVAD implantation, particularly with older generation devices like HeartMate II, is associated with significant platelet dysfunction and proinflammatory platelet-leukocyte binding compared to standard cardiac surgery.
May warrant platelet monitoring post-LVAD; leaves open device-specific effects on PNC and outcomes.
Blood flow through left ventricular assist devices (LVAD) may induce activation and dysfunction of platelets. Dysfunctional platelets cause coagulation disturbances and form platelet-neutrophil conjugates (PNC), which contribute to inflammatory tissue damage. This prospective observational cohort study investigated patients, who underwent implantation of a LVAD (either HeartMate II (HM II) (n = 7) or HeartMate 3 (HM 3) (n = 6)) and as control patients undergoing coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) (n = 10). We performed platelet and leukocyte flow cytometry, analysis of platelet activation markers, and platelet aggregometry. Platelet CD42b expression was reduced at baseline and perioperatively in HM II/3 compared to CABG/AVR patients. After surgery the platelet activation marker β-thromboglobulin and platelet microparticles increased in all groups while platelet aggregation decreased. Platelet aggregation was more significantly impaired in LVAD compared to CABG/AVR patients. PNC were higher in HM II compared to HM 3 patients. We conclude that LVAD implantation is associated with platelet dysfunction and proinflammatory platelet-leukocyte binding. These changes are less pronounced in patients treated with the newer generation LVAD HM 3. Future research should identify device-specific LVAD features, which are associated with the least amount of platelet activation to further improve LVAD therapy.
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Granja et al. (2020) conducted a cohort in Heart failure requiring LVAD or cardiac surgery (n=23). LVAD implantation (HeartMate II or HeartMate 3) vs. CABG and/or AVR was evaluated on Platelet activation, aggregation, and platelet-neutrophil conjugates. LVAD implantation was associated with impaired platelet aggregation and increased proinflammatory platelet-leukocyte binding compared to CABG/AVR, with less pronounced changes in HeartMate 3.
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