Persistent Anemia After Implantation of the Total Artificial Heart
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摘要

ss="h4">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).

ss="h4">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聽= 36; mean age 47 卤 13 years) and LVAD patients (n聽= 14; mean age 53 卤 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 卤 6%vs 37 卤 5%; P聽= .07) at baseline. After placement, TAH patients had lower HCT at 2 (20 卤 2%vs 24 卤 3%), 4 (22 卤 3%vs 26 卤 3%), 6 (22 卤 4%vs 30 卤 4%), and 8聽weeks (23 卤 4%vs 33 卤 5%; P < .001 for all). There were no differences in HCT at 1 (30 卤 4%vs 29聽卤 7%; P聽= .42) and 3 months (35 卤 7%vs 35 卤 4%; P聽= .98) after removal of the devices for HT. TAH patients had undetectable haptoglobin in 96%of assessments, increased lactate dehydrogenase (1,128 卤 384 units/L), and detectable plasma free hemoglobin in 40%of measurements (21 卤 15 mg/dL). High sensitivity C-reactive protein (52 卤 50 mg/dL) was elevated, and reticulocyte production index was decreased (1.6 卤 0.6).

ss="h4">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.

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