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首页> 外文期刊>Artificial Organs >Effect of Continuous‐Flow Mechanical Circulatory Support on Microvasculature Remodeling in the Failing Heart
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Effect of Continuous‐Flow Mechanical Circulatory Support on Microvasculature Remodeling in the Failing Heart

机译：连续流动机械循环载体对失败心脏微血管改造的影响

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Abstract Left ventricle (LV) unloading caused by a left ventricular assist device (LVAD) has been shown to enhance reverse LV remodeling in end‐stage cardiomyopathy. Several reports consistently suggest that a pulsatile‐flow LVAD has more profound effects compared to continuous‐flow LVAD, though the responsible mechanisms are not fully understood. We hypothesized that arterial pulsatility, being affected by the type of LVAD, may affect microvasculature and functional/pathological LV remodeling in end‐stage cardiomyopathy. The study included 18 patients with chronic heart failure who underwent LVAD implantation. Eight patients were implanted with pulsatile‐flow LVAD, and 10 patients were implanted with continuous‐flow LVAD. The results of serial echocardiograms and histopathological assessment of transmural LV tissues, which were collected during the implantation and removal of LVADs, were compared between the groups. The results of echocardiography showed that LV systolic dimension and LV ejection fraction improved greatly in the pulsatile‐flow LVAD group compared to the continuous‐flow LVAD group. Histological analysis showed that in both groups, increased microvasculature density and decreased cardiomyocyte size during LVAD support had no significant difference. In contrast, only the patients with continuous‐flow LVADs had presented with significant increase in α‐smooth muscle actin (α‐SMA)‐positive layer thickness and the number of proliferating cell nuclear antigen (PCNA)‐positive cells of myocardial arterioles. We concluded that the use of long‐term continuous‐flow LVAD support, having less pulsatility, had induced more thickening to the medial layer of myocardial arterioles compared to the use of pulsatile‐flow LVADs. Our findings suggest that the pathological impairment of myocardial microvascular structure during continuous‐flow LVAD support may be a novel mechanism which accounts for the difference in LV remodeling depending on the type of LVAD.
机译：摘要已显示由左心室辅助装置（LVAD）引起的左心室（LV）卸载，以增强终级心肌病中的反向LV重塑。几个报告始终如一地表明，与连续流动LVAD相比，脉动流动LVAD具有更深刻的效果，尽管不完全理解负责机制。我们假设受液体类型影响的动脉脉冲性可能影响终末期心肌病的微血管结构和功能/病理LV重塑。该研究包括18名患者患有LVAD植入的慢性心力衰竭。将八名患者植入脉动流动LVAD，10名患者植入连续流动的LVAD。在植入和去除LVAD期间，在组中收集的串联超声心动图和透际透际组织组织病理学评估的结果。超声心动图的结果表明，与连续流动的LVAD组相比，LV收缩尺寸和LV喷射馏分在脉动流动LVAD组中大大提高。组织学分析表明，在两个组中，在LVAD载体中增加的微血管密度和减少的心肌细胞尺寸下降无显着差异。相比之下，只有连续流动的肌动蛋白（α-SMA）阳性层厚度（α-SMA） - 阳性层厚度和心肌动脉酸二粒的增殖细胞核抗原（PCNA）阳性细胞的数量才呈现出显着增加的患者。我们得出结论，与使用脉动流动LVAD相比，使用长期连续流动LVAD支撑率具有较小的脉冲性，脉动率较小，与心肌动脉杆菌的内侧层诱导。我们的研究结果表明，心肌微血管结构在连续流动的LVAD支持期间的病理损害可以是一种新的机制，其根据LVAD的类型占LV重塑的差异。

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