Humoral and Hemodynamic Responses After Left Ventricular Assist Device Implantation and Heart Transplantation

Abstract

Left ventricular assist device (LVAD) implantation and heart transplantation (HTx) are established therapeutic approaches in the treatment of end-stage heart failure. The postoperative humoral responses to the two treatments have not yet been compared. All patients were treated with inhaled nitric oxide (iNO) on weaning from cardiopulmonary bypass as they presented with pulmonary hypertension. We investigated atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), cGMP, endothelin (ET)-1, big endothelin (big ET), and hemodynamic parameters after LVAD implantation (15 patients; age 51 ± 8 years) or HTx (10 patients; age 53 ± 6 years) preoperatively, on cardiopulmonary bypass and postoperatively up to 72 hrs after cessation of iNO. Preoperatively, cardiac index (CI), pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), and mean atrial pressure (MAP) were similar for both groups. Similarly, ANP, BNP, cGMP, ET-1, and big ET were comparable before surgery. Seventy-two hours after weaning from iNO, the administered epinephrine dose was higher in the HTx group (P = 0.003); whereas the CVP (P = 0.04) and pulmonary vascular resistance (PVR; P = 0.03) were lower. The following humoral parameters differed markedly: ANP (preoperatively: LVAD, 99 ± 123 pg/ml; HTx, 197 ± 199 pg/ml; P = 0.14; vs. 72 hrs after iNO: LVAD, 110 ± 106 pg/ml; HTx, > 640 ± 0 pg/ml; P = 0.003) and cGMP (preoperatively: LVAD, 4.4 ± 5.8 pg/ml; HTx, 5.0 ± 3.0 pg/ml; P = 0.35; vs. 72 hrs after iNO: LVAD, 8.0 ± 10.8 pg/ml; HTx, 26.2 ± 15.8 pg/ml; P = 0.02). Although the hemodynamic effects of both LVAD implantation and HTx in the treatment of end-stage heart failure are comparable, except for the effects on CVP and PVR, the humoral responses with respect to ANP and cGMP were strikingly different. These effects are independent of volume status, iNO, and ETs, suggesting a physiologic response to maintain circulatory homeostasis.

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