The Journal of thoracic and cardiovascular surgery

Nonphysiologic blood flow triggers endothelial and arterial remodeling in vivo: implications for novel left ventricular assist devices with a peripheral anastomosis.

PMID 24332190


Less invasive circulatory support devices have been developed that require anastomosis to a peripheral artery. The Symphony Heart Assist System (Abiomed, Inc, Danvers, Mass) is a volume-displacement pump sewn to the subclavian artery to provide partial circulatory support. The surgical configuration produces nonphysiologic blood pressure and bidirectional flow in the subclavian artery. Our objective was to identify effects of altered hemodynamics on arterial structure and function. In calves (nxa0=xa023; 80-100 kg), the Symphony pump was sewn end-to-side to the carotid artery. Acutely, carotid blood pressure and flow were recorded to evaluate hemodynamic changes. After medium-term support (1-4 weeks), carotid artery was studied. Histologic and molecular assays evaluated architectural changes. Quantitative real-time polymerase chain reaction evaluated gene expression of matrix metalloproteinase (MMP)-2, MMP-9, and connective tissue growth factor. Inxa0vitro carotid arterial-ring studies evaluated physiologic responses. During Symphony support, carotid arterial pressure was 200/15 mm Hg. Antegrade flow increased significantly (Pxa0