Purpose Aquired von Willebrand (vW) disease is induced by continuous flow ventricular assist devices (VAD) in patients under mechanical circulatory support (MCS). However, the influence of different MCS on the degradation of high molecular weight vW aggregates is less investigated. In addition the influence of intensive care therapy on vW-multimere analysis before MCS is not known. Methods and Materials We analysed the vW-antigene (vWA), ristocetin-(RCA) and collagen binding activity (CBA) and the vW multimers in patients supported by different MCS-systems: Thoratec biventricular VAD (THOB, n=30), Syncardia total artificial heart (TAH, n=40); LVADs: Thoratec (THOL, n=39), Novacor (NOV, n=37), Heartmate II (HM2, n=40) and Heartware (HW, n=38). vW-factor was analysed before and about 14 days after implantation. The data were compared to healthy blood donor controls (BDC). Results vWA, RCA and CBA was highly increased at the time of MCS-system implantation. Pulsatile LVADs and TAH had no influence on vWA, RCA and CBA during the observation period. BVAD-patients revealed significant reduction of CBA during MCS (p=0.0001). In contrast support with the axial flow HM2 was associated with reduced CBA (p Conclusions vW disease is prevalent in terminal heart failiure patients before MCS-system implantation. Continuous flow systems seem to have an increased effect on vW-factor activity compared to pulsatile devices. Centrifugal pumps may exert increased shear stress on blood components compared to other systems.

Purpose Aquired von Willebrand (vW) disease (vWD) is associated with MCS. However, a considerable number of heart failure patients reveals vW disease already before VAD-implantation. So far the reason for this phenomenon is not exactly known. In this study we analysed the influence of pre-operative intensive care with regard to medication as well as circulatory supporting measures on vWD in patients receiving MCS-systems. Methods and Materials We analysed the vW-antigene (vWA), ristocetin-(RCA) and collagen binding activity (CBA) and the vW multimers in 224 terminal heart failure patients receiving MCS and 40 healthy blood donor controls (BDC). The data were analysed in a multivariate analysis to identify the influence of pre-implantation care on the development of vWD. Results In all analysed patients vWA, RCA and CBA were significantly increased before device implantation compared to BDC (p Conclusions These data suggest that a substantial number of patients showed already increased vW activity before device implantation and that preoperative implantation of an IABP further increased vW-activity. Therefore, analysis and interpretation of aquired vWD during MCS support should consider pre implantation treatment of the patients.

Objectives: In the daily life with VADs, the safe and intuitive use of the systems including the peripheral components is not only a question of life quality, but sometimes even crucial. To investigate the advantages and disadvantages of the different systems and to get patient feedback on preferable features, a multicenter study was initiated.

We previously screened patients supported by ventricular assist devices (VAD) for plasma biomarkers related to the regulation of the myocardial extracellular matrix (ECM). We found that galectin 3 (GAL3), a profibrotic, beta-galactosidase binding lectin, was increased in terminal heart failure (HF) patients and appeared to be higher in patients, who died during VAD-support. Therefore, we analysed a large cohort of patients supported by left ventricular assist devices (VAD) and correlated GAL3 plasma levels and outcome.

Ventricular assist devices (VAD) are implanted in terminal heart failure (HF) due to limited availability of donor hearts. VADs have been used primarily as a bridge and recently as an alternative to transplantation or -in rare cases- as a bridge to recovery. It appears that mechanical unloading of the failing heart leads to favorable myocardial changes. However, cellular and molecular changes responsible for these salutary effects are incompletely understood. Therefore we identified HF-associated proteins and their regulation during VAD-support by means of proteomic analysis.

Aims: There is general agreement that mechanical circulatory support of the failing myocardium leads to regression of cardiomyocyte hypertrophy. However, little is known on the response to unphysiological unloading of the terminal failing ventricle by non-pulsatile ventricular assist devices (VAD). Therefore we analysed the circumferential diameters (CD) in cryosections of cross sectioned cardiomyocytes (CM) by computer assisted histometry.

Purpose: The Levitronix CentriMag is a novel magnetic levitated centrifugal blood pump designed for short-term circulatory support. We present the first series report of its use in extracorporeal membrane oxygenation (ECMO) for cardiogenic shock.