INFLAMMATORY MEDIATORS IN PATIENTS WITH B IVENTRICULAR ASSIST DEVICE SYSTEMS

We studied the plasma levels of TNF-alpha, IL-6, IL-8 and soluble adhe sion molecules (sE-Selectin, sL-Selectin, sVCAM-1) immediately before and during mechanical circulatory support with a Biventricular Assist Device System (BVAD-''Berlin Heart'') in comparison to patients with c hronic heart failure (NYHA classes II/III) and patients with coronary artery disease with normal ventricular function. Additionally, the bio compatibility of the membranes used in the ''Berlin Heart'' was tested in vitro. IL-6 and IL-8 but not TNF-alpha could only be detected in p atients with cardiogenic shock immediately before starting circulatory support. Furthermore, plasma concentrations of soluble adhesion molec ules were statistically significantly elevated in patients with cardio genic shock compared to patients with coronary artery disease. This pi cture of a systemic inflammatory response syndrome without significant level of TNF-alpha looks quite similar to that seen in patients follo wing trauma and severe operations. During mechanical circulatory suppo rt plasma levels of cytokines and soluble adhesion molecules dropped t o low levels in patients, who were successfully maintained on BVAD. By contrast, we have found persistently elevated levels of these mediato rs in patients with fatal outcome. This seems not to be the result of individual distinct response of blood cells to contact with the artifi cial surfaces of the device. In summary, our data suggest the developm ent of a systemic inflammatory response syndrome may be due to hypoxia during cardiogenic shock. Persistence of systemic inflammation sugges ts failing of the mechanical support. Therefore, the monitoring of inf lammatory mediators may be relevant as a prognostic marker in these pa tients (disappearance of peripheral hypoxia).