Contact of blood with artificial surfaces activates pro-inflammatory r
esponses and the complement cascade. This may have broad implications
on the post implantation fate of patients needing mechanical circulato
ry support. Therefore, we investigated the course and prognostic value
of complement factors C3a and C5a in 66 patients supported with pulsa
tile ventricular assist devices. All patients were in severe cardiogen
ic shock, i.e., catecholamine dependent and in the intensive care unit
, before implementation of mechanical circulatory support. Isolated le
ft ventricular support (Novacor [Oakland, CA] or Thermo Cardiosystems,
Inc. [TCI; Woburn, MAI) was used in 28 patients, and biventricular su
pport (Berlin Heart [Mediport, Berlin, Germany]) in 38 patients. Befor
e initiation of mechanical circulatory support, no statistically signi
ficant differences in C3a or C5a between surviving and nonsurviving pa
tients with left ventricular assist devices (LVADs) were found. Patien
ts with biventricular assist devices (BVADs) had significantly higher
C3a (804 +/- 364 ng/L) levels than patients with LVADs (536 +/- 204 ng
/L, p = 0.02) before mechanical circulatory support. Only C5a, only in
the BVAD group, was able to predict patients' post implantation cours
e before implantation of a ventricular assist device (p = 0.02). Three
weeks after initiation of mechanical circulatory support, complement
factors remained increased in all groups. There was no difference, how
ever, in complement activation between patients with LVADs and those w
ith BVADs. Patients not reaching transplantation had significantly hig
her C3a levels at this point than those successfully supported (p = 0.
007). The degree of complement activation mainly depends on the severi
ty of cardiogenic shock before initiation of mechanical circulatory su
pport, and not on the device used. Patients with extremely high levels
of complement activation before implantation of the device could be s
aved with BVAD rather than LVAD support. Patients who continued to hav
e highly elevated complement levels 3 weeks after initiation of mechan
ical circulatory support had unfavorable prognoses. Complement activat
ion indicates the severity of cardiogenic shock before implementation
of mechanical circulatory support and the degree of recovery from seco
ndary organ dysfunction while on the device. It is fairly independent
of the system used for mechanical circulatory support, and therefore c
an be applied to predict patients' post implantation course and outcom
e.