Bioprosthetic Total Artificial Heart in Autoregulated Mode Is Biologically Hemocompatible: Insights for Multimers of von Willebrand Factor

Poitier B. Chocron R. Peronino C. Philippe A. Pya Y. Rivet N. Richez U. Bekbossynova M. Gendron N. Grimmé M. Bories M.C. Brichet J. Capel A. Rancic J. Vedie B. Roussel J.C. Jannot A.-S. Jansen P. Carpentier A. Ivak P. Latremouille C. Netuka I. Smadja D.M.
1 April 2022 Lippincott Williams and Wilkins

Arteriosclerosis, Thrombosis, and Vascular Biology
2022 #42 Issue 4 470 - 480 pp.

Background: Carmat bioprosthetic total artificial heart (Aeson; A-TAH) is a pulsatile and autoregulated device. The aim of this study is to evaluate level of hemolysis potential acquired von Willebrand syndrome after A-TAH implantation. Methods: We examined the presence of hemolysis and acquired von Willebrand syndrome in adult patients receiving A-TAH support (n=10) during their whole clinical follow-up in comparison with control subjects and adult patients receiving Heartmate II or Heartmate III support. We also performed a fluid structure interaction model coupled with computational fluid dynamics simulation to evaluate the A-TAH resulting shear stress and its distribution in the blood volume. Results: The cumulative duration of A-TAH support was 2087 days. A-TAH implantation did not affect plasma free hemoglobin over time, and there was no association between plasma free hemoglobin and cardiac output or beat rate. For VWF (von Willebrand factor) evaluation, A-TAH implantation did not modify multimers profile of VWF in contrast to Heartmate II and Heartmate III. Furthermore, fluid structure interaction coupled with computational fluid dynamics showed a gradually increase of blood damage according to increase of cardiac output (P<0.01), however, the blood volume fraction that endured significant shear stresses was always inferior to 0.03% of the volume for both ventricles in all regimens tested. An inverse association between cardiac output, beat rate, and high-molecular weight multimers ratio was found. Conclusions: We demonstrated that A-TAH does not cause hemolysis or AWVS. However, relationship between HMWM and cardiac output depending flow confirms relevance of VWF as a biological sensor of blood flow, even in normal range.

Blood volume , Heart failure , Heart transplantation , Hemodynamics , Plasma

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Université de Paris, Innovative Therapies in Hemostasis, Inserm, Paris, F-75006, France
Cardiac Surgery Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France
Carmat Sas, Velizy-Villacoublay, France
Université de Paris, Parcc, Inserm, Paris, F-75015, France
Université de Paris, Innovative Therapies in Hemostasis, Inserm, Paris, F-75006, France
National Research Cardiac, Surgery Center, Nur-Sultan, Kazakhstan
Université de Paris, Cardiac Surgery Department, AP-HP, Georges Pompidou European Hospital, France
AP-HP, Biochemistry Department, Georges Pompidou European Hospital, France
Cardiac and Thoracic Surgery Department, Chu de Nantes, Hôpital Nord Laënnec, boulevard Jacques-Monod, France
Department of Bioinformatics, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

Université de Paris
Cardiac Surgery Department and Biosurgical Research Lab (Carpentier Foundation)
Carmat Sas
Université de Paris
Université de Paris
National Research Cardiac
Université de Paris
AP-HP
Cardiac and Thoracic Surgery Department
Department of Bioinformatics
Department of Cardiovascular Surgery

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