The effect of left ventricular assist devices on the propagation of coronary artery disease in explanted hearts.

Abstract

As a surgical treatment option for heart failure, left ventricular assist devices (LVAD) help to restore function in failing hearts. Recent studies suggest possible negative impacts of this therapy, as LVAD reduces blood flow and allows potential for coronary remodeling and increased intimal alteration. Our study examined patients with clinically diagnosed non-ischemic cardiomyopathy (NICM) and subsequent heart failure necessitating transplantation and the use of LVAD as a bridge to transplant. Surgically explanted heart specimens were identified and both semi-quantitatively scored and quantitatively assessed for the degree of cross-sectional coronary artery luminal narrowing. Non-parametric statistical analysis of semi-quantitative scored cases was conducted to examine differences between the test population and a control population of NICM patients undergoing transplant without the use of LVAD bridge to therapy. Parametric analysis of the quantitative digitally assessed cases was conducted to corroborate these results. The test population demonstrated a statistically significant difference in coronary artery luminal narrowing compared to the control population. Our findings suggest increased coronary artery disease in previous NICM patients receiving LVAD as a bridge to transplantation regardless of the time with the implanted device. Further work is necessary for future correlation, as these findings bear importance for improving transplant patient outcomes.