Abstracts S127
in EDV in all carotid areas compared to pre-operative period (p< 0.001). Also there was a significant decrease in post-operative carotid artery PI and RI (p< 0.001).In the aortic valve opening classification, there was no significant difference between groups for PSVs and EDVs in carotid arteries. However, for RI and PI values of the carotid tree, there was a significant difference (p< 0.05) between two groups (“closed” < “7-10 opening”). In MCA, no significant difference found among “closed” and other opening groups for the PSV, EDV, PI and RI.In the neurocognitive evaluation, learning perfor-mance of the LVAD group was better than the other two groups (p< 0.05). According to the aortic valve opening classification analysis, “7-10 opening” group had a longer reaction time and learning scores were found to be lower than “closed group”.Conclusion: After LVAD implantation, EDV was increased and PI-RIs were decreased. The learning performance of the LVAD group was significantly better than the control groups. In the LVAD group analysis, the response time was shorter, and the learning scores were higher when there was no valve opening. Cerebral autoregulation may be less needed due to the circulatory system that acquires fully device dependent flow pattern.
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Predictors of Postoperative Vasoplegia in Patients Receiving Left Ventricular Assist Devices
J. Han ,1 A. Pinsino,2 E. Royzman,2 A. Gaudig,2 M. Mabasa,2 H.
Takayama,1 P.A. Kurlansky,1 A.R. Garan,2 V. Topkara,2 Y. Naka,1 K.
Takeda,1 P.C. Colombo,2 M. Yuzefpolskaya.2 1Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY; 2Division of Cardiology, Columbia University Medical Center, New York, NY.
Purpose: We previously showed that postoperative vasoplegia measured by vasoactive-inotropic score (VIS) is associated with adverse outcomes in left ventricular assist device (LVAD) patients. The purpose of this study is to identify preoperative predictors of early vasoplegia after LVAD implantation. Methods: A total of 418 patients underwent isolated LVAD surgery from 05/2004 to 12/2015. Degree of vasoplegia was estimated by: 1) VIS [dopa-mine + dobuta[dopa-mine + 100 × milrinone + 100 × epinephrine + 100 × nor-epinephrine + 100 × epinephrine (all in μ g/kg/min) + 10000 × vasopressin (U/kg/min)] at time of intensive care unit admission after surgery, and 2) vasoactive score (VS) that only included vasopressors.
Results: The study population had mean age of 58 ± 13 years, 82.1% were male, and 36.6% were destination therapy. Univariable model showed that preoperative age, body mass index (BMI), hemoglobin, inotrope use, ami-odarone use, mean systolic blood pressure, and pulmonary artery pressure, albumin, prior sternotomy, mechanical circulatory support (MCS) use, and number of concomitant valve procedures were associated with elevated VIS. Multivariable linear regression model showed that increases in age (0.111, 95% CI: [0.001, 0.221], p = 0.047), lower BMI (-0.291, 95% CI: [-0.553, -0.029], p = 0.029), lower hemoglobin (-0.731, 95% CI: [-0.552, -0.029], p = 0.050), and pre-operative use of MCS (7.51, 95% CI: [0.276, 14.7] were associated with increased postoperative VIS. When VS was used, preoperative hemoglobin was no longer a significant predictor in the multivariate model. Preoperative thyroid function test, use of angio-tensin converting enzyme inhibitor, or beta-blockers were not predictors of increased VIS or VS. Neither VIS nor VS were significant predictors (
301)
Modification of Complement Activity in Donor Lungs with Cigarette Smoke Exposure History Improves Post-Lung Transplantation Outcomes
K.J. Patel ,1 Q. Cheng,1 D.P. Allen,1 S. Esckilsen,1 M. Goddard,2 S.N.
Nadig,1 C. Atkinson.3 1Surgery, Medical University of South Carolina, Charleston, SC; 2Transplantation, Papworth Hospital NHS Foundation Trust, Cambridgeshire, United Kingdom; 3Microbiology and Immunology, Medical University of South Carolina, Charleston, SC.
Purpose: Given the limited donor pool, recent trends in lung transplantation (LTx) have moved towards the use of expanded criteria donors, including donors with history of cigarette smoke (CS) exposure. CS history is related to poor LTx outcomes, however, so the use of these donors remains some-what controversial. The complement (Cp) system plays a significant role in the lung microenvironment in response to CS, and therefore here we sought to investigate whether Cp blockade would better facilitate the use of these organs.
Methods: Balb/c mice were chronically exposed to CS for 6 months. To determine the impact of CS on LTx outcomes, CS or non-smoke-exposed (NS) age-matched Balb/c donor lungs were transplanted into NS C57BL/6 recipients. To determine the impact of recipient Cp deficiency on LTx out-comes CS donor lungs were transplanted into C3-/- (central Cp component), fB-/- (alternative pathway), and C3aR-/- (C3a receptor signaling) recipients. Finally, to determine the impact of modifying C3aR signaling in CS donors, we nebulized donor CS mice with C3aR antagonist (C3aRA) 30 minutes prior to procurement and LTx. Grafts were analyzed for lung function, and harvested at 7 days post-LTx to determine immune cell infiltration, mRNA expression, and acute rejection (AR) using ISHLT scoring criteria. Results: Consistent with previous studies donor CS exposure resulted in increased inflammation, lung injury, and elevated Cp signaling. LTx of CS donor lung results in a significantly increased ISHLT A score (4 vs 2 CS vs NS donor, n= 5 p< 0.001). Pulmonary function testing performed at 2, 5, and 7 days post-LTx demonstrated patterns suggestive of early rejection of CS vs NS donors. Tx of CS donors into C3, fB, or C3aR deficient recipients had no significant impact on AR score. However, nebulization with C3aRA prior to Tx significantly reduced ISHLT A score (2 vs 4, CS+C3aRA vs CS alone, n= 3 p< 0.001) and decreased IL-17 and IL-6 mRNA expression post-Tx. Conclusion: Taken together these data demonstrate that donor CS exposure exacerbates AR and graft failure, and that modification of donor lung C3a signaling can ameliorate this exacerbated injury phenotype. Pre-LTx donor lung therapy inhibiting the Cp C3a signaling cascade represents a viable target for improving outcomes from this marginal donor pool, and could be readily applied to EVLP systems.
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Ventricular Assist Device May Enhance Learning in End Stage Heart Failure
M. Karahan ,1 S. Kocabeyoglu,1 U. Kervan,1 D. Sert,1 E. Aygun,1 M.
Tola,2 B. Demirkan,3 E. Bakar,4 S. Mungan,5 O. Kursun,5 Z. Catav,1
M. Pac.1 1Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey; 2Radiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey; 3Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey; 4Psychology, Ufuk University, Ankara, Turkey; 5Neurology, Ankara Numune Hospital, Ankara, Turkey.
Purpose: We aimed to analyze flow forms in patients who underwent left ventricular assist device (LVAD) implantation and to investigate whether these findings affect neurocognitive function.
Methods: From January 2012 to March 2016, 31 adult patients whom LVAD was implanted were compared with 26 patients with heart failure and 27 healthy volunteers. LVAD group was also classified as “closed”, “1-6 open-ing” and “7-10 openopen-ing” per ten heart beats. Carotid and middle cerebral artery (MCA) flow velocities [peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI) and resistance index (RI)] and neuro-cognitive function test scores were analyzed.
Results: In the LVAD group, the EDV values of the carotid artery and MCAs were higher than the heart failure group (p< 0.05). PI and RI values of carotid artery and MCAs were found lower in LVAD group, compared to heart failure group (p< 0.001).Analysis of LVAD group revealed post-operative increase
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