Ventricular assist device in severe heart failure: Effects on cytokines, complement and body weight

Aims: Inflammatory and immune activation and body wasting are important features of end-stage chronic heart failure. It is not known whether restoration of cardiac output by assist device implantation can improve these abnormalities. Methods: We studied 48 patients (39 males; age 2 45±2 years) with NYHA class IV heart failure. All patients underwent ventricular assist device implantation for endstage heart failure as a bridge to cardiac transplantation. Plasma levels of tumour necrosis factor α, and its receptors, interleukin-6, elastase, activated complement, and soluble CD14 receptors were measured at the time of operation and in survivors at 1 week (n=46), 40 days (n=35) and 90 days (n=26). Follow-up was for a minimum of 1 year. Results: One-year survival was 35% (95% CI: 22-49%). Body mass index was the only predictor of survival (body mass index >25 (n=16); survival 63 (39-86) %; body mass index <25 (n=32); survival 22 (7·5-36)%: P=0·003). Tumour necrosis factor α fell from 9·66 ± 1·33 pg. ml^-1 to 4·2 ± 1·0 at 1 week (P=0·008), but returned to preoperative levels at 90 days. Interleukin-6, activated complement and elastase fell progressively to 40 days, but were rising at 90 days. There was no change in tumour necrosis factor receptor. There was a gradual rise in CD14 (3·99 ± 0·15 μg. ml^-1 at baseline, 5·02 ± 0·39 at 90 days, P=0·006). After surgery, body weight fell from 80 ± 2 to 73 ± 2kg by 1 month (P<0·001) and to 72 ± 2kg at 90 days. Conclusions: Ventricular assist device implantation results in a short-term fall in tumour necrosis factor α and interleukin-6, but no change in CD14 or tumour necrosis factor receptor, suggesting that the pathophysiological process resulting in inflammation was not altered by left ventricular assist device implantation. Low body mass index is related to poor outcome after assist device implantation, and no weight gain.