ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Christophe Baufreton
Daniel Y. Loisance
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Baufreton, C.
Right arrow Articles by Loisance, D. Y.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Baufreton, C.
Right arrow Articles by Loisance, D. Y.
Related Collections
Right arrowRelated Article

Ann Thorac Surg 1999;67:1828-1829
© 1999 The Society of Thoracic Surgeons

Correspondence

Reply

Christophe Baufreton, MD, PhDa, Matthias Kirsch, MDb, Daniel Y. Loisance, MDb

a Department of Cardiovascular Surgery, University Hospital of Angers, 4 rue Larrey, 49033 Angers, Cedex 01 France
b Centre de Recherches Chirurgicales and Department of Thoracic and Cardiovascular Surgery, Hôpital Henri Mondor, Créteil, France

e-mail: chbaufreon{at}chu-angers.fr

To the Editor

Our review of blood activation during assisted circulation is obviously a call for papers as mentioned by Dr Alexander. From this point of view, all directions need to be investigated, even the possibility that new engineered smooth artificial surfaces surfaces could passively coexist with platelets. However, this approach of biocompatibility would be limited because blood activation is multifactorial. In the mean time, postulating that only textured surfaces are the key for the future needs a word of caution. We are well aware of the low incidence of thromboembolic complications using the HeartMate left ventricular assist device (Thermo Cardiosystems Inc, Woburn, MA) despite high fibrinolytic activity after increased thrombin formation [1]. The development of a neointima within the chamber of the HeartMate left ventricular assist device has been reported, but the source and nature of cells in the lining remain controversial. There are only a few arguments to postulate that endothelial cells exist, whether they are functional components of the lining, and where these endothelial cells originate. Cultured endothelial cells attach poorly to the materials that compose the HeartMate left ventricular assist device, whereas smooth muscle cells attach strongly to such surfaces [2]. Most hematopoïetic cells present are myeloid or monocytic in origin and have the capability to proliferate and produce an extracellular matrix that results in the formation of a nonthrombogenic neointima [3]. Seeding of vascular grafts with genetically modified endothelial cells overexpressing tissue-type plasminogen activator has been proposed to improve the interface between biomaterials and the blood [4]. Unfortunately the secretion of recombinant tissue-type plasminogen activator resulted in decreased seeded cell adherence in vitro and in vivo. Because of their propensity to strongly attach to textured surfaces, smooth muscle cells have been modified genetically to prevent their activation of platelets and to decrease their exuberant proliferative activity [2]. Preliminary results showed that smooth muscles cells, transduced with the genes to optimize nitric oxide production, adhered well to the pump surface under in vitro and in vivo flow conditions after short-term implantation. This gene therapy approach shows that spontaneous colonization of artificial surfaces by host blood-borne endothelial cells is not satisfactory. Thus the debate of biocompatibility of ventricular assist devices is still open, and future research is mandatory.

References

  1. Spanier T., Oz M., Lewin H., et al. Activation of coagulation and fibrinolytic pathways in patients with left ventricular assist devices. J Thorac Cardiovasc Surg 1996;112:1090-1097.[Abstract/Free Full Text]
  2. Scott-Burden T., Tock C.L., Bosely J.P., et al. Nonthrombogenic, adhesive cellular lining for left ventricular assist devices. Circulation 1998;98:II-339-II-345.
  3. Rafii S., Oz M.C., Seldomridge J.A., et al. Characterization of human hematopoietic cells arising on the textured surface of left ventricular devices. Ann Thorac Surg 1995;60:1627-1632.[Abstract/Free Full Text]
  4. Dunn P.F., Newman K.D., Jones M., et al. Seeding of vascular grafts with genetically modified endothelial cells. Secretion of recombinant TPA results in decreased seeded cell retention in vitro and in vivo. Circulation 1996;93:1439-1446.[Abstract/Free Full Text]

Related Article

Current review of blood activation: actually a call for papers
W. Allan Alexander
Ann. Thorac. Surg. 1999 67: 1828. [Extract] [Full Text] [PDF]




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Christophe Baufreton
Daniel Y. Loisance
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Baufreton, C.
Right arrow Articles by Loisance, D. Y.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Baufreton, C.
Right arrow Articles by Loisance, D. Y.
Related Collections
Right arrowRelated Article

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS