969-99 Biocompatible Mechanical Left Ventricular Support: Potential Alternative to Transplantation

Use of mechanical circulatory support has been limited by its associated bleeding and thrombotic complications. Blood contact with an artificial surface results in a well-deined pattern of hematologic alterations. The TCI HeartMate® left ventricular assist device (LVAD) is an implantable circulatory support pump currently used as a bridge to transplantation. Its textured blood contacting surfaces result in a formation of an adherent pseudoneointimal lining which eliminates the direct interaction of blood elements with the artificial surface. To determine if this biological lining could mitigate the stereotypical blood-synthetic surface interactions, we studied eight patients who underwent implantation at our institution over a 10 month period from 5/93 to 3/94. Seven of the 8 patients were bridged to transplantation. Three patients were transplanted within 10 days and one month data could not be obtained. Hemodynamic and hemostatic parameters (mean±sd) were studied as follows:Pre-implantPOD 7POD 28Cardiac index (I/min/m2)1.8±0.73.2±0.43.1±0.5Systolic BP (mmHg)759±6.8125.8±9.7130.4±8.1Hemoglobin (mg/dl)7.4±1.88.2±1.69.6±2.0Plasma free hemoglobin (mg/dl)15.4±1.76.4±2.36.8±1.9Prothrombin time (sec)14.2±1.113.4±0.713.3±0.7Partial thromboplastin time (sec)56.7±15.931.8±4.837.6±11.9Platelet count (× 103lcu mm)250±81269±63325±37In vitro platelet reactivity to the agonist ADP remained normal pre and post implantation. Average perioperative blood requirements included PRBC, 3.3±1.3 units; platelets, 2.3±4.5 units; fresh frozen plasma, 2±1.9 units. No blood products were required after postoperative day 2.We conclude that TCI LVAD support improves hemodynamics and can bridge patients in pre-implant cardiogenic shock to transplantation. Furthermore, no red cell destruction or hemostatic and thrombotic complications were observed despite one month of support without anticoagulation therapy. Therefore, as the donor shortage continues, LVADs with biocompatible surfaces may provide an alternative to cardiac transplantation

The United States Record of Site-Specific Information Regarding The Uintah-Ouray Reservation: Findings of a Survey of National Archives, Smithsonian, and Library of Congress Collections

UteThis study covers the traditional and cultural properties of Native American cultures on teh Uinta-Ouray Reservatio