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 -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