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Reduced Pulsatility Induces Periarteritis in Kidney: Role of the Local Renin-Angiotensin System

Chiyo Ootaki, Michifumi Yamashita, Yoshio Ootaki, Keiji Kamohara, Stephan Weber, Ryan S Klatte, William A Smith, Alex L Massiello, Steven N Emancipator, Leonard AR Golding, and Kiyotaka Fukamachi

J Thorac Cardiovasc Surg 136(1):9 (2008) PMID 18603068

Objective: The need for pulsatility in the circulation during long-term mechanical support has been a subject of debate. We compared histologic changes in calf renal arteries subjected to various degrees of pulsatile circulation in vivo. We addressed the hypothesis that the local renin-angiotensin system may be implicated in these histologic changes. Methods and Results: Sixteen calves were implanted with devices giving differing degrees of pulsatile circulation: 6 had a continuous flow left ventricular assist device (LVAD); 6 had a continuous flow right ventricular assist device (RVAD); and 4 had a pulsatile total artificial heart (TAH). Six other calves were histologic and immunohistochemical controls. In the LVAD group, the pulsatility index was significantly lower (0.28 +/- 0.07 LVAD vs 0.56 +/- 0.08 RVAD, vs 0.53 +/- 0.10 TAH; P < 0.01), and we observed severe periarteritis in all cases in the LVAD group. The number of angiotensin II type 1 receptor-positive cells and angiotensin converting enzyme-positive cells in periarterial areas was significantly higher in the LVAD group (angiotensin II type 1 receptor: 350 +/- 139 LVAD vs 8 +/- 6 RVAD, vs 3 +/- 2 TAH, vs 3 +/- 2 control; P < .001; angiotensin-converting enzyme: 325 +/- 59 LVAD vs 6 +/- 4 RVAD, vs 6 +/- 5 TAH, vs 3 +/- 1 control; P < .001). Conclusions: The reduced pulsatility produced by a continuous flow LVAD implantation induced severe periarteritis in the kidneys. The local renin-angiotensin system was up-regulated in the inflammatory cells only in the continuous flow LVAD group.

Copyright © 2008 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jtcvs.2007.12.023
Version: za2963e q8zad q8zb7 q8zcc q8zde q8ze4 q8zf5 q8zg6
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