HELP-(Heparin-induced Extracorporeal LDL Precipitation)-apheresis in heart recipients with cardiac allograft vasculopathy and concomitant hypercholesterolemia: Influence of long-term treatment on the microcirculation
Issue title: Selected papers of the 38th Conference of the German Society for Clinical Microcirculation and Hemorheology, 21-23 November 2019, Braunschweig, Germany
Guest editors: P. Wiggermann, A. Krüger-Genge and F. Jung
Affiliations: [a] Division of Cardiology, Dietrich Bonhoeffer Hospital, Academic Teaching Hospital of University of Greifswald, Germany
| [b] Heart Center Dresden, Technical University Dresden, Dresden, Germany
| [c] Institute for Animal Hygiene, Animal Welfare and Farm Animal Behavior, Virtual Center for Replacement – Complementary Methods to Animal Testing, University of Veterinary Medicine Hannover, Hannover, Germany
| [d]
Fraunhofer Institute for Applied Polymer Research (IAP), Germany
| [e]
Institute of Biotechnology, Brandenburgische Technische Universität Cottbus-Senftenberg, Senftenberg, Germany
Correspondence:
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Corresponding author: Prof. Dr. F. Jung, Institute of Biotechnology, Brandenburgische Technische Universität Cottbus-Senftenberg, Senftenberg, Germany. E-mail: [email protected].
Abstract: Hyperlipidemic heart transplant patients who develop cardiac allograft vasculopathy (CAV) benefit from HELP-apheresis (Heparin-induced Extracorporeal LDL Precipitation) which enables drastic lowering of plasma low-density lipoprotein, lipoprotein (a), and fibrinogen. There is evidence that HELP-apheresis also improves microcirculation by an immediate improvement of impaired endothelial-dependent vasodilatation and additive hemorheological effects. Therefore, cutaneous microcirculation was examined before, during, and after the first HELP-apheresis in eight hyperlipidemic cardiac transplant recipients with CAV. To study the long-term effect the intravital microscopy was repeated after three and 12 months of weekly apheresis treatment. In CAV patients the baseline mean erythrocyte velocity was pathologically reduced with 0.13±0.07 mm/s. During the first HELP-apheresis the erythrocyte velocity increased significantly (p = 0.0001) and remained increased until the end of the HELP procedure (p < 0.05). After three months of weekly apheresis treatment a decrease of temporary flow stops in the capillaries with a progressive homogenization (concordance) of the cutaneous microcirculation was observed. After one year of weekly treatment a markedly increase in mean erythrocyte velocity under resting conditions occurred. In addition, a reactive post-ischemic hyperemia could be established for the first time. Even the first single HELP-apheresis resulted in a significant improvement of the cutaneous microcirculation. The long-term treatment of these patients resulted in a marked improvement of the cutaneous microcirculation with the tendency to a normalization of the regulation of the capillary perfusion.
