Journal of Artificial Organs最新文献

Elucidation of the mechanism of precipitate formation on mixing nafamostat mesylate solution with dialysate. 甲磺酸那莫他酯溶液与透析液混合沉淀形成机理的探讨。

IF 1.1 4区医学

Journal of Artificial Organs Pub Date : 2025-04-08 DOI: 10.1007/s10047-025-01500-3

Iori Okamoto, Koichiro Oji, Otoka Nakashima, Yoka Shu, Hisatsugu Takahara, Hitoshi Suzuki, Hitoshi Muguruma

{"title":"Elucidation of the mechanism of precipitate formation on mixing nafamostat mesylate solution with dialysate.","authors":"Iori Okamoto, Koichiro Oji, Otoka Nakashima, Yoka Shu, Hisatsugu Takahara, Hitoshi Suzuki, Hitoshi Muguruma","doi":"10.1007/s10047-025-01500-3","DOIUrl":"https://doi.org/10.1007/s10047-025-01500-3","url":null,"abstract":"This study clarifies the reagent preparation and administration conditions that lead to precipitation when nafamostat mesylate salt (NM) solution is mixed with dialysate. The objective is to elucidate the mechanism of precipitation. It was observed that the Carbostar® dialysate forms a precipitate immediately after mixing with the NM solution, whereas Kindaly® and Subpac® dialysates form a precipitate after approximately 30 min. This variance is attributed to the pH adjusters used: citric acid for Carbostar®, acetic acid for Kindaly®, and hydrochloric acid for Subpac®. As trivalent negative ions, citrate ions promote faster precipitation compared to acetic acid and hydrochloric acid, which are monovalent ions. Nafamostat acetate and nafamostat chloride salts are soluble, while nafamostat citrate is poorly soluble, leading to differences in precipitation timing. The bicarbonate ion's pKa value is 6.1, meaning precipitation does not occur if the pH is lowered below 6.1 using acetic acid or hydrogen chloride as pH adjusters. The solubility product of nafamostat bicarbonate is 8.1 × 10-7 (mol/L)3, making precipitation inevitable under dialysis conditions ([nafamostat2+] = 5 mg/mL (9.2 mM), [HCO3-] = 35 mM). The primary precipitate component is nafamostat bicarbonate salt. Although NM is initially water-soluble, it undergoes chemical transformation into a poorly soluble salt through ion exchange from mesylate ions to bicarbonate ions within the dialysate, resulting in precipitation. Based on these findings, we propose conditions to avoid precipitation.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case of fatal acute saddle embolism of the terminal aorta after long-term support using Impella CP. 长期使用Impella CP后致死性急性主动脉鞍状栓塞1例。

IF 1.1 4区医学

Journal of Artificial Organs Pub Date : 2025-03-12 DOI: 10.1007/s10047-025-01499-7

Satoru Kishimoto, Arudo Hiraoka, Genta Chikazawa, Hidenori Yoshitaka

{"title":"A case of fatal acute saddle embolism of the terminal aorta after long-term support using Impella CP.","authors":"Satoru Kishimoto, Arudo Hiraoka, Genta Chikazawa, Hidenori Yoshitaka","doi":"10.1007/s10047-025-01499-7","DOIUrl":"https://doi.org/10.1007/s10047-025-01499-7","url":null,"abstract":"A 69-year-old male diagnosed with subacute myocardial infarction was subsequently transferred to our institution. Upon admission, echocardiography revealed ventricular septal rupture (VSR). The patient was promptly supported via venoarterial (VA) extracorporeal membrane oxygenation (ECMO) and Impella CP before surgical VSR repair on the 12th day of admission. Following surgery, the patient decided to be transferred to the intensive care unit under new VA-ECMO assistance. Subsequently, Impella CP removal and arterial cannula reinsertion were performed at the ipsilateral site, with no pulsatile bleeding observed from the arterial cannulation site. Emergency aortography revealed a contrast defect at the terminal aorta. Owing to the possibility of acute thrombotic occlusion, the Fogarty procedure was performed through the bilateral common femoral artery (CFA); however, no thrombus retrieved. Contrast-enhanced computed tomography revealed complete occlusion of the bilateral common iliac arteries, extending to the abdominal aorta. The uncontrollable, rapid progression of acidemia resulted in sudden cardiac arrest. Acute arterial occlusion leading to fatal outcomes can occur because of thrombosis following long-term Impella CP use. Impella-associated thrombi can form around the shaft of a mixed area of blood flow caused by the interaction between Impella and ECMO and often develop distal to the aortic arch, which is often overlooked during routine examinations. Therefore, planning for long-term Impella with ECMO support must utilize various imaging modalities to search for thrombi and prepare several means of revascularization during Impella removal.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sedation management and processed EEG-based solutions during venovenous extracorporeal membrane oxygenation: a narrative review of key challenges and potential benefits. 在静脉-静脉体外膜氧合过程中，镇静管理和基于处理脑电图的解决方案：主要挑战和潜在益处的叙述性回顾。

IF 1.1 4区医学

Journal of Artificial Organs Pub Date : 2025-03-08 DOI: 10.1007/s10047-025-01494-y

Lajos Szentgyorgyi, Samuel Henry Howitt, Heather Iles-Smith, Bhuvaneswari Krishnamoorthy

{"title":"Sedation management and processed EEG-based solutions during venovenous extracorporeal membrane oxygenation: a narrative review of key challenges and potential benefits.","authors":"Lajos Szentgyorgyi, Samuel Henry Howitt, Heather Iles-Smith, Bhuvaneswari Krishnamoorthy","doi":"10.1007/s10047-025-01494-y","DOIUrl":"10.1007/s10047-025-01494-y","url":null,"abstract":"Extracorporeal membrane oxygenation (ECMO) is an established technique for managing severe cardiorespiratory failure. However, it is invasive and requires profound analgo-sedation during initiation and often throughout the therapy. Managing sedation in venovenous (VV) ECMO patients is particularly challenging due to the impact of ECMO circuits on pharmacokinetics and specific patient requirements. This can lead to unpredictable sedative effects and require multiple drugs at higher doses. Additionally, sedation is usually managed with traditional scoring methods, which are subjective and invalid during neuromuscular blockade. These uncertainties may impact outcomes. Recent clinical practice increasingly focuses on reducing sedation to enable earlier physiotherapy and mobilisation, particularly in patients awaiting transplants or receiving mechanical circulatory support. In this context, processed electroencephalogram-based (pEEG) sedation monitoring might be promising, having shown benefits in general anaesthesia and intensive care. However, the technology has limitations, and its benefits in ECMO practice have yet to be formally evaluated. This review provides insights into the challenges of ECMO sedation, including pharmacokinetics, unique ECMO requirements, and the implications of inadequate sedation scores. Finally, it includes a brief overview of the practicality and limitations of pEEG monitoring during VV-ECMO, highlighting a significant research gap.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impella support for refractory cardiogenic shock accompanied by diabetic ketoacidosis: a case report. Impella支持治疗伴有糖尿病酮症酸中毒的难治性心源性休克：病例报告。

IF 1.1 4区医学

Journal of Artificial Organs Pub Date : 2025-03-01 Epub Date: 2024-05-26 DOI: 10.1007/s10047-024-01450-2

Masaki Nakagaito, Makiko Nakamura, Teruhiko Imamura, Hiroshi Ueno, Koichiro Kinugawa

{"title":"Impella support for refractory cardiogenic shock accompanied by diabetic ketoacidosis: a case report.","authors":"Masaki Nakagaito, Makiko Nakamura, Teruhiko Imamura, Hiroshi Ueno, Koichiro Kinugawa","doi":"10.1007/s10047-024-01450-2","DOIUrl":"10.1007/s10047-024-01450-2","url":null,"abstract":"Sodium-glucose cotransporter 2 (SGLT2) inhibitors are strongly recommended in patients with heart failure, regardless of the presence of diabetes mellitus. A 74 year-old woman with a reduced left ventricular ejection fraction and diabetes mellitus (the types were unknown), receiving insulin and SGLT2 inhibitor, was hospitalized for altered consciousness with systemic hypotension. Upon admission, she was diagnosed with cardiogenic shock due to diabetic ketoacidosis. Intensive fluid resuscitation under Impella CP support successively improved her metabolic acidosis, preventing worsening pulmonary congestion by mechanically unloading the heart. After hemodynamic stabilization, she was diagnosed with type 1 diabetes mellitus for the first time. She was discharged on day 54 and was followed for 6 months without any recurrences. We must remain vigilant regarding the risk of diabetic ketoacidosis in patients using SGLT2 inhibitors, particularly those on insulin therapy or with diabetes mellitus of unknown types. Impella device shows promise as a circulatory support system in alleviating the left ventricle's workload and averting exacerbated pulmonary congestion, especially in cases where patients necessitate aggressive fluid replacement therapy, such as in the treatment of diabetic ketoacidosis concurrent with compromised cardiac function.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"78-82"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case of truncus arteriosus with severe heart failure and pulmonary stenosis: bridge to transplant candidacy with surgical correction and a ventricular-assist device. 一例动脉导管未闭并伴有严重心衰和肺动脉狭窄的病例：通过手术矫正和心室辅助装置为移植候选者搭建桥梁。

IF 1.1 4区医学

Journal of Artificial Organs Pub Date : 2025-03-01 Epub Date: 2024-07-15 DOI: 10.1007/s10047-024-01456-w

Kazuki Tanimoto, Takashi Kido, Masaki Taira, Takuji Watanabe, Jun Narita, Hidekazu Ishida, Ryo Ishii, Takayoshi Ueno, Shigeru Miyagawa

{"title":"A case of truncus arteriosus with severe heart failure and pulmonary stenosis: bridge to transplant candidacy with surgical correction and a ventricular-assist device.","authors":"Kazuki Tanimoto, Takashi Kido, Masaki Taira, Takuji Watanabe, Jun Narita, Hidekazu Ishida, Ryo Ishii, Takayoshi Ueno, Shigeru Miyagawa","doi":"10.1007/s10047-024-01456-w","DOIUrl":"10.1007/s10047-024-01456-w","url":null,"abstract":"Ventricular-assist device therapy for small patients with congenital heart disease is challenging due to its complex anatomy and hemodynamics. We describe a 3-year-old patient with heart failure with truncus arteriosus in the palliative stage. The patient underwent palliative right ventricular outflow tract reconstruction following bilateral pulmonary artery banding. At 6 months of age, the patient developed severe truncal valve regurgitation and left ventricular dysfunction. Emergent truncal valve replacement with a mechanical valve was performed, but left ventricular dysfunction persisted. At 3 years of age, the patient developed acute progression of heart failure triggered by influenza infection. The patient was intubated and transferred to our center to determine the indication for heart transplantation. On the second day after admission, signs of multiorgan failure appeared. Emergent ventricular-assist device implantation for both ventricles was performed with truncal valve closure, ventricular septal defect closure, atrial septal defect closure, and re-right ventricular outflow tract reconstruction. The right ventricular-assist device was successfully removed on the seventh postoperative day. Due to the small pulmonary arteries, severe pulmonary stenosis persisted after ventricular-assist device implantation, but it gradually improved with multiple pulmonary angioplasties. The patient was registered in the Japanese organ transplant network and is awaiting a donor organ in a stable condition.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"90-94"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case of destination therapy for post-fulminant myocarditis with myelodysplastic syndrome. 骨髓增生异常综合征后急性心肌炎的终点治疗病例。

IF 1.1 4区医学

Journal of Artificial Organs Pub Date : 2025-03-01 Epub Date: 2024-06-11 DOI: 10.1007/s10047-024-01455-x

Makiko Nakamura, Teruhiko Imamura, Yuki Hida, Toshihide Izumida, Masaki Nakagaito, Saori Nagura, Toshio Doi, Kazuaki Fukahara, Koichiro Kinugawa

{"title":"A case of destination therapy for post-fulminant myocarditis with myelodysplastic syndrome.","authors":"Makiko Nakamura, Teruhiko Imamura, Yuki Hida, Toshihide Izumida, Masaki Nakagaito, Saori Nagura, Toshio Doi, Kazuaki Fukahara, Koichiro Kinugawa","doi":"10.1007/s10047-024-01455-x","DOIUrl":"10.1007/s10047-024-01455-x","url":null,"abstract":"We encountered a 64-year-old woman who experienced fulminant myocarditis and underwent treatment with veno-arterial extracorporeal membrane oxygenation and Impella CP support. Subsequently, she underwent a device upgrade to Impella 5.5 and received continuous hemodiafiltration for 3 months. During mechanical circulatory support, she developed refractory anemia and thrombocytopenia, leading to a diagnosis of myelodysplastic syndrome. Following the removal of the devices, she no longer required blood transfusions. She received HeartMate 3 left ventricular assist device implantation as a destination therapy indication despite the presence of myelodysplastic syndrome. She was successfully managed by aspirin-free antithrombotic therapy without any hemocompatibility-related adverse events for 4 months after index discharge on foot. We present a patient with a unique and rare presentation, wherein HeartMate 3 was implanted and successfully managed without aspirin to prevent bleeding complications associated with myelodysplastic syndrome.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"30-35"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Arterial oxygen pressure during veno-venous extracorporeal membrane oxygenation may be increased by advancing the tip of the drainage cannula into the superior vena cava: a case report. 将引流插管尖端推进上腔静脉可增加静脉体外膜氧合过程中的动脉氧压：一份病例报告。

IF 1.1 4区医学

Journal of Artificial Organs Pub Date : 2025-03-01 Epub Date: 2024-05-21 DOI: 10.1007/s10047-024-01448-w

Tomoyuki Nakamura, Naohide Kuriyama, Yoshitaka Hara, Hidefumi Komura, Naoki Hoshino, Soshi Miyamoto, Ken Sawada, Takahiro Kawaji, Satoshi Komatsu, Osamu Nishida

{"title":"Arterial oxygen pressure during veno-venous extracorporeal membrane oxygenation may be increased by advancing the tip of the drainage cannula into the superior vena cava: a case report.","authors":"Tomoyuki Nakamura, Naohide Kuriyama, Yoshitaka Hara, Hidefumi Komura, Naoki Hoshino, Soshi Miyamoto, Ken Sawada, Takahiro Kawaji, Satoshi Komatsu, Osamu Nishida","doi":"10.1007/s10047-024-01448-w","DOIUrl":"10.1007/s10047-024-01448-w","url":null,"abstract":"A simple and robust method for veno-venous extracorporeal membrane oxygenation (V-V ECMO) involves a drainage cannula into the inferior vena cava via the femoral vein (FV) and a reinfusion cannula into the right atrium (RA) via the internal jugular vein (IJV) (F-J configuration). However, with this method, the arterial oxygen (PaO2) is said to remain below 100 mmHg.Since recently, in our ICU, to prevent drainage failure, we apply a modification from the commonly practiced F-J configuration by advancing the tip of the drainage cannula inserted via the FV into the superior vena cava (SVC) and crossing the reinfusion cannula inserted via the IJV in the RA (F(SVC)-J(RA) configuration). We experienced that this modification can be associated with unexpectedly high PaO2 values, which here we investigated in detail.Veno-arteriovenous ECMO was induced in a 65-year-old male patient who suffered from repeated cardiac arrest due to acute respiratory distress syndrome. His chest X-ray images showed white-out after lung rest setting, consistent with near-absence of self-lung ventilation. Cardiac function recovered and the system was converted to F(SVC)-J(RA) configuration, after which both PaO2 and partial pressure of pulmonary arterial oxygen values remained high above 200 mmHg. Transesophageal echocardiography could not detect right-to-left shunt, and more efficient drainage of the native venous return flow compared to common F-J configuration may explain the increased PaO2.Although the F(SVC)-J(RA) configuration is a small modification of the F-J configuration, it seems to provide a revolutionary improvement in the ECMO field by combining robustness/simplicity with high PaO2 values.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"95-101"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141071093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Usefulness of bicarbonate-based Impella purge solution in a patient with heparin-induced thrombocytopenia: the first case report of long-term management in Japan. 以碳酸氢盐为基础的 Impella 冲洗液在肝素诱发血小板减少症患者中的应用：日本首例长期管理病例报告。

IF 1.1 4区医学

Journal of Artificial Organs Pub Date : 2025-03-01 Epub Date: 2024-06-06 DOI: 10.1007/s10047-024-01452-0

Shin Nagai, Hiroaki Hiraiwa, Ryota Ito, Yuichiro Koyama, Kiyota Kondo, Shingo Kazama, Toru Kondo, Ryota Morimoto, Takahiro Okumura, Hideki Ito, Tomo Yoshizumi, Masato Mutsuga, Toyoaki Murohara

{"title":"Usefulness of bicarbonate-based Impella purge solution in a patient with heparin-induced thrombocytopenia: the first case report of long-term management in Japan.","authors":"Shin Nagai, Hiroaki Hiraiwa, Ryota Ito, Yuichiro Koyama, Kiyota Kondo, Shingo Kazama, Toru Kondo, Ryota Morimoto, Takahiro Okumura, Hideki Ito, Tomo Yoshizumi, Masato Mutsuga, Toyoaki Murohara","doi":"10.1007/s10047-024-01452-0","DOIUrl":"10.1007/s10047-024-01452-0","url":null,"abstract":"Percutaneous mechanical circulatory support utilizing micro-axial flow pumps, such as the Impella group of devices, has become a life-saving technique in the treatment of refractory cardiogenic shock, with ever-increasing success rates. A 30-year-old man presented with acute decompensated heart failure and a severely reduced left ventricular ejection fraction (17%). Despite initial treatment with inotropic drugs and intra-aortic balloon pump support, his hemodynamic status remained unstable. Transition to Impella CP mechanical circulatory support was made on day 6 owing to persistently low systolic blood pressure. A significant decline in platelet count prompted suspicion of heparin-induced thrombocytopenia (HIT), later confirmed by positive platelet-activated anti-platelet factor 4/heparin antibody and a 4Ts score of 6 points. Argatroban was initially used as the purge solution, but owing to complications, a switch to Impella 5.0 and a bicarbonate-based purge solution (BBPS) was performed. Despite additional veno-arterial extracorporeal membrane oxygenation support on day 24, the patient, aiming for ventricular assist device treatment and heart transplantation, died from infection and multiple organ failure. Remarkably, the Impella CP continued functioning normally until the patient's demise, indicating stable Impella pump performance using BBPS. This case highlights the usefulness of BBPS as an alternative to conventional Impella heparin purge solution when HIT occurs.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"83-89"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hypothermic circulatory arrest at 20 ℃ does not deteriorate coagulopathy compared to 28 ℃ in a pig model. 在猪模型中，与 28 ℃ 相比，20 ℃ 低温停循环不会恶化凝血病。

IF 1.1 4区医学

Journal of Artificial Organs Pub Date : 2025-03-01 Epub Date: 2024-05-23 DOI: 10.1007/s10047-024-01449-9

Hayato Ise, Kyohei Oyama, Ryohei Ushioda, Aina Hirofuji, Keisuke Kamada, Yuri Yoshida, Payam Akhyari, Hiroyuki Kamiya

{"title":"Hypothermic circulatory arrest at 20 ℃ does not deteriorate coagulopathy compared to 28 ℃ in a pig model.","authors":"Hayato Ise, Kyohei Oyama, Ryohei Ushioda, Aina Hirofuji, Keisuke Kamada, Yuri Yoshida, Payam Akhyari, Hiroyuki Kamiya","doi":"10.1007/s10047-024-01449-9","DOIUrl":"10.1007/s10047-024-01449-9","url":null,"abstract":"It is believed that a lower temperature setting of hypothermic circulatory arrest (HCA) in thoracic aortic surgery causes coagulopathy, resulting in excessive bleeding. However, experimental studies that eliminate clinical factors are lacking. The objective of this study is to investigate the influence of the temperature setting of HCA on coagulation in a pig model. Ten pigs were divided into the following two groups: moderate temperature at 28 °C (group M, n = 5) or lower temperature at 20 °C (group L, n = 5). Two hours of HCA during a total of 4 h of cardiopulmonary bypass (CPB) were performed. Blood samples were obtained at the beginning (T1) and the end (T2) of the surgery, and coagulation capability was analyzed through standard laboratory tests (SLTs) and rotational thromboelastometry (ROTEM). In SLTs, hemoglobin, fibrinogen, platelet count, prothrombin time, and activated partial thromboplastin time were analyzed. In ROTEM analyses, clotting time and clot formation time of EXTEM, maximum clot firmness (MCF), and maximum clot elasticity (MCE) of EXTEM and FIBTEM were analyzed. Fibrinogen decreased significantly in both groups (group M, p = 0.008; group L, p = 0.0175) at T2, and FIBTEM MCF and MCE also decreased at T2. There were no differences regarding changes in parameters of SLTs and ROTEM between groups. CPB decreases coagulation capacity, contributed by fibrinogen. However, a lower temperature setting of HCA at 20 °C for 2 h did not significantly affect coagulopathy compared to that of HCA at 28 °C after re-warming to 37 °C.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"36-42"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Aortic valve area index values of Trifecta implants correlate with energy loss and increased valve stress. Trifecta 植入物的主动脉瓣面积指数值与能量损失和瓣膜应力增加相关。

IF 1.1 4区医学

Journal of Artificial Organs Pub Date : 2025-03-01 Epub Date: 2024-06-25 DOI: 10.1007/s10047-024-01453-z

Toru Tsukada, Yasuyuki Suzuki, Bryan J Mathis, Kimi Sato, Takeshi Kawamata, Akito Imai, Tomomi Nakajima, Yuichiro Kaminishi, Hideyuki Kato, Hiroaki Sakamoto, Yuji Hiramatsu

{"title":"Aortic valve area index values of Trifecta implants correlate with energy loss and increased valve stress.","authors":"Toru Tsukada, Yasuyuki Suzuki, Bryan J Mathis, Kimi Sato, Takeshi Kawamata, Akito Imai, Tomomi Nakajima, Yuichiro Kaminishi, Hideyuki Kato, Hiroaki Sakamoto, Yuji Hiramatsu","doi":"10.1007/s10047-024-01453-z","DOIUrl":"10.1007/s10047-024-01453-z","url":null,"abstract":"Biological valves are becoming more frequently used in aortic valve replacement. While several reports have evaluated the performance of biological valves, echocardiography studies during exercise stress remain scarce. Furthermore, no current reports compare rate changes in the aortic valve area of biological valves under increased exercise load. Here, we performed exercise stress echocardiography in patients after AVR with Trifecta or Inspiris valves and compared the rates of change in aortic valve areas (AVA). In addition, hydrodynamic analysis at rest was conducted with four-dimensional flow magnetic resonance imaging (4D-flow MRI). Exercise stress echocardiography was performed in seven Trifecta and seven Inspiris patients who underwent AVR at our hospital while 4D flow MRI was performed in all but two Trifecta cases. Comparing the percentage change in AVA when loaded to 25 W versus at rest, Trifecta was greater than Inspiris (28.7 ± 36.0 vs - 0.8 ± 12.4%). The smaller AVA at rest was considered causative for this. Meanwhile, Trifecta systolic energy loss in the prosthetic valve segment on 4D-flow MRI (97.5 ± 35.9 vs 52.7 ± 25.3 mW) was higher than Inspiris. The opening of the Trifecta valve was considered to be restricted at rest and this may reflect the current reports of early valve degradation requiring reoperation. Taken together, we observed that the Trifecta design may promote faster wear due to higher valve stress.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"61-68"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0