Journal of Artificial Organs最新文献

{"title":"Selective visceral perfusion in thoracoabdominal aortic surgery: optimal flow rate in a porcine model.","authors":"Noburo Ohashi, Hajime Ichimura, Noritoshi Kikuchi, Yuki Tanaka, Tohru Mikoshiba, Yuko Wada, Kenji Okada, Tatsuichiro Seto","doi":"10.1007/s10047-025-01521-y","DOIUrl":"https://doi.org/10.1007/s10047-025-01521-y","url":null,"abstract":"<p><p>To determine the optimal perfusion volume for the celiac artery (CA) and superior mesenteric artery (SMA) in a porcine model. Fifteen Yorkshire pigs (46.7 ± 5.2 kg) underwent selective CA and SMA perfusion using a roller pump at either 400 mL/min (G400, n = 5) or 800 mL/min (G800, n = 6). Hemodynamic parameters, blood gas analyses, and biochemical markers were evaluated over time (T1 to T5). The intestinal tissue was assessed for edema and histological damage. Portal vein SvO2 was lower in G400 (65.0 ± 30.2% at T2) compared to G800 (87.0 ± 5.2%), indicating reduced perfusion. Lactate levels were significantly higher in G400 (7.8 ± 2.3 mmol/L at T2) than in G800 (4.1 ± 2.1 mmol/L), suggesting increased anaerobic metabolism. Aspartate aminotransferase levels were elevated in G400, reflecting intestinal ischemia, whereas alanine aminotransferase levels remained stable. Histological analysis revealed mucosal desquamation in G400 but not in G800. No significant differences in intestinal edema were observed between groups. A selective perfusion volume of 800 mL/min for the CA and SMA maintains portal vein SvO2 and prevents mucosal injury, suggesting it approximates physiological blood flow. These findings indicate that increasing selective visceral perfusion during thoracoabdominal aortic surgery may reduce postoperative intestinal complications and improve patient outcomes.</p>","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753388","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}

{"title":"Key markers and detection methods for evaluating platelet dysfunction in mechanical circulatory support devices.","authors":"Zhenling Wei, Zhuo Li, Wangwang Su, Longhui Cheng, Liudi Zhang","doi":"10.1007/s10047-025-01520-z","DOIUrl":"https://doi.org/10.1007/s10047-025-01520-z","url":null,"abstract":"<p><p>Mechanical circulatory support devices (MCSDs) have emerged as life-saving interventions for patients with end-stage heart failure. However, the non-physiological shear stress (NPSS) generated by MCSDs is a known precipitant of platelet dysfunction, augmenting risks of thrombotic and bleeding complications. Addressing this issue necessitates innovative approaches to attenuate platelet dysfunction, thereby enhancing the safety of MCSDs. This review synthesizes knowledge pertaining to the normal hemostatic process, the implications of NPSS on platelet function, the array of markers extensively employed to assess platelet dysfunction, and relevant detection assays, within the scope of MCSDs-related hemocompatibility. NPSS can induce platelet activation and receptor shedding, causing both thrombosis and bleeding. The use of fluorescence-activated cell sorting (FACS) to monitor changes in markers, including platelet surface receptors, P-selectin, platelet monocyte aggregation (PMA), platelet-derived microparticles (PDMPs), and phosphatidylserine (PS), Enzyme-Linked Immunosorbent Assay (ELISA) for platelet secretion analysis, and the modified prothrombinase platelet activity state (PAS) for thrombin assessment, are central to investigating these consequences. PS and thrombin, particularly, present unique responses to NPSS, underscoring their potential as targeted markers for platelet dysfunction research. Additionally, assessments of morphological shifts and platelet aggregation, through scanning electron microscopy (SEM) and fluorescence microscopy provide a more visualized evaluation of NPSS-mediated platelet dysfunction. Combining distinct markers and assays is essential to understanding and potentially mitigating NPSS-induced complications in MCSD therapy. Future research should focus on validating NPSS-specific biomarkers, standardizing detection methodologies, and elucidating interactions with MCSD-induced hemolysis and coagulopathy, ultimately improving safety and efficacy.</p>","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742181","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}

{"title":"End-of-life decision-making and changing preferences in patients with a left ventricular assist device for destination therapy: insights from advance directives in Japan.","authors":"Toshihide Izumida, Eisuke Amiya, Masaru Hatano, Junichi Ishida, Miki Kanno, Asako Shimada, Miyoko Endo, Masahiko Ando, Mitsutoshi Kimura, Shogo Shimada, Minoru Ono, Norihiko Takeda","doi":"10.1007/s10047-025-01519-6","DOIUrl":"https://doi.org/10.1007/s10047-025-01519-6","url":null,"abstract":"<p><p>End-of-life decision-making and the evolution of patient preferences over time remain insufficiently explored in destination therapy with left ventricular assist device (DT-LVAD) in Japan. This retrospective observational study analyzed standardized advance directives from DT-LVAD patients in Japan. The advance directives comprised (1) preferred end-of-life medical care, (2) designated surrogate decision-makers, and (3) personal life wishes. This study comprises two components: a cross-sectional analysis of all patients at the time of LVAD implantation, and a longitudinal analysis evaluating changes in advance directive preferences among patients who completed the 1-year follow-up assessment. This study included 27 patients who initially received DT-LVAD (median age 47 years, 21 men). At the time of LVAD implantation, approximately 30% of DT-LVAD patients preferred continued mechanical support, including LVAD, mechanical ventilator, and hemodialysis, until the end-of-life stage in a cross-sectional analysis. In addition, 56% preferred receiving end-of-life care at home. In a longitudinal analysis, patients remaining on DT-LVAD showed increased preference for \"independence\" and \"end-of-life care at home\" after 1 year of DT-LVAD, whereas their inclination toward invasive treatments decreased. In contrast, patients switched to BTT demonstrated lower inclination toward invasive therapies from the outset, with this tendency becoming more pronounced over time. This study demonstrates the changes in the end-of-life preferences of DT-LVAD patients in Japan. With the continuous increase in the number of DT-LVAD patients, further refinement of advance directive frameworks and the development of structured community-based support systems will be essential for optimizing end-of-life care among LVAD recipients.</p>","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690388","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}

{"title":"Investigation of contamination and environmental exposure of cold/heated water supply systems for extracorporeal circulation used in ECMO and other applications.","authors":"Masaya Sakakibara, Satoshi Kohira, Kiyotaka Fujii, Daichi Niiyama, Yugo Nagae, Ritsuko Kikuno, Keiichi Ajito","doi":"10.1007/s10047-025-01518-7","DOIUrl":"https://doi.org/10.1007/s10047-025-01518-7","url":null,"abstract":"<p><p>Infection cases have been reported where Legionella spp. and NTM (non-tuberculous mycobacteria) increased due to the contamination of circulating water in cold/heated water supply systems for extracorporeal circulation used in cardiac surgery and ECMO (extracorporeal membrane oxygenation) for blood temperature regulation. The contaminated circulating water became aerosolized and may have been a source of infection. The internal structure of these systems is complex, making it difficult to clean and disinfect the inside of tanks and piping, posing a risk of becoming a breeding ground for bacteria. However, contamination and environmental exposure risks have not been clearly understood. Therefore, we conducted an experimental investigation to evaluate the potential spread of NTM from the circulating water to the surrounding environment, using Mycobacterium fortuitum as a test organism and confirmed that Mycobacterium was dispersed into the air during system operation and when opening the cover of the cold/heated water tank for water supply. It is urgent to establish methods to maintain effective cleaning and disinfection of cold/heated water supply systems for extracorporeal circulation and to implement operational improvements, such as enhancing the sealing of water tank covers, minimizing the opening of water tank covers during operation, and isolating the system in the operating environment.</p>","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591261","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}

{"title":"Correction: Contemporary optimal therapeutic strategy with escalation/de-escalation of temporary mechanical circulatory support in patients with cardiogenic shock and advanced heart failure in Japan.","authors":"Makiko Nakamura, Teruhiko Imamura, Koichiro Kinugawa","doi":"10.1007/s10047-025-01517-8","DOIUrl":"https://doi.org/10.1007/s10047-025-01517-8","url":null,"abstract":"","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591251","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}

{"title":"Hemodynamic changes and mid-term results of surgical correction of de novo aortic valve insufficiency after left ventricular assist device implantation.","authors":"Takashi Murakami, Yusuke Misumi, Daisuke Yoshioka, Takuji Kawamura, Ai Kawamura, Shin Yajima, Shunsuke Saito, Takashi Yamauchi, Shigeru Miyagawa","doi":"10.1007/s10047-025-01516-9","DOIUrl":"https://doi.org/10.1007/s10047-025-01516-9","url":null,"abstract":"<p><p>Severe aortic insufficiency (AI) is a common complication associated with prolonged continuous-flow left ventricular assist device (CF-LVAD) therapy. This study aimed to investigate the clinical outcomes after surgical correction of de novo AI after LVAD implantation. A total of 190 patients underwent CF-LVAD implantation between January 2013 and June 2022. Of these, 24 had trivial or no AI before LVAD implantation and developed moderate or greater de novo AI after LVAD implantation. Patients who underwent aortic valve surgery before or concomitant with LVAD surgery were excluded. Among the 24 patients, surgeries were indicated for medically refractory de novo AI in 11 patients, who were included. The primary outcome was postoperative improvement in hemodynamics as assessed by right heart catheter examination, and the secondary endpoints were 3-year survival and freedom from death and/or heart failure readmission rates. The correction of de novo AI was accomplished with aortic valve closure using a bovine pericardial patch in 10 patients and prosthetic valve replacement in one patient. Significant differences (all p < 0.01) in pre- vs. post-surgery pulmonary artery wedge pressure, cardiac index, and mixed venous blood oxygen saturation were found. The mean follow-up period after LVAD implantation was 1413 days, and the 3-year survival rate was 90.9%. Three-year freedom from postoperative moderate or greater AI rate and freedom from heart failure readmission rate were both 90.9%. Postoperative hemodynamic status and survival outcomes are favorable in patients who underwent surgical aortic valve repair de novo AI after LVAD implantation.</p>","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528067","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}

{"title":"A data-driven framework for fair and efficient organ transplantation using gradient boosting and adaptive genetic allocation.","authors":"Sangeetha Gnanasambandan, Vanathi Balasubramanian","doi":"10.1007/s10047-025-01512-z","DOIUrl":"https://doi.org/10.1007/s10047-025-01512-z","url":null,"abstract":"<p><p>This study proposes a comprehensive data-driven framework aimed at enhancing organ transplantation efficiency through optimized risk assessment, donor-recipient matching, and equitable organ allocation. Utilizing the gradient boosting algorithm (GBA) for risk prioritization, A* search for optimal donor location, the modified convolutional neural network-based hybrid extreme learning classifier (MCNN-HELM) model for precise matching, and an adaptive objective-weighted genetic allocation (AOWGA) algorithm, the framework addresses critical challenges in organ allocation and distribution. The experimental results indicate strong performance metrics, with the integrated system achieving an overall accuracy of 96%, allocation efficiency of 97%, and a fairness index of 0.92. The MCNN-HELM model showed a matching precision of 0.94 and an accuracy of 97.5%, outperforming existing methods. AOWGA surpassed comparative allocation methods, demonstrating an allocation efficiency of 0.96 and a positive outcome rate of 0.95. By integrating these modules, the framework not only improves organ allocation processes but also enhances survival rates and promotes ethical practices in organ distribution. By innovatively integrating these techniques, the framework reduces waiting times, improves patient outcomes, and ensures fair allocation, marking a significant advancement in addressing the persistent organ shortage and setting a new standard for ethical and efficient organ transplantation.</p>","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234231","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}

{"title":"The foremost and greatest barrier to end-stage heart failure treatment: the impact of caregiver shortage.","authors":"Shunsuke Saito, Daisuke Yoshioka, Takuji Kawamura, Ai Kawamura, Yusuke Misumi, Yasuhiro Akazawa, Fusako Sera, Kaori Kubota, Takashi Yamauchi, Yasushi Sakata, Shigeru Miyagawa","doi":"10.1007/s10047-024-01463-x","DOIUrl":"10.1007/s10047-024-01463-x","url":null,"abstract":"<p><p>We examined the number of patients abandoning cardiac replacement therapy due to the inability to secure a designated caregiver. At Osaka University Hospital Heart Center, when we receive a consultation for a patient with severe heart failure from another hospital, a heart failure team makes a visit to the referring hospital as soon as possible. We retrospectively analyzed this hospital-visit database. We received 199 severe heart failure consultations from 2016-2023. Issues identified during hospital visits included age ≥ 65 years (8%), inability to confirm the patient's intention (8.5%), and explicit refusal of therapy (2.5%). Medical problems included multiple organ failure (18.1%), obesity (13.1%), diabetes (9.5%), malignancy (5.5%), chronic dialysis (1.0%), and other systemic diseases (12.6%). Adherence problems included poor medication compliance (3.5%), history of heavy drinking (2.5%), and smoking (2.0%). Social problems included inadequate family support in 16.1% of patients. Of the 199 patients, 95 (48.0%) proceeded to a heart transplant and LVAD indication review meeting at Osaka University Hospital. The remaining 104 patients (52.0%) did not proceed to the meeting. Reasons included improvement of heart failure with conservative treatment in 37 cases (35.6%), death before discussion in 21 cases (20.2%), medical contraindications in 18 cases (18.3%), lack of caregivers in 18 cases (18.3%; 9.5% of 199 cases), and patient refusal in 5 cases (4.8%). Approximately 10% of patients consulted at Osaka University Hospital Heart Center for severe heart failure abandoned cardiac replacement therapy due to the lack of caregivers.</p>","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"192-197"},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897528","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}

{"title":"A case of successful surgical treatment of left ventricular thrombus associated with acute myocardial infarction by Impella combined with extracorporeal membrane oxygenation approach.","authors":"Rieko Kutsuzawa, Naoki Tadokoro, Satoshi Kainuma, Naonori Kawamoto, Kouta Suzuki, Ayumi Ikuta, Kohei Tonai, Masaya Hirayama, Yoshiyuki Tomishima, Yasuhide Asaumi, Satsuki Fukushima","doi":"10.1007/s10047-024-01469-5","DOIUrl":"10.1007/s10047-024-01469-5","url":null,"abstract":"<p><p>The mortality rate in patients with heart failure complicated by cardiogenic shock following acute myocardial infarction (AMI) remains high, prompting research on mechanical circulatory support. Improved mortality rates have been reported with the early introduction of EcMELLA (Impella combined with extracorporeal membrane oxygenation, ECMO). However, clear indications for this treatment have not been established, given the associated risks and limitations related to access routes. Left ventricular thrombosis is traditionally considered a contraindication for Impella use. A 74-year-old man without specific medical history or coronary risk factors was diagnosed with Forrester IV heart failure due to cardiogenic shock complicated by AMI and left ventricular thrombosis. The patient underwent emergency coronary artery bypass surgery, intracardiac thrombus removal, and Dor surgery. Following cardiopulmonary bypass, ongoing heart failure was observed, necessitating the implementation of EcMELLA for circulatory support. Preoperative computed tomography showed that the bilateral subclavian arteries were too narrow (< 7 mm) and anatomically unsuitable for traditional access methods. Thus, we introduced a single-access EcMELLA 5.5, through which the Impella was introduced and veno-arterial-ECMO blood was delivered from a single artificial vessel anastomosed to the brachiocephalic artery. The patient was weaned off veno-arterial-ECMO and extubated on postoperative day 3. By postoperative day 14, improved cardiac function allowed for Impella removal. The patient was discharged on postoperative day 31 with improved ambulation; thereafter, the patient returned to work. Thus, the single-access EcMELLA5.5 treatment strategy combined with Dor procedure was effective in left ventricular thrombosis in patients with heart failure with cardiogenic shock complicated by AMI.</p>","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"266-269"},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055636","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}

{"title":"Computational fluid dynamics simulating of the FDA benchmark blood pump with different coefficient sets and scaler shear stress models used in the power-law hemolysis model.","authors":"Ahmet Onder, Omer Incebay, Rafet Yapici","doi":"10.1007/s10047-024-01468-6","DOIUrl":"10.1007/s10047-024-01468-6","url":null,"abstract":"<p><p>Hemolysis is the most important issue to consider in the design and optimization of blood-contacting devices. Although the use of Computational Fluid Dynamics (CFD) in hemolysis prediction studies provides convenience and has promising potential, it is an extremely challenging process. Hemolysis predictions with CFD depend on the mesh, implementation method, coefficient set, and scalar-shear-stress model. To this end, an attempt was made to find the combination that would provide the most accurate result in hemolysis prediction with the commonly cited power-law based hemolysis model. In the hemolysis predictions conducted using CFD on the Food and Drug Administration (FDA) benchmark blood pump, 3 different scalar-shear-stress models, and 5 different coefficient sets with the power-law based hemolysis model were used. Also, a mesh independence test based on hemolysis and pressure head was performed. The pressure head results of CFD simulations were compared with published pressure head of the FDA benchmark blood pump and a good agreement was observed. In addition, results of CFD-hemolysis predictions which are conducted with scalar-shear-stress model and coefficient set combinations were compared with experimental hemolysis data at three operating conditions such as 6-7 L/min flow rates at 3500 rpm rotational speeds and 6 L/min at 2500 rpm. One of the combinations of the scalar-shear-stress model and the coefficient set was found to be within the error limits of the experimental measurements, while all other combinations overestimated hemolysis.</p>","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"184-191"},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035872","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}