Journal of Artificial Organs最新文献_第10页

Patient-tailored silicone plug for HeartMate 3™ left ventricular assist device explantation. 为HeartMate 3™左心室辅助装置植入量身定制的硅胶塞。

IF 1.1 4区医学

Journal of Artificial Organs Pub Date : 2024-06-01 Epub Date: 2023-04-26 DOI: 10.1007/s10047-023-01397-w

Mohamed Elbayomi, Rene Tandler, Nina Ebel, Dirk W Schubert, Siegfried Werner, Markus Kondruweit, Micheal Weyand, Christian Heim

引用次数: 0

Monocyte to HDL ratio may predict thrombosis in patients with mechanical mitral and aortic valve prosthesis. 单核细胞与高密度脂蛋白的比率可预测二尖瓣和主动脉瓣机械假体患者的血栓形成。

IF 1.3 4区医学

Journal of Artificial Organs Pub Date : 2024-06-01 Epub Date: 2023-04-21 DOI: 10.1007/s10047-023-01395-y

Mustafa Ozan Gürsoy, Cemalettin Yılmaz, Emrah Bayam, Ahmet Güner, Sadık Volkan Emren, Semih Kalkan, Yusuf Üzüm, Nurşen Keleş, Ali Karagöz, Mehmet Özkan

{"title":"Monocyte to HDL ratio may predict thrombosis in patients with mechanical mitral and aortic valve prosthesis.","authors":"Mustafa Ozan Gürsoy, Cemalettin Yılmaz, Emrah Bayam, Ahmet Güner, Sadık Volkan Emren, Semih Kalkan, Yusuf Üzüm, Nurşen Keleş, Ali Karagöz, Mehmet Özkan","doi":"10.1007/s10047-023-01395-y","DOIUrl":"10.1007/s10047-023-01395-y","url":null,"abstract":"Increased inflammatory biomarkers have been reported in prosthetic heart valve thrombosis (PHVT). Monocyte to HDL ratio (MHR) and albumin to CRP levels (CAR) are two biomarkers used widely for systemic inflammation but there is a lack of data on prosthetic heart valves. This study aimed to find out the potential predictive value of MHR and CAR for PHVT. Patients who had the diagnosis of mechanical mitral/aortic PHVT and normally functioning prosthesis were retrospectively analyzed. Laboratory data including complete blood count and biochemistry were recorded. Transesophageal echocardiography was performed to diagnose PHVT. The study included 118 patients with mechanical PHVT and 120 patients with normally functioning prosthesis. White blood count, monocyte levels, C-reactive protein, MHR and CAR were significantly higher whereas the lymphocyte, HDL and INR levels on admission were lower in patients with PHVT. Multivariate analysis showed that as well as inadequate anticoagulation, MHR, but not CAR, was found to be an independent predictor of thrombosis in patients with PHVT. Receiver operating characteristic curve analysis was performed to detect the best cut-off value of MHR in the prediction of thrombosis in patients with prosthetic valves. MHR level of > 12.8 measured on admission, yielded an AUC value of 0.791 [(CI 95% 0.733-0.848 p < 0.001) sensitivity 71%, specificity 70%]. Inadequate anticoagulation is the primary cause that leads to thrombosis in mechanical prosthetic valves. Increased MHR, but not CAR, was also shown to be an independent predictor of thrombosis in patients with mechanical mitral and aortic prosthetic valves.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"117-124"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9423740","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

Nighttime sleep and daytime sleepiness patterns among left ventricular assist device patients. 左心室辅助装置患者的夜间睡眠和白天嗜睡模式。

IF 1.3 4区医学

Journal of Artificial Organs Pub Date : 2024-06-01 Epub Date: 2023-06-30 DOI: 10.1007/s10047-023-01410-2

Umar A Siddiqi, Aashka Patel, Yena Jang, Jennifer Cruz, Pamela Combs, Jesus M Casida

{"title":"Nighttime sleep and daytime sleepiness patterns among left ventricular assist device patients.","authors":"Umar A Siddiqi, Aashka Patel, Yena Jang, Jennifer Cruz, Pamela Combs, Jesus M Casida","doi":"10.1007/s10047-023-01410-2","DOIUrl":"10.1007/s10047-023-01410-2","url":null,"abstract":"Despite the high prevalence of sleep disturbance in the heart failure population, information about its consequence on daytime function in patients with left-ventricular assist devices (LVADs) is limited. This study examined the nighttime and daytime sleep patterns and changes from pre-implant to 6 months post-implant. This study included 32 LVAD patients. Demographics, nighttime and daytime sleep variables were collected pre-implant and at 1, 3, and 6 months post-implant. Wrist actigraphy and self-report questionnaires measured objective and subjective sleep, respectively. Objective nighttime sleep data were sleep efficiency (SE), sleep latency (SL), total sleep time (TST), wake after sleep onset (WASO), and sleep fragmentation (SF). Objective daytime sleep data were nap times. Self-reported Subjective Sleep Quality Scale (SSQS) and Stanford Sleepiness Scale (SSS) were subjective measures. Increased SF and WASO scores and decreased TST and SE scores were found pre-LVAD implant, indicative of poor sleep quality. TST, SE, naptime and SSQS scores were higher at 3 and 6 months post-implant compared to baseline. Decreases in TST and SF scores were observed at 3 and 6 months post-implant along with increases in SSS scores. Increasing SSS scores and decreasing overall scores from pre- and up to 6 months post-implant suggest improvement in daytime function. This study provides information on sleep-daytime function in the LVAD patient population. Improvements in daytime sleepiness do not imply \"good\" sleep quality, consistent with the extant knowledge in LVAD literature. Future investigations should elucidate the mechanism by which sleep-daytime function influences quality of life.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"172-176"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9696917","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

Mid-term outcomes and hemodynamic performance of the St Jude Medical Epic aortic bioprosthesis for severe aortic stenosis. St Jude Medical Epic 主动脉生物假体治疗重度主动脉瓣狭窄的中期疗效和血液动力学表现。

IF 1.3 4区医学

Journal of Artificial Organs Pub Date : 2024-06-01 Epub Date: 2023-06-08 DOI: 10.1007/s10047-023-01405-z

Tatsuto Wakami, Naoto Fukunaga, Akio Shimoji, Toshi Maeda, Otohime Mori, Kosuke Yoshizawa, Nobushige Tamura

{"title":"Mid-term outcomes and hemodynamic performance of the St Jude Medical Epic aortic bioprosthesis for severe aortic stenosis.","authors":"Tatsuto Wakami, Naoto Fukunaga, Akio Shimoji, Toshi Maeda, Otohime Mori, Kosuke Yoshizawa, Nobushige Tamura","doi":"10.1007/s10047-023-01405-z","DOIUrl":"10.1007/s10047-023-01405-z","url":null,"abstract":"The St. Jude Medical Epic Supra valve is a porcine bioprosthesis designed for complete supraannular implantation. No report has shown the hemodynamic performance and clinical outcomes of aortic valve replacement with the Epic Supra valve for severe aortic stenosis in a Japanese cohort. We retrospectively evaluated 65 patients who underwent aortic valve replacement using the Epic Supra valve for aortic stenosis at our department between May, 2011 and October, 2016. The mean follow-up period was 68.7 ± 32.7 months, and the follow-up rate was 89.2%. The mean age was 76.8 ± 5.3 years. The 1-, 5-, and 8-year survival rates were 96.9%, 79.4%, and 60.3%, respectively. The rates of freedom from valve-related events were 96.6% and 81.9% at 5 and 8 years, respectively. Four patients were diagnosed with structural valve deterioration (SVD), and reintervention was performed in two patients. The rates of freedom from SVD were 98.2% and 83.3% at 5 and 8 years, respectively, and the mean time to diagnosis of SVD was 72.5 ± 25.3 months. The mean pressure gradient (MPG) was 16.8 ± 6.0 mmHg postoperatively, 17.5 ± 9.4 mmHg at 5 years, and 21.2 ± 12.4 mmHg at 8 years (p = 0.08). The effective orifice area index (EOAI) was 0.95 ± 0.2 cm2/m2 immediately after surgery, 0.96 ± 0.27 cm2/m2 at 5 years, and 0.84 ± 0.2 cm2/m2 at 8 years (p = 0.10). An increase in MPG and decrease in EOAI were also observed, which may be associated with SVD. Follow-up after 5 years is important to determine if there is an increase.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"125-130"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9598924","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

3D porous structure imaging of membranes for medical devices using scanning probe microscopy and electron microscopy: from membrane science points of view. 利用扫描探针显微镜和电子显微镜对医疗设备用膜进行三维多孔结构成像：从膜科学的角度。

IF 1.1 4区医学

Journal of Artificial Organs Pub Date : 2024-06-01 Epub Date: 2024-02-05 DOI: 10.1007/s10047-023-01431-x

Makoto Fukuda, Kiyotaka Sakai

{"title":"3D porous structure imaging of membranes for medical devices using scanning probe microscopy and electron microscopy: from membrane science points of view.","authors":"Makoto Fukuda, Kiyotaka Sakai","doi":"10.1007/s10047-023-01431-x","DOIUrl":"10.1007/s10047-023-01431-x","url":null,"abstract":"The evolution of hemodialysis membranes (dialyzer, artificial kidney) was remarkable, since Dow Chemical began manufacturing hollow fiber hemodialyzers in 1968, especially because it involved industrial chemistry, including polymer synthesis and membrane manufacturing process. The development of hemodialysis membranes has brought about the field of medical devices as a major industry. In addition to conventional electron microscopy, scanning probe microscopy (SPM), represented by atomic force microscopy (AFM), has been used in membrane science research on porous membranes for hemodialysis, and membrane science contributes greatly to the hemodialyzer industry. Practical studies of membrane porous structure-function relationship have evolved, and methods for analyzing membrane cross-sectional morphology were developed, such as the ion milling method, which was capable of cutting membrane cross sections on the order of molecular size to obtain smooth surface structures. Recently, following the global pandemic of SARS-CoV-2 infection, many studies on new membranes for extracorporeal membrane oxygenator have been promptly reported, which also utilize membrane science researches. Membrane science is playing a prominent role in membrane-based technologies such as separation and fabrication, for hemodialysis, membrane oxygenator, lithium ion battery separators, lithium recycling, and seawater desalination. These practical studies contribute to the global medical devices industry.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":" ","pages":"83-90"},"PeriodicalIF":1.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681127","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

Percutaneous intravascular micro-axial blood pump: current state and perspective from engineering view 经皮血管内微型轴向血泵：从工程学角度看现状和前景

IF 1.3 4区医学

Journal of Artificial Organs Pub Date : 2024-04-25 DOI: 10.1007/s10047-024-01433-3

Eiji Okamoto, Yoshinori Mitamura

{"title":"Percutaneous intravascular micro-axial blood pump: current state and perspective from engineering view","authors":"Eiji Okamoto, Yoshinori Mitamura","doi":"10.1007/s10047-024-01433-3","DOIUrl":"https://doi.org/10.1007/s10047-024-01433-3","url":null,"abstract":"The utilization of a minimally invasively placed catheter-mounted intravascular micro-axial flow blood pump (IMFBP) is increasing in the population with advanced heart failure. The current development of IMFBPs dates back around the 1990s, namely the Hemopump with a wire-drive system and the Valvopump with a direct-drive system. The wire-drive IMFBPs can use a brushless motor in an external console unit to transmit rotational force through the drive wire rotating the impeller inside the body. The direct-drive IMFBPs require an ultra-miniature and high-power brushless motor. Additionally, the direct-drive system necessitates a mechanism to protect against blood immersion into the motor. Therefore, the direct-drive IMFBPs can be categorized into two types of devices: those with seal mechanisms or those with sealless mechanisms using magnetically coupling. The IMFBPs can be classified into two groups depending on their purpose. One group is for cardiogenic shock following a heart attack or for use in high-risk percutaneous coronary intervention (PCI), and the other group serves the purpose of acute decompensated heart failure. Both direct-drive IMFBPs and wire-drive IMFBPs have their own advantages and disadvantages, and efforts are being made to develop and improve, and clinically implement them, leveraging their own strengths. In addition, there is a possibility that innovative new devices may be invented. For researchers in the field of artificial heart development, IMFBPs offer a new area of research and development, providing a novel treatment option for severe heart failure.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140799032","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

Feasibility of an animal model for long-term mechanical circulatory support with Impella 5.5 implanted through carotid artery access in sheep 绵羊颈动脉通路植入 Impella 5.5 长期机械循环支持动物模型的可行性

IF 1.3 4区医学

Journal of Artificial Organs Pub Date : 2024-04-20 DOI: 10.1007/s10047-024-01444-0

Shusuke Imaoka, Tomohiro Nishinaka, Toshihide Mizuno, Akihide Umeki, Takashi Murakami, Tomonori Tsukiya, Masashi Kawamura, Shigeru Miyagawa

{"title":"Feasibility of an animal model for long-term mechanical circulatory support with Impella 5.5 implanted through carotid artery access in sheep","authors":"Shusuke Imaoka, Tomohiro Nishinaka, Toshihide Mizuno, Akihide Umeki, Takashi Murakami, Tomonori Tsukiya, Masashi Kawamura, Shigeru Miyagawa","doi":"10.1007/s10047-024-01444-0","DOIUrl":"https://doi.org/10.1007/s10047-024-01444-0","url":null,"abstract":"Impella is a mechanical circulatory support device of a catheter-based intravascular microaxial pump for left ventricular support and unloading. However, nonclinical studies assessing the effects of the extended duration of left ventricular unloading on cardiac recovery are lacking. An animal model using Impella implanted with a less invasive procedure to enable long-term support is required. This study aimed to evaluate the feasibility of an animal model for long-term support with Impella 5.5 implanted through carotid artery access in sheep.Impella 5.5 was implanted in four sheep through the proximal region of the left carotid artery without a thoracotomy, and myocardial injuries were induced by coronary microembolization. Support by Impella 5.5 was maintained for 4 weeks, and the animals were observed. The position of Impella 5.5 and cardiac function was evaluated using cardiac computer tomography at 2 and 4 weeks after implantation.All four animals completed the 4-week study without major complications. The discrepancy in the Impella 5.5 flow rate between the conscious and anesthetized states was observed depending on the device’s position. Animals in whom the inflow was above the left ventricular papillary muscle had a relatively high flow rate under the maximum performance level without a suction alarm during the conscious state. Pathological changes in the aortic valve were observed. Cardiac function under the minimum performance level was observed with no remarkable deterioration.The animal model with myocardial injuries supported for 4 weeks by Impella 5.5 implanted through carotid artery access in sheep was feasible.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":"60 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140623648","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

Advance care planning in the treatment of implantable left ventricular assist device: a republication of the review published in Japanese Journal of Artificial Organs 植入式左心室辅助装置治疗中的预先护理计划：重新发表在《日本人工器官杂志》上的评论文章

IF 1.3 4区医学

Journal of Artificial Organs Pub Date : 2024-04-13 DOI: 10.1007/s10047-024-01443-1

Yoko Sakamoto, Ryohei Matsuura, Daisuke Yoshioka, Ai Kawamura, Sumiharu Nakamae, Shigeru Miyagawa

{"title":"Advance care planning in the treatment of implantable left ventricular assist device: a republication of the review published in Japanese Journal of Artificial Organs","authors":"Yoko Sakamoto, Ryohei Matsuura, Daisuke Yoshioka, Ai Kawamura, Sumiharu Nakamae, Shigeru Miyagawa","doi":"10.1007/s10047-024-01443-1","DOIUrl":"https://doi.org/10.1007/s10047-024-01443-1","url":null,"abstract":"Advance care planning (ACP) is essential in managing serious and chronic illnesses to ensure that patients receive care aligned with their personal values, goals, and preferences. This review focuses on integrating ACP in the treatment of patients receiving implantable left ventricular assist devices (VADs). The heart failure palliative care team developed a unique advance directive form and pamphlet to facilitate ACP discussions, emphasizing not only medical treatment preferences but also patients’ values and life goals.The study highlights the distinction between bridge to transplantation (BTT) and destination therapy (DT) in VAD patients, with different goals and considerations for ACP. The use of decision aids developed especially for DT candidates as a communication tool helps in sharing patients’ wishes and facilitates shared decision-making, particularly in the complex decisions surrounding DT therapy.Challenges in implementing ACP, such as time constraints due to urgent medical conditions, difficulties in patient communication, and the recent COVID-19 pandemic, are addressed. The need for a comprehensive healthcare system capable of supporting patients’ ACP wishes, especially in the community setting, is also pointed out.Future directions include not only developing materials to ease ACP discussions and ensuring that ACP content is shared among healthcare providers to foster collaborative and detailed planning, but also a call for widespread adoption of ACP in Japan.This is a translation of a paper written in Japanese Journal of Artificial Organs (Vol. 52, No. 1, pp. 89–92) with additions and corrections.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":"2016 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140583601","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

Management of aortic valve insufficiency in patients with continuous-flow left ventricular assist device: a republication of the review published in Japanese Journal of Artificial Organs 使用持续流左心室辅助装置的主动脉瓣功能不全患者的管理：重新发表在《日本人工器官杂志》上的评论文章

IF 1.3 4区医学

Journal of Artificial Organs Pub Date : 2024-04-10 DOI: 10.1007/s10047-024-01439-x

Naoki Tadokoro, Kohei Tonai, Satoshi Kainuma, Naonori Kawamoto, Kota Suzuki, Masaya Hirayama, Satsuki Fukushima

{"title":"Management of aortic valve insufficiency in patients with continuous-flow left ventricular assist device: a republication of the review published in Japanese Journal of Artificial Organs","authors":"Naoki Tadokoro, Kohei Tonai, Satoshi Kainuma, Naonori Kawamoto, Kota Suzuki, Masaya Hirayama, Satsuki Fukushima","doi":"10.1007/s10047-024-01439-x","DOIUrl":"https://doi.org/10.1007/s10047-024-01439-x","url":null,"abstract":"Since 2011, implantable ventricular assist devices have been a standard treatment for severe heart failure alongside heart transplantation in Japan. However, the limited availability of donors has led to a prolonged wait for transplants, now averaging 1719 days, intensifying the issue of aortic insufficiency in patients with continuous flow ventricular assist devices. These devices limit the opening of the aortic valve, leading to sustained closure and increased shear stress, which accelerates valve degradation. Risk factors for aortic insufficiency include having a smaller body surface area, being of advanced age, and the presence of mild aortic insufficiency prior to device implantation. In patients presenting with mild or moderate aortic regurgitation at the time of ventricular assist device implantation, interventions such as aortic valve repair or bioprosthetic valve replacement are performed with the aim of halting its progression. The choice of surgical procedure should be tailored to each patient’s individual condition. The management of de novo aortic insufficiency in patients with continuous flow ventricular assist devices remains challenging, with no clear consensus on when to intervene. Interventions for significant aortic insufficiency typically consider the patient’s symptoms and aortic insufficiency severity. De novo aortic insufficiency progression in continuous flow ventricular assist devices patients necessitates careful monitoring and intervention based on individual patient assessments and valve condition. This review was created based on a translation of the Japanese review written in the Japanese Journal of Artificial Organs in 2023 (Vol. 52, No. 1, pp. 77–80), with some modifications.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":"25 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140583609","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

Impact of inflammation and steroids on anti-coagulation in children supported on a ventricular assist device 炎症和类固醇对使用心室辅助装置的儿童抗凝血功能的影响

IF 1.3 4区医学

Journal of Artificial Organs Pub Date : 2024-04-06 DOI: 10.1007/s10047-024-01442-2

{"title":"Impact of inflammation and steroids on anti-coagulation in children supported on a ventricular assist device","authors":"","doi":"10.1007/s10047-024-01442-2","DOIUrl":"https://doi.org/10.1007/s10047-024-01442-2","url":null,"abstract":"<h3>Abstract</h3> Critically ill pediatric patients supported on ventricular assist devices (VADs) are increasingly being anticoagulated on bivalirudin, but with difficulty monitoring anticoagulation. Activated partial thromboplastin time (aPTT) has recently been shown to poorly correlate with bivalirudin plasma concentrations, while dTT had excellent correlation. However, aPTT is the more common monitoring test and dTT testing is rarely used. In addition, effects of frequent clinical VAD scenarios (such as inflammation) on the accuracy of aPTT and dTT testing remains uncertain. We reviewed the effects of clinical scenarios (infection/inflammation, chylothorax, and steroids administration) on anticoagulation monitoring in 10 pediatric VAD patients less than 3 years at Cincinnati Children's Hospital Medical Center from 10/27/2020 to 5/6/2022 using bivalirudin for anticoagulation. There were 16 inflammation/infection, 3 chylothorax, and 6 steroids events. Correlation between dTT and aPTT was significantly lower after infection/inflammation, with dTT increasing prior to inflammation/infection while aPTT remained unchanged. In addition, steroids are administered to VAD patients to reduce inflammation and thus additionally stabilize anticoagulation. However, this anticoagulation stabilization effect was reflected more accurately by dTT compared to aPTT. In children requiring VAD support utilizing bivalirudin anticoagulation, inflammation/infection is a common occurrence resulting in anticoagulation changes that may be more accurately reflected by dTT as opposed to aPTT.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":"57 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140583610","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