Journal of Artificial Organs最新文献_第7页

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 1.3 4区医学

Journal of Artificial Organs Pub 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":"https://doi.org/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":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-26","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

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 1.3 4区医学

Journal of Artificial Organs Pub 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":"https://doi.org/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":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Introduction of ex vivo perfusion of extended-criteria donor hearts in a single center in Asia. 在亚洲的一个中心引入扩展标准供体心脏体外灌注。

IF 1.3 4区医学

Journal of Artificial Organs Pub Date : 2024-05-23 DOI: 10.1007/s10047-024-01447-x

Oswald Joseph On Jing Lee, Inderjeet Bhatia, Sylvia Ho Yan Wan, Katherine Yue Yan Fan, Michael Ka Lam Wong, Timmy Wing Kuk Au, Cally Ka Lai Ho

{"title":"Introduction of ex vivo perfusion of extended-criteria donor hearts in a single center in Asia.","authors":"Oswald Joseph On Jing Lee, Inderjeet Bhatia, Sylvia Ho Yan Wan, Katherine Yue Yan Fan, Michael Ka Lam Wong, Timmy Wing Kuk Au, Cally Ka Lai Ho","doi":"10.1007/s10047-024-01447-x","DOIUrl":"https://doi.org/10.1007/s10047-024-01447-x","url":null,"abstract":"The shortage of organs for heart transplantation has created a need to explore the use of extended-criteria organs. We report the preliminary use of normothermic TransMedics Organ Care System-an ex vivo approach to preserve extended-criteria brain-dead donor hearts. This System maintains a normal temperature, provides continuous perfusion and oxygenation, reduces ischemic time, and enables additional viability assessment options. In a retrospective single-centre study conducted from April 2020 to March 2023, four extended criteria brain-dead donor hearts were perfused and monitored using the Organ Care System. Suitability for transplantation was assessed based on stable or decreasing lactate levels, along with appropriate perfusion parameters. The Organ Care for use of the Organ Care System were coronary artery disease, left ventricular hypertrophy, high-dose inotrope use in the donor, a downtime exceeding 20 min, and a left ventricular ejection fraction of 40-50%. Three out of the four donor hearts were transplanted, while one was discarded due to rising lactate concentration. The three recipients had a higher surgical risk profile for heart transplant. All showed normal cardiac function and no primary graft dysfunction postoperatively. At 2-3 years post-transplant, all recipients have a ventricular function of > 60%, with only one showing evidence of mild rejection. The Organ Care System enables the successful transplantation of marginal donor organs in high-risk recipients, showcasing the feasibility of recruiting donors with extended criteria. This technique is safe and promising, expanding the donor pool and addressing the organ shortage in heart transplantation in Hong Kong.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081720","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 1.3 4区医学

Journal of Artificial Organs Pub 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":"https://doi.org/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":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Difference in coagulation systems of large animal species used in cardiovascular research: a systematic review. 心血管研究中使用的大型动物物种凝血系统的差异：系统综述。

IF 1.3 4区医学

Journal of Artificial Organs Pub Date : 2024-05-20 DOI: 10.1007/s10047-024-01446-y

Louis Staelens, Tom Langenaeken, Filip Rega, Bart Meuris

{"title":"Difference in coagulation systems of large animal species used in cardiovascular research: a systematic review.","authors":"Louis Staelens, Tom Langenaeken, Filip Rega, Bart Meuris","doi":"10.1007/s10047-024-01446-y","DOIUrl":"https://doi.org/10.1007/s10047-024-01446-y","url":null,"abstract":"Preclinical testing using animal models is indispensable in cardiovascular research. However, the translation to clinical practice of these animal models is questionable since it is not always clear how representative they are. This systematic review intends to summarize the interspecies differences in the coagulation profile of animal models used in cardiovascular research. It aims to guide future research in choosing the optimal animal species. A literature search of PubMed, Embase, Web of Science (Core Collection) and Cochrane Library was performed using a search string that was well defined and not modified during the study. An overview of the search terms used in each database can be found in the appendix. Articles describing coagulation systems in large animals were included. We identified 30 eligible studies of which 15 were included. Compared to humans, sheep demonstrated a less active external pathway of coagulation. Sheep had a higher platelet count but the platelet activatability and response to biomaterials were lower. Both sheep and pigs displayed no big differences in the internal coagulation system compared to humans. Pigs showed results very similar to those of humans, with the exception of a higher platelet count and stronger platelet aggregation in pigs. Coagulation profiles of different species used for preclinical testing show strong variation. Adequate knowledge of these differences is key in the selection of the appropriate species for preclinical cardiovascular research. Future thrombogenicity research should compare sheep to pig in an identical experimental setup.","PeriodicalId":15177,"journal":{"name":"Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141071122","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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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