Sara S Inglis, Sarah D Schettle, Mauricio A Villavicencio, Philip J Spencer, John M Stulak, Paul C Tang, Sudhir S Kushwaha, Atta Behfar, Andrew N Rosenbaum
{"title":"Assessment of Left-Sided Hemodynamics With Exercise in Patients With Continuous Flow Left Ventricular Assist Device Support.","authors":"Sara S Inglis, Sarah D Schettle, Mauricio A Villavicencio, Philip J Spencer, John M Stulak, Paul C Tang, Sudhir S Kushwaha, Atta Behfar, Andrew N Rosenbaum","doi":"10.1111/aor.14995","DOIUrl":"https://doi.org/10.1111/aor.14995","url":null,"abstract":"<p><strong>Background: </strong>Addition of left heart catheterization (LHC) to exercise protocols allows for a unique focus on parameters of systolic and diastolic responses to increased activity in patients with left ventricular assist device (LVAD) support.</p><p><strong>Methods: </strong>A retrospective review was conducted of all consecutive adult patients who underwent LHC with exercise for any indication from June 2017 to June 2023. For all patients, the relationship between exercise and parameters of LV systolic and diastolic response was assessed. Patients were divided into two cohorts based on the indication for testing: hemodynamic optimization (Optim, n = 5) or weaning consideration (Wean, n = 3).</p><p><strong>Results: </strong>Eight patients (88% male, median age 57 years (IQR 44, 65)) were included. LVEF was 45% (IQR 45, 56) in Wean and 25% (IQR 20, 42) in Optim. LV systolic work index (LVSWI) increased more rapidly over levels of exercise in Wean vs. Optim (slope 46.3 vs. -0.625; p = 0.044) and LVSWI rose more quickly at lower levels of LV end diastolic pressure (LVEDP) in Wean vs. Optim (slope 219.5 vs. -2.008; p = 0.0026). Pulse power index was higher in Wean patients at baseline (0.046 (IQR 0.04, 0.07) vs. 0.016 (IQR 0.001, 0.04); p = 0.14) and peak exercise (0.12 (IQR 0.12, 0.12) vs. 0.06 (IQR 0.03, 0.1); p = 0.29).</p><p><strong>Conclusions: </strong>Patients with favorable remodeling on LVAD support have significantly improved LV systolic and diastolic responses to exercise and a trend of higher systemic pulsatility. Improving our understanding of LV-LVAD interactions with activity may aid in future efforts to improve exercise tolerance through speed modulation.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yitian Fang, Anton V Nikolaev, Jeroen Essers, Gisela Ambagtsheer, Marian C Clahsen-van Groningen, Robert C Minnee, Ron W F de Bruin, Gijs van Soest
{"title":"Enhancing Kidney Quality Assessment: Power Doppler During Normothermic Machine Perfusion.","authors":"Yitian Fang, Anton V Nikolaev, Jeroen Essers, Gisela Ambagtsheer, Marian C Clahsen-van Groningen, Robert C Minnee, Ron W F de Bruin, Gijs van Soest","doi":"10.1111/aor.14983","DOIUrl":"https://doi.org/10.1111/aor.14983","url":null,"abstract":"<p><strong>Objectives: </strong>Marginal donor kidneys are increasingly used for transplantation to overcome organ shortage. This study aims to investigate the additional value of Power Doppler (PD) imaging in kidney quality assessment during normothermic machine perfusion (NMP).</p><p><strong>Methods: </strong>Porcine kidneys (n = 22) retrieved from a local slaughterhouse underwent 2 h of NMP. Based on creatinine clearance (CrCl) and oxygen consumption (VO<sub>2</sub>) at 120 min, kidneys were classified into Group 1 (n = 7, CrCl > 1 mL/min/100 g and VO<sub>2</sub> > 2.6 mL/min/100 g) and Group 2 (n = 15, CrCl ≤ 1 mL/min/100 g and/or VO<sub>2</sub> ≤ 2.6 mL/min/100 g). PD imaging was performed at 30, 60, and 120 min, and PD metrics, including vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were calculated. Renal blood flow (RBF), CrCl, and VO<sub>2</sub> were measured at the same time points during NMP. The metrics were compared utilizing correlation analysis.</p><p><strong>Results: </strong>FI and VFI moderately correlated with CrCl (r = 0.537, p < 0.0001; r = 0.536, p < 0.0001, respectively), while VI strongly correlated with VO<sub>2</sub> (r = 0.839, p < 0.0001). At 120 min, PD metrics demonstrated the highest diagnostic accuracy for distinguishing between the two groups, with an area under the curve (AUC) of 0.943 for VI, 0.924 for FI, and 0.943 for VFI. Cutoff values of 17% for VI, 50 a.u. for FI, and 9 a.u. for VFI provided 100% specificity and 73% sensitivity in identifying kidneys in Group 2, with an overall diagnostic accuracy of 82%. Baseline kidney biopsies showed moderate acute tubular necrosis in both groups, with no significant differences.</p><p><strong>Conclusions: </strong>PD metrics strongly correlate with renal viability and effectively differentiate kidneys with higher and lower functionality during NMP. PD imaging can be a valuable alternative to RBF during NMP for kidney quality assessment.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association of Aortic Root and Valve Morphology With De Novo Aortic Valve Regurgitation After Implantation of Left Ventricular Assist Device.","authors":"Takashi Murakami, Yusuke Misumi, Daisuke Yoshioka, Takuji Kawamura, Ai Kawamura, Shin Yajima, Shunsuke Saito, Takashi Yamauchi, Shigeru Miyagawa","doi":"10.1111/aor.14987","DOIUrl":"https://doi.org/10.1111/aor.14987","url":null,"abstract":"<p><strong>Background: </strong>The development of aortic valve regurgitation (AR) negatively affects the survival of patients with continuous-flow left ventricular assist device (LVAD) support. Although several risk factors have been identified, little is known about the effect of preoperative aortic root and valve morphology on the development of de novo AR after LVAD implantation.</p><p><strong>Methods: </strong>Between April 2018 and September 2023, 87 patients underwent durable LVAD implantation at our department. Of these, the 15 eligible patients who underwent preoperative electrocardiography-synchronized cardiac contrast-enhanced computed tomography were included in this study. Baseline aortic root and valve morphology and its relationship with the postoperative development of AR were retrospectively reviewed.</p><p><strong>Results: </strong>The mean duration of LVAD support was 1208 ± 618 days. At 60 months postsurgery, 10 patients had mild or greater AR (Group I) and the others did not (Group N). The measurement of baseline aortic root morphology showed that the ratio of virtual basal ring diameter to geometric height (VBD/GH) was significantly larger for Group I (1.70 ± 0.024 vs. 1.48 ± 0.034; p = 0.0001).</p><p><strong>Conclusions: </strong>A large preoperative VBD/GH is a significant risk factor for de novo AR. This finding may assist in determining the surgical indications for concomitant aortic valve procedures with durable LVAD implantation.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Debora Zrinscak, Claudia M De Chirico, Lucrezia Lorenzon, Fabiola Coluccia, Mauro De Luca, Martina Maselli, Jolanda Kluin, Johannes T B Overvelde, Matteo Cianchetti
{"title":"Design of a Soft Robotic Artificial Cardiac Wall.","authors":"Debora Zrinscak, Claudia M De Chirico, Lucrezia Lorenzon, Fabiola Coluccia, Mauro De Luca, Martina Maselli, Jolanda Kluin, Johannes T B Overvelde, Matteo Cianchetti","doi":"10.1111/aor.14978","DOIUrl":"https://doi.org/10.1111/aor.14978","url":null,"abstract":"<p><strong>Background: </strong>In cardiovascular engineering, the recent introduction of soft robotic technologies sheds new light on the future of implantable cardiac devices, enabling the replication of complex bioinspired architectures and motions. To support human heart function, assistive devices and total artificial hearts have been developed. However, the system's functionality, hemocompatibility, and overall implantability are still open challenges.</p><p><strong>Methods: </strong>Here, the design of a soft robotic artificial cardiac wall is presented: the action of a bioinspired myocardium of pneumatic McKibben actuators in a double helix is coupled with an engineered passive and deformable endocardial layer made of silicone. The correlation between the helix angle of the actuators and the ejection fraction of the artificial cardiac wall was preliminarily studied with a simplified analytical model. A FEM model was introduced to represent the complex deformation of the endocardial layer during the actuation of the cardiac wall.</p><p><strong>Results: </strong>Experimental tests report an ejection fraction of 68%, i.e., 77.2 ± 0.4 mL against 90 mmHg, satisfying the minimum physiological requirements and, therefore, proving the concept's functionality.</p><p><strong>Conclusions: </strong>The conceived device paves the way for a new generation of innovative approaches where engineered bioinspiration might be the key to future artificial cardiac pumps that could support or even substitute the human failing heart.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julia R James, Madeline Fuller, Madison Hanford Hunt, Elizabeth Powell, Gary Lu, Quefeng Li, Arwa Omary, Ian B Hollis
{"title":"Hemocompatibility-Related Adverse Events Associated With or Without Low Molecular Weight Heparin Bridging in Outpatients With a HeartMate 3 Left Ventricular Assist Device.","authors":"Julia R James, Madeline Fuller, Madison Hanford Hunt, Elizabeth Powell, Gary Lu, Quefeng Li, Arwa Omary, Ian B Hollis","doi":"10.1111/aor.14986","DOIUrl":"https://doi.org/10.1111/aor.14986","url":null,"abstract":"<p><strong>Background: </strong>Prior studies of anticoagulation bridging during periods of low International Normalized Ratio (INR) in outpatients with a durable, continuous flow left ventricular assist device (CF-LVAD) have shown a variable impact on thrombotic and bleeding events. These studies include predominantly older devices such as the HeartMate 2 (HM2) and HeartWare HVAD, which are known to experience more overall thrombotic events than the HeartMate 3 (HM3) device. The majority of these patients also received concomitant aspirin.</p><p><strong>Methods: </strong>The primary objective of this study was to compare hemocompatibility-related adverse events (HRAEs) occurring while bridging subtherapeutic (≤ 1.7) INRs with therapeutic low-molecular weight heparin (LMWH) versus not bridging in outpatients with an HM3 CF-LVAD, many of whom were not receiving concomitant aspirin.</p><p><strong>Results: </strong>Of the 79 patients eligible for inclusion in this study, 64 were not bridged and 15 were bridged at least once during the study period. In the non-bridged group, there were a total of 12 HRAEs of 997 bridging opportunities (BOs) (1.20%) versus 0 of 39 BOs in the bridged group. Of the 12 HRAEs in the non-bridged group, 10 were bleeding events; the 2 thrombotic events were minor venous thromboembolisms.</p><p><strong>Conclusion: </strong>Omission of LMWH bridging in HM3 CF-LVAD patients with a subtherapeutic INR and low rates of background aspirin use did not result in a statistically significant or clinically relevant increase in the rate of HRAEs.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Masashi Kai, Junichi Shimamura, Sooyun Caroline Tavolacci, Guy Elgar, Hajime Ichikawa, Elliot Levine, David Spielvogel, Suguru Ohira
{"title":"Reoperative Left Ventricular Assist Device Insertion Following Previous Coronary Artery Bypass Grafting: Less Invasive Versus Sternotomy Approach.","authors":"Masashi Kai, Junichi Shimamura, Sooyun Caroline Tavolacci, Guy Elgar, Hajime Ichikawa, Elliot Levine, David Spielvogel, Suguru Ohira","doi":"10.1111/aor.14984","DOIUrl":"https://doi.org/10.1111/aor.14984","url":null,"abstract":"<p><strong>Purpose: </strong>Reoperative durable left ventricular assist device (LVAD) insertion after coronary artery bypass grafting (CABG) is challenging due to potential injury to bypass grafts, great vessels, or the right ventricle (RV). We sought to compare the less invasive (LI) approach to the full sternotomy (FS) technique for LVAD implantation in patients with a prior history of CABG.</p><p><strong>Methods: </strong>From March 2012 to April 2023, 29 patients with a history of CABG underwent reoperative LVAD implantation: Group FS, N = 16, and Group LI, N = 13. The LI approach includes an upper hemisternotomy and left thoracotomy without dissecting around the RV and bypass grafts.</p><p><strong>Results: </strong>The median age was 68 years in Group FS and 70 years in Group LI (p = 0.83). HeartMate II was only used in group FS (FS: 56.3% [N = 9] vs. LI: 0%), whereas HeartWare (FS: 31.3% [N = 5] vs. LI: 53.8% [N = 7]) and Heartmate 3 (FS: 12.5% [N = 2] vs. LI: 46.2% [N = 6]) were used in both groups. None of the patients experienced intraoperative injury of bypass grafts. In isolated LVAD implantation, cardiopulmonary bypass time was comparable between groups (FS: 92 [68, 96] min vs. LI: 82 [61, 96] min, p = 0.33). The incidence of severe RV failure requiring mechanical support was lower in Group LI (FS: 43.8% [N = 7] vs. LI: 0%, p = 0.02). Hospital mortality was numerically lower in the LI group (FS: 31.3% [N = 5] vs. LI: 9.1% [N = 1], p = 0.35). One-year estimated survival rates were not significantly different (FS: 68.8% ± 11.6% vs. LI: 81.8% ± 11.6%, p = 0.85).</p><p><strong>Conclusions: </strong>The less invasive technique for reoperative LVAD insertion after CABG may improve outcomes by reducing RV failure.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zurab Darbaidze, Bastian Schmack, Günes Dogan, Ali Saad Merzah, Maria M Gabriel, Adelheid Görler, Aron-Frederik Popov, Alexander Weymann, Arjang Ruhparwar, Jan D Schmitto, Jasmin S Hanke
{"title":"Peritoneal Dialysis in Patients Supported by Left Ventricular Assist Device.","authors":"Zurab Darbaidze, Bastian Schmack, Günes Dogan, Ali Saad Merzah, Maria M Gabriel, Adelheid Görler, Aron-Frederik Popov, Alexander Weymann, Arjang Ruhparwar, Jan D Schmitto, Jasmin S Hanke","doi":"10.1111/aor.14970","DOIUrl":"https://doi.org/10.1111/aor.14970","url":null,"abstract":"<p><strong>Introduction: </strong>Terminal heart failure is often associated with end-stage kidney disease. Due to advantages concerning patient independence, peritoneal dialysis (PD) is an alternative to conventional hemodialysis treatment. As left ventricular assist device implantations continuously increase, data on combined PD and LVAD is rare. We present the first and largest cohort study on this exclusive patient cohort.</p><p><strong>Methods: </strong>A retrospective study was conducted on patients who underwent LVAD implantation at a high-volume heart failure center from 2000 to 2024. Adverse events were analyzed according to the INTERMACS classification.</p><p><strong>Results: </strong>A total of nine patients were identified as undergoing PD on LVAD therapy. Mean age at the time of LVAD implantation was 67 years. Main cause of kidney disease was cardio-renal syndrome (67%). In all patients, PD therapy was established before LVAD implantation. Mean time on PD before LVAD implantation was 72 months. None of the patients were weaned from dialysis nor were converted to conventional dialysis. Four patients experienced driveline infection. Three patients suffered an infection of their PD catheter. A combination of PD and DL infection was detected in two cases. None of these infections were associated with the same pathogens. Mean survival after LVAD + PD was 56.5 months.</p><p><strong>Conclusion: </strong>Peritoneal dialysis has advantages over hemodialysis including fewer bloodstream infections, fewer hemodynamic shifts, and the comfort of the ambulant setting. This study illustrates that PD in LVAD patients is feasible and long-term support up to several years is achievable without major complications.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association of Left Ventricular Size on Outcomes in Patients With Left Main Coronary Artery Myocardial Infarction Complicated by Cardiogenic Shock.","authors":"Naoki Tadokoro, Satoshi Kainuma, Kimito Minami, Satsuki Fukushima","doi":"10.1111/aor.14974","DOIUrl":"https://doi.org/10.1111/aor.14974","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock in left main coronary artery acute myocardial infarction patients has high mortality rates. This study investigates the association between left ventricular size and outcomes in these patients treated with veno-arterial extracorporeal membrane oxygenation.</p><p><strong>Methods: </strong>This retrospective single-center study examined patients who underwent percutaneous coronary intervention for left main coronary artery acute myocardial infarction and developed refractory cardiogenic shock between April 2013 and August 2021. Baseline characteristics and echocardiographic assessments were conducted 24-48 h after veno-arterial extracorporeal membrane oxygenation initiation. Patients were divided into two groups: small left ventricle (S-group, ≤ 23 mm/m<sup>2</sup> for males and ≤ 26 mm/m<sup>2</sup> for females, n = 11) and regular left ventricle (R-group, n = 22). The primary outcome was a 1-year survival. The analysis included survival and adjusted multivariate Cox proportional hazards modeling.</p><p><strong>Results: </strong>The S-group showed a significantly higher mortality rate during support (63.6% vs. 4.5%, p = 0.001). In the unadjusted survival analysis, the 1-year survival rate was significantly lower in the S-group (9.0% [95% CI, 1.4-58.9] vs. 59.1% [95% CI, 41.7-83.6], p < 0.01). After adjusting for confounders, multivariate Cox analysis identified a small left ventricle (adjusted HR 8.38, 95% CI 2.33-30.16, p = 0.001), advanced age (per 10-year increase, adjusted HR 2.35, 95% CI 1.39-3.98, p = 0.001), and lower baseline left ventricular ejection fraction (per 10% decrease, adjusted HR 0.48, 95% CI 0.26-0.88, p = 0.018) as significant predictors of 1-year all-cause mortality.</p><p><strong>Conclusions: </strong>In patients with severe cardiogenic shock following left main coronary artery acute myocardial infarction requiring veno-arterial extracorporeal membrane oxygenation, a small left ventricle is associated with a poor prognosis.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Justa Friebus-Kardash, Amina Louzi, Andreas Kribben, Hartmut H Schmidt, Michael Jahn, Bartosz Tyczynski, Jassin Rashidi-Alavijeh, Andreas Schütte, Amos Zeller
{"title":"Comparison of Open Albumin Dialysis (OPAL) With Prometheus Fractionated Plasma Separation and Adsorption (FPSA) and Standard Medical Treatment for Acute-On-Chronic Liver Failure.","authors":"Justa Friebus-Kardash, Amina Louzi, Andreas Kribben, Hartmut H Schmidt, Michael Jahn, Bartosz Tyczynski, Jassin Rashidi-Alavijeh, Andreas Schütte, Amos Zeller","doi":"10.1111/aor.14977","DOIUrl":"https://doi.org/10.1111/aor.14977","url":null,"abstract":"<p><strong>Background: </strong>Acute-on-chronic liver failure (ACLF) is associated with high short-term mortality of up to 40%. Albumin dialysis is a therapeutic option that can be used to bridge patients with ACLF to liver transplantation or recovery.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted to determine the effectiveness and adverse effects of open albumin dialysis (OPAL) by comparing the biochemical and clinical variables of model for end-stage liver disease (MELD)-matched ACLF patients who received one of three treatments: OPAL plus standard medical treatment (SMT; 22 patients), Prometheus dialysis fractionated plasma separation and adsorption (FPSA) plus SMT (41 patients), or hemodialysis plus SMT (24 patients) at the University Hospital Essen.</p><p><strong>Results: </strong>OPAL treatment significantly reduced liver function tests such as bilirubin (p = 0.0001) and creatinine levels (p = 0.049). Therefore, OPAL therapy significantly reduced the MELD score (p = 0.001) and the Chronic Liver Failure Consortium (CLIF-C) ACLF (p = 0.0005) score. In both extracorporeal liver support groups, the decrease in MELD score was significantly stronger than that achieved with SMT (OPAL vs. SMT, p = 0.002; Prometheus vs. SMT, p = 0.0001; OPAL vs. Prometheus p = 0.90). In comparison to the SMT group, survival rates after 14 and 30 days were significantly higher in the Prometheus group (p = 0.0008 and 0.03) and tended to be better in the OPAL group, although statistical significance was not reached (p = 0.06 and p = 0.11).</p><p><strong>Conclusions: </strong>Our analysis revealed OPAL is an efficient method of albumin dialysis yielding a reduction of bilirubin and creatinine levels and improving clinical scoring in ACLF patients. OPAL as well as Prometheus were associated with a stronger reduction of relevant biochemical variables of liver function and amelioration in clinical scoring in comparison to SMT. However, it should be considered that patients from the SMT group were older and experienced progressive ACLF with high mortality risks compared to the patients from the OPAL and Prometheus groups. Thus, when interpreting the study results, several limitations including small sample size and heterogeneity of the treatment groups due to the lack of randomization should be taken into account.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}