Artificial organs最新文献

{"title":"Thresholds for Transfusion Practice During ECMO Support. A Systematic Review and Network Meta-Analysis.","authors":"Annalisa Boscolo, Nicolò Sella, Tommaso Pettenuzzo, Elisa Pistollato, Francesco Zarantonello, Sofia Gazzea, Giuliana Carofiglio, Erika Angela Lanzafame, Giulia Aviani Fulvio, Alessandro Zambianchi, Angela Bianco, Giordana Coniglio, Francesca Toma, Annachiara Cremone, Sindi Mustaj, Carlo Alberto Bertoncello, Camilla Triulzi, Maria Bisi, Giulia Mormando, Honoria Ocagli, Dario Gregori, Alessandro De Cassai, Paolo Navalesi","doi":"10.1111/aor.70001","DOIUrl":"10.1111/aor.70001","url":null,"abstract":"<p><strong>Purpose: </strong>The benefits of adopting restrictive transfusion strategies, as opposed to a liberal approach, during extracorporeal membrane oxygenation (ECMO) remain unclear. This network meta-analysis aims to determine whether a restrictive transfusion strategy is more effective than liberal thresholds in minimizing red blood cell (RBC) transfusions and improving secondary outcomes.</p><p><strong>Methods: </strong>A comprehensive literature search (PROSPERO-CRD42025637794) across Medline, Embase, and Scopus was conducted. All studies enrolling adults on ECMO, receiving RBC transfusions according to either restrictive or 'targeted' thresholds, compared to liberal thresholds, were included. The primary outcome was the number of RBC transfusions during ECMO. Secondary outcomes included the use of fresh frozen plasma (FFP) and platelet units, ECMO duration, and survival.</p><p><strong>Results: </strong>Five retrospective observational studies (1339 patients) met the inclusion criteria. RBC transfusions were lower when a transfusion threshold of 7 g/dL was used, compared to a liberal threshold (mean difference (MD) -5.75, 95% confidence interval (CI) -10.90 to -0.59, p = 0.029), while not with thresholds of 8 or 9 g/dL. Both FFP and platelet transfusions were reduced at thresholds of 7 g/dL and 9 g/dL, compared to liberal transfusion strategies. A shorter ECMO duration was observed only at a threshold of 9 g/dL (MD -1.06, 95% CI -2.11 to -0.01, p = 0.048). Finally, a restrictive threshold of 7 g/dL improved 28-day survival.</p><p><strong>Conclusions: </strong>A restrictive transfusion strategy reduces the number of blood products administered to ECMO patients and, secondarily, ECMO duration and mortality at 28 days. However, our findings may not be generalizable to patients with severe thrombocytopenia, bleeding disorders, or underlying cardiac conditions who may be potentially benefiting from higher transfusion thresholds.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871163","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":"Report on the 30th Annual Meeting of the International Society for Mechanical Circulatory Support (ISMCS).","authors":"Koichi Toda, Antonio Loforte, Vakhtang Tchantchaleishvili","doi":"10.1111/aor.15056","DOIUrl":"https://doi.org/10.1111/aor.15056","url":null,"abstract":"","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871162","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":"Microaxial Support as a Bridge to Repair in Post-Myocardial Infarction Ventricular Septal Rupture: A Systematic Review and Patient-Level Analysis.","authors":"Nayeem Nasher, Daler Rahimov, Keerti Mallur, T Reese Macmillan, Konstadinos A Plestis, Keshava Rajagopal, Charles W Hoopes, John W Entwistle, Joseph E Bavaria, Vakhtang Tchantchaleishvili","doi":"10.1111/aor.70000","DOIUrl":"https://doi.org/10.1111/aor.70000","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend immediate surgical repair for post-infarct ventricular septal rupture (VSR); however, mortality remains exceedingly high. We sought to report outcomes following delayed surgical management bridged with microaxial support.</p><p><strong>Methods: </strong>A comprehensive literature search yielded 42 case reports/series comprising 78 patients who were initiated on microaxial support following the diagnosis of post-infarct VSR. Patient-level data were extracted and analyzed according to survival status.</p><p><strong>Results: </strong>Overall, 78% (54/69) of patients were male, and the median age was 69 [IQR: 60-74] years, with no difference in age between survivors and non-survivors. Those who survived were significantly less likely to have a history of prior cardiac surgery than non-survivors [3% (1/30) vs. 43% (3/7), p = 0.016], and less likely to have undergone percutaneous coronary intervention at the time of presentation [41% (22/54) vs. 69% (11/16), p = 0.049]. There were no significant differences in culprit vessel (p = 0.875), VSR size (p = 1), or VSR location (p = 0.253). Those who survived had a significantly higher median Qp/Qs ratio than non-survivors [3.0 [2.3-3.8] vs. 2.1 [1.9-2.3], p = 0.038]. Patients were successfully bridged to definitive surgical management in 76% (59/78) of cases at a median time of 8 [5-14] days following microaxial support placement. The 30-day/in-hospital mortality rate was 22% (17/78), and the overall mortality rate was 27% (21/78).</p><p><strong>Conclusion: </strong>Microaxial devices can safely and feasibly provide the necessary support to allow for a successful delayed repair in hemodynamically unstable patients following post-infarct VSR.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871161","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":"Multi-Objective CFD Optimization of an Intermediate Diffuser Stage for PediaFlow Pediatric Ventricular Assist Device.","authors":"Mansur Zhussupbekov, JingChun Wu, Greg W Burgreen, Scott Stelick, Jeongho Kim, James F Antaki","doi":"10.1111/aor.70004","DOIUrl":"10.1111/aor.70004","url":null,"abstract":"<p><strong>Background: </strong>Computational fluid dynamics (CFD) has become an essential design tool for ventricular assist devices (VADs), where the goal of maximizing performance often conflicts with biocompatibility. This tradeoff becomes even more pronounced in pediatric applications due to the stringent size constraints imposed by the smaller patient population. This study presents an automated CFD-driven shape optimization of a new intermediate diffuser stage for the PediaFlow pediatric VAD, positioned immediately downstream of the impeller to improve pressure recovery.</p><p><strong>Methods: </strong>We adopted a multi-objective optimization approach to maximize pressure recovery while minimizing hemolysis. The proposed diffuser stage was isolated from the rest of the flow domain, enabling efficient evaluation of over 450 design variants using Sobol sequence, which yielded a Pareto front of nondominated solutions. The selected best candidate was further refined using a local T-search algorithm. We then incorporated the optimized front diffuser into the full pump for CFD verification and in vitro validation.</p><p><strong>Results: </strong>We identified critical dependencies where longer blades increased pressure recovery but also hemolysis, while the wrap angle showed a strong parabolic relationship with pressure recovery but a monotonic relationship with hemolysis. Counterintuitively, configurations with fewer blades (2, 3) consistently outperformed those with more blades (4, 5) in both metrics. The optimized two-blade design enabled operation at lower pump speeds (14 000 vs. 16 000 RPM), improving hydraulic efficiency from 26.3% to 32.5% and reducing hemolysis by 31%.</p><p><strong>Conclusion: </strong>This approach demonstrates that multi-objective CFD optimization can systematically explore complex design spaces while balancing competing priorities of performance and hemocompatibility for pediatric VADs.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854370","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":"Safety and Feasibility of Intradialytic Exercise Including Upper Limb Neuromuscular Electrical Stimulation in Adults With Chronic Kidney Disease: A Randomized Controlled Pilot Clinical Trial.","authors":"Mariana Rios Rosa, Vitoria Silva de Souza, Flavia Marini Paro, Daniella Cristina De Assis Pinto Gomes, Michelly Louise Sartório Altoé Toledo, Alexandre Bittencourt Pedreira, Halina Duarte, Veronica Lourenço Wittmer, Marcela Cangussu Barbalho Moulim","doi":"10.1111/aor.70006","DOIUrl":"https://doi.org/10.1111/aor.70006","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the safety and feasibility of an intradialytic exercise protocol, including unilateral upper limb neuromuscular electrical stimulation (NMES) superimposed on a voluntary contraction combined with leg cycle ergometer exercise, in adults with chronic kidney disease (CKD).</p><p><strong>Methods: </strong>This was a pilot randomized clinical trial in which patients with CKD underwent an intradialytic exercise protocol using a cycle ergometer and active upper limb NMES in the intervention group (IG) or cycle ergometer and SHAM in the control group (CG). Safety was assessed by monitoring blood pressure, heart rate (HR), peripheral oxygen saturation, and any abnormal signs or adverse events. Feasibility was evaluated based on the rate of adherence to the protocol, number of dropouts, and protocol acceptability by patients and healthcare teams.</p><p><strong>Results: </strong>HR increased in both groups during exercise, but there was no difference between the groups. The post-exercise HR remained higher than the initial HR only in the IG (p = 0.04), and the post-exercise systolic blood pressure (SBP) was lower than the initial SBP only in the CG (p = 0.05); however, these variables remained within the safety values. The adherence rate was 87.5% in the IG and 82.29% in the CG, with no reported adverse events, and the majority expressed interest in continuing exercise after the end of the study, with positive acceptance from the healthcare staff at the HD center.</p><p><strong>Conclusion: </strong>This intradialytic exercise protocol, including active upper limb NMES, seems to be safe and feasible, suggesting that NMES may be incorporated into intradialytic protocols.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT05374863.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833836","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":"Recent Progress in the Field of Artificial Organs.","authors":"Aakash M Shah, John A Treffalls, Jacopo D'Andria Ursoleo, Brian E Woolley, Brett F Curran, Ander Doran-Gallastegi","doi":"10.1111/aor.70002","DOIUrl":"https://doi.org/10.1111/aor.70002","url":null,"abstract":"","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793358","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":"Hypothermic Oxygenated Machine Perfusion (HOPE) During Total Vascular Exclusion With Veno-Venous Bypass for Giant Hepatic Hemangioma Resection.","authors":"Mehdi Boubaddi, Florence Jeune, Chetana Lim, Claire Goumard, Eric Savier, Géraldine Rousseau, Fabiano Perdigao, Olivier Scatton","doi":"10.1111/aor.15065","DOIUrl":"https://doi.org/10.1111/aor.15065","url":null,"abstract":"<p><p>Hypothermic oxygenated machine perfusion (HOPE) during total vascular exclusion with veno-venous bypass for major hepatic resection is a safe procedure and could help to reduce ischemia-reperfusion lesions and related complications.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783317","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":"Kidney Machine Perfusion Is Associated With Improved Long-Term Graft Survival Mediated by Reduced Delayed Graft Function: A Mate-Kidney Analysis.","authors":"Gabriel Cojuc-Konigsberg, Bhavna Chopra","doi":"10.1111/aor.15066","DOIUrl":"https://doi.org/10.1111/aor.15066","url":null,"abstract":"<p><strong>Background: </strong>Kidney machine perfusion (MP) prevents delayed graft function (DGF). Whether this benefit translates into improved long-term graft survival (LGS) remains uncertain. We evaluated the association between MP and LGS and its potential mediation by DGF.</p><p><strong>Methods: </strong>UNOS analysis of adult deceased donor kidney transplant recipients (KTRs) from January 2010 to June 2019. We selected KTRs with cold ischemia time (CIT) > 12 h and on tacrolimus maintenance. We included KTRs from dual-kidney donors and compared outcomes where one mate kidney received MP and the other did not. The primary endpoint was all-cause graft failure (GF) analyzed using a stratified multivariable Cox proportional hazards model. We assessed the association of MP and DGF with conditional logistic regression. We evaluated the mediation effect of DGF by combining the predictor and outcome models and bootstrapping with 1000 iterations to calculate 95% confidence intervals (CI).</p><p><strong>Results: </strong>We included 2355 mate-kidney pairs with 5.8 years (IQR 4-8) median follow-up. MP was associated with lower GF risk (aHR 0.86, 95% CI 0.75-0.98) and DGF odds (aOR 0.41, 95% CI 0.34-0.51) than no MP. DGF fully mediated the association between MP and GF, as the effect was no longer statistically significant after adjusting for DGF (aHR 0.89, 95% CI 0.78-1.03). DGF explained 76.8% of the association between MP and GF.</p><p><strong>Conclusions: </strong>In mate-kidney pairs with discordant MP use and CIT > 12 h, MP was associated with decreased GF risk, mediated by decreased DGF likelihood. MP both mate kidneys with CIT > 12 h should be considered to potentially improve LGS.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774596","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":"Switched Controllers in Fully Closed Loop Insulin Delivery Systems: Reducing the Trade-Off Between Prandial Control and Safety.","authors":"Fernando Leonel Da Rosa Jurao, Emilia Fushimi, Fabricio Garelli","doi":"10.1111/aor.15064","DOIUrl":"https://doi.org/10.1111/aor.15064","url":null,"abstract":"<p><strong>Background: </strong>One of the main challenges in control algorithm design for full closed-loop automated insulin delivery systems is the trade-off between the effective compensation of meal-related disturbances and ensuring user safety during the postprandial and fasting periods.</p><p><strong>Methods: </strong>This paper proposes and evaluates the performance of a switched tuning strategy, a promising but relatively underexplored solution in this domain. This method employs two distinct tunings of a primary control algorithm: an aggressive tuning for meal compensation and a conservative tuning for fasting periods. The analysis considers implementing the switched strategy for three control algorithms: model predictive control and proportional-derivative control, both widely used for glucose regulation, and a linear quadratic Gaussian control, an optimal algorithm previously validated in clinical settings under a switched structure. Additionally, to obtain a more comprehensive understanding of the switched strategy implications, two nonswitched controllers are implemented for each control algorithm: an aggressive and a conservative tuning strategy.</p><p><strong>Results: </strong>The switched strategy significantly improves the trade-off between meal compensation and safety, increasing the time within the target range of 70-180 [mg/dL] for all three algorithms. For proportional-derivative control, the time in range increases from 69.1% with the conservative tuning and 83.1% with the aggressive to 86.6% with the switched structure. For model predictive control, the improvement is from 73.4% and 74.1% to 85.8%. Last, linear quadratic Gaussian control increases from 65.0% and 70.4% to 85.6%.</p><p><strong>Conclusion: </strong>The findings suggest that the switched strategy may be a feasible and straightforward approach for enhancing meal compensation without increasing the risk of postprandial hypoglycemia in people with diabetes.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764396","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":"The Challenges of Pushing the Limits of Organ Utilization by Ex-Situ Machine Perfusion.","authors":"Damiano Patrono, Nicola De Stefano, Renato Romagnoli","doi":"10.1111/aor.15067","DOIUrl":"https://doi.org/10.1111/aor.15067","url":null,"abstract":"","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726887","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}