ASAIO Journal最新文献_第5页

Differential Oxygenation During Peripheral Thoracoabdominal Normothermic Regional Perfusion in Controlled Donation After Circulatory Death: An Underrecognized Cause of Potential Allograft Dysfunction and Discard. 循环死亡后控制捐献胸腹周围恒温区域灌注时的差异氧合：一个未被认识的潜在同种异体移植物功能障碍和丢弃的原因。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-25 DOI: 10.1097/MAT.0000000000002865

Bleri Celmeta, Camilla Crepaldi, Mauro Bosi, Daniele Ronco, Mattia Maria Barbiero, Aldo Cannata, Claudio Francesco Russo

{"title":"Differential Oxygenation During Peripheral Thoracoabdominal Normothermic Regional Perfusion in Controlled Donation After Circulatory Death: An Underrecognized Cause of Potential Allograft Dysfunction and Discard.","authors":"Bleri Celmeta, Camilla Crepaldi, Mauro Bosi, Daniele Ronco, Mattia Maria Barbiero, Aldo Cannata, Claudio Francesco Russo","doi":"10.1097/MAT.0000000000002865","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002865","url":null,"abstract":"Thoracoabdominal normothermic regional perfusion (TA-NRP) is increasingly adopted for cardiac allograft procurement in controlled donation after circulatory death (cDCD). In settings where ante-mortem femoral guidewire placement is permitted, peripheral TA-NRP may be employed following declaration of death to enable rapid restoration of organ perfusion, reducing warm ischemic time and avoiding manipulation of the cardiac structures before procurement. However, the differential oxygenation that may develop in this setting can be dangerously unrecognized due to supra-aortic vessel occlusion and the resulting inability to monitor upper-body oxygenation as an estimation of blood oxygenation in the ascending aorta. This phenomenon may lead to impaired myocardial oxygenation, potentially resulting in primary graft dysfunction after transplantation or, alternatively, in the unnecessary discard of an otherwise suitable cardiac allograft. In order to detect and correct this phenomenon, we implemented a modification of the TA-NRP circuit by incorporating a continuous aortic root oxygenation monitoring device. Continuous monitoring proved crucial in two scenarios: first, by identifying differential oxygenation resolved by left ventricular unloading; and second, by detecting severe aortic root desaturation after TA-NRP discontinuation, undetectable by conventional upper-body oxygenation monitoring. This simple strategy may improve the safety and reliability of donor heart functional assessment during TA-NRP.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149057765","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}

引用次数: 0

Intravascular Retrieval of a Kinked Inferior Vena Cava Cannula Complicating Venovenous Extracorporeal Life Support. 下腔静脉扭结插管并发静脉-静脉体外生命支持的血管内回收。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-24 DOI: 10.1097/MAT.0000000000002867

Taylor S Conrad, Philip G Botelho, Giles J Peek, Steven A Conrad

{"title":"Intravascular Retrieval of a Kinked Inferior Vena Cava Cannula Complicating Venovenous Extracorporeal Life Support.","authors":"Taylor S Conrad, Philip G Botelho, Giles J Peek, Steven A Conrad","doi":"10.1097/MAT.0000000000002867","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002867","url":null,"abstract":"Cannula malpositioning is one of several complications recognized during the insertion of cannulas for extracorporeal life support that can lead to loss of cannula function or more serious injury due to vessel perforation. In the absence of vessel perforation, repositioning the cannula is often sufficient to restore function. We report a case of a kinked femoral drainage cannula with folding and retroflexion in the inferior vena cava (IVC) that was successfully repositioned with intravascular intervention. A 41-year-old woman was placed on venovenous extracorporeal life support (VV ECLS) for near-fatal asthma-induced hypercapnic respiratory failure following successful resuscitation from cardiac arrest. Emergent cannulation of the left femoral vein and right internal jugular vein was completed without difficulty. Subsequent imaging revealed the 55 cm 25 Fr drainage cannula was kinked in the mid-IVC with the tip retroflexed and terminating in the lower IVC. Drainage was adequate for VV ECLS. Since simple withdrawal of the cannula for decannulation was not possible, the patient successfully underwent a complex snare-assisted retrieval in the interventional suite after a run time of 101 hours. Her subsequent course was eventful, but she recovered and was discharged after 29 days.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029607","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}

引用次数: 0

ABO Blood Group Mismatch in Heart Transplantation Is Not Associated With Elevated Donor-Derived Cell-Free DNA. 心脏移植中ABO血型不匹配与供体来源的无细胞DNA升高无关。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-21 DOI: 10.1097/MAT.0000000000002813

Daniel Oren, Cathrine M Moeller, Andrea Fernández-Valledor, Adi Hertz, Julia Baranowska, Carolyn Hennecken, Boris Fishman, Ilan Richter, Dor Lotan, Ersilia M Defilippis, Adil Yunis, Jayant Raikhelkar, Kevin Clerkin, Justin Fried, David T Majure, Koji Takeda, Melana Yuzefpolskaya, Farhana Latif, Nir Uriel, Gabriel T Sayer

{"title":"ABO Blood Group Mismatch in Heart Transplantation Is Not Associated With Elevated Donor-Derived Cell-Free DNA.","authors":"Daniel Oren, Cathrine M Moeller, Andrea Fernández-Valledor, Adi Hertz, Julia Baranowska, Carolyn Hennecken, Boris Fishman, Ilan Richter, Dor Lotan, Ersilia M Defilippis, Adil Yunis, Jayant Raikhelkar, Kevin Clerkin, Justin Fried, David T Majure, Koji Takeda, Melana Yuzefpolskaya, Farhana Latif, Nir Uriel, Gabriel T Sayer","doi":"10.1097/MAT.0000000000002813","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002813","url":null,"abstract":"Donor-derived cell-free DNA (dd-cfDNA) is a reliable, noninvasive marker for detecting allograft rejection after heart transplantation (HT). We evaluated whether dd-cfDNA levels differ in recipients of ABO-compatible, nonidentical (mismatched) grafts. We performed a retrospective single-center cohort study of 219 adult HT recipients transplanted between January 2019 and May 2023, each with at least one dd-cfDNA sample collected between November 2019 and April 2024. ABO mismatch was defined as a donor blood type A, B, or AB that was compatible with but nonidentical to the recipient's type; only ABO-compatible transplants were included. dd-cfDNA was measured using a commercially available assay (AlloSure, CareDx, Brisbane, CA), and a level ≥0.20% was defined as positive. A total of 1,783 dd-cfDNA tests were analyzed, with a 16.0% overall positivity rate. Positivity was 20.1% in the mismatched group and 15.5% in the matched group, with no statistically significant difference whether dd-cfDNA was treated as a binary (p = 0.95) or continuous (p = 0.26) variable. No statistically significant differences were observed between groups in gene expression profiling, donor-specific antibodies, rejection, or survival. In this adult cohort, ABO-compatible nonidentical HT was not associated with higher dd-cfDNA levels, although the small mismatched subgroup limits statistical power.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011799","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}

引用次数: 0

Antithrombin Activity and Inflammatory Phenotypes as Predictors of Outcome in Venovenous Extracorporeal Membrane Oxygenation. 抗凝血酶活性和炎症表型作为静脉-静脉体外膜氧合预后的预测因子。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-18 DOI: 10.1097/MAT.0000000000002840

Riccardo Del Signore, Sridevi Shetty, Barnaby Sanderson, Lorenzo Giosa, Benedetta Fumagalli, Louise Rose, Luigi Camporota

{"title":"Antithrombin Activity and Inflammatory Phenotypes as Predictors of Outcome in Venovenous Extracorporeal Membrane Oxygenation.","authors":"Riccardo Del Signore, Sridevi Shetty, Barnaby Sanderson, Lorenzo Giosa, Benedetta Fumagalli, Louise Rose, Luigi Camporota","doi":"10.1097/MAT.0000000000002840","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002840","url":null,"abstract":"Antithrombin (AT) depletion is common in critical illness, and during venovenous extracorporeal membrane oxygenation (VV ECMO), blood-surface interactions further amplify coagulation and inflammation cascades. The prognostic value of baseline AT activity complications at ECMO initiation remains unclear. We conducted a single-center retrospective cohort study of adults receiving VV ECMO (2013-2023) to investigate associations between baseline AT activity and bleeding and thrombosis risk. Clinical outcomes included computed tomography (CT)-confirmed ischemic, thrombotic, and bleeding complications and death during ECMO. Analyses included logistic regression, cause-specific Cox models, and unsupervised methods. Among 734 patients, 64% were AT-deficient (< 77%). Antithrombin activity inversely correlated with inflammatory markers. Ischemic complications were more frequent in AT-deficient patients (7.6% vs. 1.9%, p < 0.01), while thrombotic and bleeding rates were similar. Antithrombin activity predicted reduced odds of ischemic events (odds ratio [OR]: 0.97 per 1% increase, 95% confidence interval [CI]: 0.95, 0.98), with an optimal AT threshold of 49 for prediction of ischemic complications (area under the curve [AUC] = 0.74). Three subphenotypes were identified: a consumptive phenotype with markedly reduced AT activity, which carried the highest burden of ischemic complications and mortality. Baseline AT activity and inflammatory status may identify VV ECMO patients at increased risk of ischemia and death, particularly those with a consumptive profile.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001032","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}

引用次数: 0

HeartMate 3 External Outflow Graft Obstruction: Incidence and Treatment Considerations. 心脏伴侣3外流出道移植物梗阻：发生率和治疗考虑。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-18 DOI: 10.1097/MAT.0000000000002858

Parsa Jahangiri, Parama Gandi, Kadir Caliskan

引用次数: 0

Quantitative Electroencephalography Correlates With Acute Neurologic Events in Extracorporeal Membrane Oxygenation: A Pediatric Case Series. 定量脑电图与体外膜氧合中的急性神经事件相关：一个儿科病例系列。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-18 DOI: 10.1097/MAT.0000000000002862

James Hwang, Lakshmi Raman, Molly McGetrick

{"title":"Quantitative Electroencephalography Correlates With Acute Neurologic Events in Extracorporeal Membrane Oxygenation: A Pediatric Case Series.","authors":"James Hwang, Lakshmi Raman, Molly McGetrick","doi":"10.1097/MAT.0000000000002862","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002862","url":null,"abstract":"Extracorporeal membrane oxygenation (ECMO) is associated with a high risk of neurologic injury in pediatric patients, and early detection of injury is often challenging because the clinical examination is frequently limited by illness, medication, and developmental factors. Quantitative electroencephalography (qEEG), derived from standard continuous electroencephalography (cEEG), offers a bedside, continuous, and objective approach to neuromonitoring. We present a case series of two pediatric patients supported on ECMO who underwent cEEG monitoring within 6 hours of cannulation. Quantitative electroencephalography metrics, including global suppression percentage (SP) and total power (TP), were analyzed in relation to clinically significant neurologic events. In both cases, acute neurologic insults, including cardiac arrest, cerebral infarction, and intracranial hemorrhage, were associated with marked increases in global SP and concurrent decreases in TP. These findings highlight an inverse relationship between SP and TP across different mechanisms of brain injury and support further investigation of qEEG as a real-time physiologic marker of cortical suppression during acute neurologic deterioration.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001222","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}

引用次数: 0

Mid-Term Durability of Tissue-Engineered Vascular Graft Patches for Pulmonary Artery Reconstruction. 组织工程血管移植补片用于肺动脉重建的中期耐久性。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-18 DOI: 10.1097/MAT.0000000000002859

Hiroki Nakatsuji, Shinichiro Oda, Shuhei Fujita, Hisayuki Hongu, Haruka Fu, Takaaki Hayashi, Masaaki Yamagishi

{"title":"Mid-Term Durability of Tissue-Engineered Vascular Graft Patches for Pulmonary Artery Reconstruction.","authors":"Hiroki Nakatsuji, Shinichiro Oda, Shuhei Fujita, Hisayuki Hongu, Haruka Fu, Takaaki Hayashi, Masaaki Yamagishi","doi":"10.1097/MAT.0000000000002859","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002859","url":null,"abstract":"Autologous pericardium is commonly used for pulmonary artery (PA) reconstruction in congenital heart surgery but is not always available. Synthetic materials lack growth potential and may cause calcification or infection. Tissue-engineered vascular grafts (TEVGs), created by in-body tissue architecture, may overcome these limitations. This study evaluated mid-term outcomes of PA reconstruction using TEVG patches. From July 2014 to December 2024, TEVG molds were implanted in 19 patients; seven underwent PA reconstruction using 15 patches. Diagnoses included pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (n = 4), coarctation with aortic stenosis (n = 1), double outlet right ventricle with coarctation (n = 1), and tetralogy of Fallot (n = 1). Median follow-up was 2.8 years (range, 1.0-7.9 years). No mortality or patch-related calcification, aneurysm, or infection occurred. Restenosis developed in three of 15 patches (20%), all in the central PA near the right ventricle-to-PA conduit anastomosis; two patients required balloon angioplasty, with no surgical reintervention. No restenosis occurred in peripheral patches. Freedom from reintervention was 85.7% at 1 year and 71.4% at 5 years. TEVG patches demonstrated acceptable durability, particularly for peripheral PA augmentation, and may represent a reliable alternative to autologous pericardium.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001233","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}

引用次数: 0

Extending Normothermic Ex Situ Heart Preservation and Viability to 48 Hours via Protein Supplementation and Plasma Exchange. 通过补充蛋白质和血浆交换延长常温离体心脏保存和存活至48小时。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-16 DOI: 10.1097/MAT.0000000000002861

Wyeth D Alexander, Syed Sikandar Raza, Takahiro Nakashima, Vikramjit Chakrabortty, Kristopher A Urrea, Sarah King, Martin G Daman, Spencer G Amacher, Ingrid L Bergin, Joseph B Niman, Brandon Hernandez, Karen Zimmerman, Gabe E Owens, Yuliya Tipograf, Daniel H Drake, Alvaro Rojas-Peña

{"title":"Extending Normothermic Ex Situ Heart Preservation and Viability to 48 Hours via Protein Supplementation and Plasma Exchange.","authors":"Wyeth D Alexander, Syed Sikandar Raza, Takahiro Nakashima, Vikramjit Chakrabortty, Kristopher A Urrea, Sarah King, Martin G Daman, Spencer G Amacher, Ingrid L Bergin, Joseph B Niman, Brandon Hernandez, Karen Zimmerman, Gabe E Owens, Yuliya Tipograf, Daniel H Drake, Alvaro Rojas-Peña","doi":"10.1097/MAT.0000000000002861","DOIUrl":"10.1097/MAT.0000000000002861","url":null,"abstract":"Prolonged normothermic ex situ heart perfusion (NEHP) could expand the donor pool by decoupling procurement, transport, and implantation, but clinically used systems rarely exceed 4-6 hours. We evaluated pragmatic protein replacement strategies enabling 48-hour NEHP in adult porcine hearts without biologic cross-circulation. Thirteen juvenile pigs (50.6 ± 5.0 kg) underwent Langendorff NEHP and were randomly assigned to 65 kDa serum fractionate (SF65; n = 5), continuous infusion of serum fractionated to <65 kDa with hemofiltration; 120 kDa serum fractionate (SF120; n = 3), consisting of serum fractionated to <120 kDa with hemofiltration; or plasma exchange (PE, n = 5), consisting of unfractionated plasma with concomitant plasma filtration and intermittent hemofiltration. Hearts were perfused for 48 hours with intermittent working-mode assessments under predefined failure criteria. All hearts completed 48 hours without failure. PE demonstrated the lowest coronary resistance at 37-48 hours (0.13 ± 0.05 vs. 0.30 ± 0.13 SF65, 0.69 ± 0.31 SF120 mm Hg/ml/min); SF120 exhibited markedly higher aortic regurgitation (38.1% ± 27.7% vs. 5.7% ± 4.9% SF65, 5.0% ± 6.7% PE); SF65 showed the greatest edema (interventricular septal wall diameter [IVSd] increase 102% ± 23% vs. 37% ± 17% SF120, 33% ± 19% PE); and echocardiographic indices and composite histologic injury scores were similar among groups. Reproducible 48-hour NEHP of adult porcine hearts is feasible using clinically accessible protein replacement strategies. PE approximates the benefits of fractionated serum regimens while avoiding large-protein accumulation and represents a practical path toward translational long-duration heart perfusion.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148981855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Plasma Angiotensin Levels and Postoperative Hypotension in Patients With and Without Chronic Heart Failure Undergoing Cardiac Surgery. 血浆血管紧张素水平与心脏手术后慢性心力衰竭患者术后低血压的关系。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-16 DOI: 10.1097/MAT.0000000000002854

Laura DiChiacchio, Rana Hamouche, Eleni Maneta, Forest Riekhof, Stavros G Drakos, Craig H Selzman, Thomas C Hanff

{"title":"Plasma Angiotensin Levels and Postoperative Hypotension in Patients With and Without Chronic Heart Failure Undergoing Cardiac Surgery.","authors":"Laura DiChiacchio, Rana Hamouche, Eleni Maneta, Forest Riekhof, Stavros G Drakos, Craig H Selzman, Thomas C Hanff","doi":"10.1097/MAT.0000000000002854","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002854","url":null,"abstract":"The renin-angiotensin-aldosterone system (RAAS) is essential to cardiovascular homeostasis, particularly in heart failure (HF) and cardiogenic shock states. Relative angiotensin II depletion is a potential mechanism for postoperative hypotension and may be potentiated by pre-existing HF. The availability of exogenous AT2 allows for tailored vasoplegia management in a state of RAAS dysregulation. This prospective, single-institution pilot study aimed to characterize the expected reduction in angiotensin II (AT2) and angiotensin I (AT1) levels following cardiopulmonary bypass (CPB) in patients with and without chronic systolic HF, with enrollment of 10 patients in each arm. Preoperative AT2 and AT1 levels were significantly higher in patients with HF and remained so following cardiac surgery. A lower postoperative AT2 correlated with lower mean arterial pressure and a trend toward higher pressor requirements in HF patients only. No association was seen in HF or non-HF patients between CPB time and the change in AT1, AT2, or their ratio. Taken together, this pilot study suggests a role for characterizing RAAS function in patients with HF undergoing cardiac surgery for prediction and treatment of postcardiotomy vasoplegia.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148981842","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}

引用次数: 0

Chorda Tendinea Obstruction of Impella Causing Massive Hemolysis Detected by Methemoglobinemia: A Case Report. 高铁血红蛋白血症检出腱索梗阻引起大溶血1例。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-14 DOI: 10.1097/MAT.0000000000002856

Alf Schmidt, Rolf Erlebach, Pascal Locher, Peter Dietrich, Bernd Yuen

{"title":"Chorda Tendinea Obstruction of Impella Causing Massive Hemolysis Detected by Methemoglobinemia: A Case Report.","authors":"Alf Schmidt, Rolf Erlebach, Pascal Locher, Peter Dietrich, Bernd Yuen","doi":"10.1097/MAT.0000000000002856","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002856","url":null,"abstract":"The Impella microaxial flow pump is increasingly used in cardiogenic shock and high-risk coronary interventions. Hemolysis is a frequent complication, but established markers lack bedside availability. We report the first case of Impella obstruction by a chorda tendinea, causing massive hemolysis detected through severe methemoglobinemia. A 60-year-old male with non-ST-elevation myocardial infarction and cardiogenic shock underwent protected percutaneous coronary intervention with Impella CP SmartAssist support. After 42 hours, motor current increased abruptly while purge flow remained unchanged. Despite correct positioning and optimized volume status, hemoglobin fell from 9.2 to 4.6 g/dl within 14 hours, methemoglobin peaked at 10.2%, and anuric kidney injury developed. Device explantation revealed a native filamentous structure incorporated in the impeller, morphologically consistent with a chorda tendinea. Hemolysis resolved promptly post-explantation. The patient recovered and was discharged home after three months. Mobile cardiac structures can cause impeller obstruction leading to severe hemolysis. Methemoglobinemia-measured on routine blood gas analysis-may serve as an early indicator of evolving hemolysis during mechanical circulatory support and warrants prospective validation. Increased motor current with unchanged purge flow may differentiate intraluminal obstruction from thrombosis and guide targeted intervention.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963302","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}

引用次数: 0