International Journal of Artificial Organs最新文献

A variety of right ventricular assist devices (RVAD) options are commonly used, including traditional surgical RVAD and various percutaneous RVAD like the ProtekDuo cannula (LivaNova, London, UK). We report the first case of a patient with a ProtekDuo cannula inserted directly via the transauricular route through a mini right thoracotomy due to the inability to implant via the jugular vein.

Background: Pulse wave velocity (PWV) is a recognised risk factor for mortality and cardiovascular disease in peritoneal dialysis (PD) patients. However, debate continues as to which factors increase PWV. We reviewed the effect of volume overload and calcium balance on PWV.

Methods: Aortic PWV (aoPWV) was measured in PD patients attending for routine assessments of peritoneal membrane function, with assessments of extracellular water with bioimpedance and cardiac biomarkers.

Results: A total of 122 patients were included (55.6% male; mean age = 64.8 ± 15.3 years; 36.1% diabetic; median dialysis vintage = 19.5 (7.9-37.3) months; weight = 72.7 ± 16.4 kg; mean aoPWV = 9.9 ± 2.2 m/s). Patients with elevated aoPWV (>2 standard deviations above the age-adjusted mean) were compared to those within the expected range. We found that increased adjusted aoPWV was associated on receiver operator curves (ROC) with younger age (ROC = 0.15, p < 0.001), higher sodium removal (ROC = 0.69, p = 0.002), greater use of hypertonic dialysates (ROC = 0.68, p = 0.04), higher PD ultrafiltration (ROC = 0.68, p = 0.005) and elevated N-terminal probrain natriuretic peptide (NTproBNP; ROC = 0.62, p = 0.38), but with lower residual kidney function (KtVurine; 0.34, p = 0.023). On multivariable analysis, both younger age (OR = 0.90; 95% confidence interval (CI) = 0.86-0.95; p < 0.001) and higher log-transformed NTproBNP (OR = 3.24; 95% CI = 1.05-9.96; p = 0.04) remained independently associated with a raised adjusted aoPWV.

Conclusions: This study demonstrates that, after adjusting for age, elevated aoPWV is associated with an increased NTproBNP, suggesting that volume overload increases arterial stiffness. These results reinforce the importance of improving volume control in PD patients to reduce cardiovascular risk.

Cardiovascular disease (CVD) is a leading cause of death worldwide. CVD includes conditions such as myocardial infarction (MI), arrhythmias, valvular heart disease, and cardiomyopathy. The limitations of heart treatment are related to the inability of damaged cells to regenerate, which leads to an increasing demand for new therapies. Cardiac tissue engineering (CTE) aims to efficiently regenerate damaged cardiac tissues by combining cells and biomaterials to address these diseases. Various cell types have been used in CTE research, including adult and pluripotent stem cells, the latter differentiating into functional cardiomyocytes. An ideal biomaterial promotes efficient adhesion, growth, and differentiation of cardiac cells and possesses the appropriate characteristics needed for functional cardiac cells, showing great potential for heart repair and regeneration. This review focuses on various tissue engineering approaches for the regeneration and repair of cardiac tissues following myocardial infarction.

Background: There is a lack of consensus regarding the optimal anticoagulation strategy for continuous renal replacement therapy (CRRT) in patients with hyperlactataemia and a high risk of bleeding. The purpose of this study was to evaluate the safety and efficacy of the commonly used anticoagulation methods for CRRT in these patients.

Methods: The present study included patients with hyperlactataemia (⩾2 mmol/L) and a high risk of bleeding who underwent CRRT at Xijing Hospital from 2020 to 2024. Filter lifespan, bleeding complications, blood infusion and adverse effects were recorded.

Results: The present study included a total of 53 patients who underwent no anticoagulation (NA)-CRRT, 32 patients who underwent nafamostat mesylate (NM)-CRRT and 47 patients who underwent regional citrate anticoagulation (RCA)-CRRT. The filter lifespan was significantly different among the three groups (NA = 25 h (IQR = 18.4, 34.5), NM = 41 h (IQR = 24.0, 54.3) and RCA = 36 h (IQR = 23.0, 53.5), p < 0.001). The 30-day mortality rate was significantly higher in the NA group (p = 0.037). Furthermore, the incidence of bleeding complications (43.4%, p = 0.003) and blood transfusions (28.3%, p = 0.047) were higher in the NA group.ConclusionThe utilization of either NM or RCA has the potential to extend the filter lifespan and may be associated with a reduced risk of bleeding. These findings suggest that NM and RCA may be safe and effective for CRRT patients with hyperlactataemia and a high risk of bleeding if careful monitoring and timely adjustment are employed.

Background: Transporting patients on extracorporeal membrane oxygenation (ECMO) is a standard practice in high-resource settings but remains limited in low- and middle-income countries due to financial, infrastructural, and staffing constraints. This study evaluated the safety, complications, and outcomes of ECMO transport in a low-resource setting.

Methods: This retrospective study conducted ECMO transport at a tertiary hospital in Ho Chi Minh City, Vietnam, from January 2019 to January 2023. Data on demographics, transport logistics, ECMO configuration, complications, and clinical outcomes were analyzed, including subgroup comparisons between COVID-19 and non-COVID-19 patients.

Results: Thirty-nine patients (mean age 45 years; 56.4% female) underwent inter-hospital ECMO transport over a median distance of 7.9 km. All patients survived transport, although one patient (2.6%) had a mechanical complication. Other complications recorded during ECMO support included infection in 53.8%, major bleeding in 23.1%, and pneumothorax in 5.1%. Overall survival to discharge was 69.2%. COVID-19 patients had a significantly lower discharge survival than non-COVID-19 patients (42.9% vs. 81.8%, p = 0.029)Conclusion:ECMO transport can be safely implemented in low-resource settings, achieving outcomes comparable to in-house ECMO support. Further research is essential to develop standardized protocols and expand ECMO networks to improve patient outcomes in resource-limited settings.

Objective: To explore the clinical efficacy of acupoint massage combined with auricular points plaster therapy on sleep quality and quality of life in patients undergoing Maintenance Hemodialysis (MHD).

Methods: One hundred and twenty insomnia patients undergoing MHD from January 2022 to December 2024 were selected and randomly divided into an observation group (n = 60) and a control group (n = 60). The control group was given conventional treatment, while the observation group received acupoint massage combined with auricular points plaster therapy in addition to conventional treatment, with an intervention period of 4 weeks. After 4 weeks, the pre- and post-treatment Pittsburgh Sleep Quality Index (PSQI) and World Health Organization Quality of Life-BREF (WHOQOL-BREF) scores were compared, along with the Newcastle Nursing Satisfaction Scale (NSNS) scores between the two groups.

Results: After 4 weeks of intervention, the observation group showed significant efficacy in TCM syndrome differentiation, with a response rate of 80.0%. The total PSQI and WHOQOL scores decreased (p < 0.05), with an overall response rate of 90.0%. Meanwhile, after 4 weeks of intervention, the observation group demonstrated significant efficacy in TCM syndrome differentiation after intervention for 4 weeks, with an overall response rate of 90.0%. Additionally, the PSQI score remarkably decreased (p < 0.05) and the WHOQOL-BREF score substantially increased (p < 0.05), with the NSNS score being markedly higher than that of the control group (p < 0.05).

Conclusion: The selection of acupoints for acupoint massage combined with auricular points plaster therapy can improve sleep quality, quality of life, and nursing satisfaction in patients undergoing MHD.

Background: We present the case of a 68-year-old patient who underwent secondary thoracotomy, implantation of a continuous-flow ventricular assist device (VAD) in a biventricular configuration, and aortic valve replacement (AVR) 2 years after receiving a continuous-flow left ventricular assist device (LVAD) and coronary artery bypass grafting (CABG), due to right ventricular failure, moderate aortic insufficiency, and damage to the original LVAD device cable.

Case report: The patient initially received a Corheart 6 LVAD, CABG, and tricuspid annuloplasty due to end-stage heart failure resulting from ischemic cardiomyopathy and severe tricuspid regurgitation. Following the surgery, the patient was discharged with favorable outcomes. However, 2 years later, the patient was readmitted with severe right heart failure. Given the current shortage of heart donors, the decision was made to implant a Corheart 6 biventricular VAD (BiVAD) as destination therapy.

Conclusion: Severe right ventricular failure is a well-recognized complication following continuous-flow LVAD implantation. In this case, it was successfully managed with BiVADs as destination therapy for this high-risk patient.