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Ice-cold storage or controlled hypothermia to preserve marginal grafts in high-risk heart transplantation 在高风险心脏移植手术中,通过冰冷储存或控制低温来保存边缘移植物。
IF 2.2 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2024-10-17 DOI: 10.1111/aor.14887
Andrea Lechiancole, Sandro Sponga, Gregorio Gliozzi, Sofia Martin-Suarez, Pierluigi Visentin, Luca Botta, Stefano Copetti, Andriy Dralov, Giovanni Benedetti, Nicoletta Finato, Davide Pacini, Ugolino Livi, Igor Vendramin

Background

To evaluate the effectiveness of the Paragonix SherpaPak cardiac transport system (PSP) compared to the standard ice-cold storage (ICS) in extended-criteria donor grafts implanted in high-risk recipients.

Methods

Data of all HTx at the University Centers of Udine and Bologna, between January 2020 and December 2023, employing extended-criteria donors in high-risk HTx conditions were retrospectively analyzed. Patient outcomes and complications after HTx were assessed. Endomyocardial biopsies were performed in donor hearts immediately after retrieval (T0), before implantation (T1) and at reperfusion (T2) to evaluate signs of myocardial damage.

Results

Overall, 90 patients who had heart transplantation (HTx) with a donor graft preserved with either ICS (n = 60) or PSP (n = 30) were included in the study. The 30-day mortality was 3% in both groups (p = 0.99), and 1-year survival 90% and 88% (p = 0.89) for recipients transplanted with PSP and ICS preserved grafts. Rates of moderate-to-severe graft dysfunction and bradi-arrhythmias for PSP and ICS groups were 7% versus 20% (p = 0.08), and 3% versus 15% (p = 0.09). Histologically, severe degrees of cellular and endothelial damage were absent in all PSP grafts while severe degree of contraction bands were higher in ICS hearts at T2.

Conclusions

In high-risk donor–recipient matching, donor heart preservation with PSP seems to show a tendency toward better graft protection.

背景:评估Paragonix SherpaPak心脏转运系统(PSP)与标准冰冷储存(ICS)相比,在高风险受体中植入扩展标准供体移植物的有效性:回顾性分析了乌迪内和博洛尼亚大学中心 2020 年 1 月至 2023 年 12 月期间在高风险 HTx 条件下使用扩展标准供体进行 HTx 的所有数据。评估了患者的预后和心内直视手术后的并发症。在供体心脏取回后(T0)、植入前(T1)和再灌注时(T2)立即进行了心内膜活检,以评估心肌损伤的迹象:共有90名患者接受了心脏移植手术(HTx),其供体移植物通过ICS(60例)或PSP(30例)保留。两组患者的 30 天死亡率均为 3%(P = 0.99),PSP 和 ICS 保存移植物受体的 1 年存活率分别为 90% 和 88%(P = 0.89)。PSP组和ICS组的中重度移植物功能障碍和臂阵发性心律失常发生率分别为7%对20%(P = 0.08)和3%对15%(P = 0.09)。从组织学角度看,所有PSP移植物都没有严重的细胞和内皮损伤,而ICS心脏在T2时的严重收缩带程度更高:结论:在高风险供体与受体配型中,使用 PSP 保存供体心脏似乎能更好地保护移植物。
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引用次数: 0
Apple AirPods Pro 2 receives FDA approval to be used as hearing aids 苹果 AirPods Pro 2 获得 FDA 批准,可用作助听器。
IF 2.2 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2024-10-15 DOI: 10.1111/aor.14889
John A. Treffalls MD, Aakash M. Shah MD

Apple AirPods Pro 2 recently received approval from the US Food and Drug Administration for use as an over-the-counter hearing aid device, the first approval of an over-the-counter hearing aid software by the Agency.

苹果 AirPods Pro 2 最近获得了美国食品和药物管理局的批准,可用作非处方助听设备,这是该机构首次批准非处方助听软件。
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引用次数: 0
Pioneer interview with Stanton B. Miller: Bernard J. Miller's role in the development of the Gibbon heart–lung machine 对斯坦顿-米勒(Stanton B. Miller)的先锋访谈:伯纳德-米勒(Bernard J. Miller)在吉本心肺机开发中的作用。
IF 2.2 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2024-10-15 DOI: 10.1111/aor.14882
Joshua R. Chen, Vakhtang Tchantchaleishvili
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引用次数: 0
Recent progress in the field of Artificial Organs 人造器官领域的最新进展。
IF 2.2 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2024-10-15 DOI: 10.1111/aor.14888
Maria C. Beyer MD, Aakash M. Shah MD
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引用次数: 0
Upcoming meetings 即将举行的会议
IF 2.2 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2024-10-14 DOI: 10.1111/aor.14868
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引用次数: 0
Comparison of waitlist and post-transplant outcomes in patients supported with total artificial heart versus continuous biventricular assist devices 使用全人工心脏和连续双心室辅助装置的患者等待名单和移植后结果的比较。
IF 2.2 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2024-10-09 DOI: 10.1111/aor.14884
Joel Ferrall, Ajay S. Vaidya, Eric S. Kawaguchi, Sanjeet G. Patel, Raymond C. Lee, Emily S. Lee, Aaron M. Wolfson

Background

Durable biventricular support may be necessary to bridge patients with end-stage biventricular failure to heart transplantation. This study compares waitlist and post-transplant outcomes between patients supported with continuous flow, durable biventricular assist devices (BiVAD), and total artificial heart (TAH).

Methods

Using the UNOS registry, we analyzed adult (≥18 years old), first-time transplant candidates with TAH or BiVAD at the time of listing or transplantation from 10/1/2010–10/31/2020, with follow-up through 3/31/2022. Multivariable proportional subdistribution hazards models and cause-specific Cox proportional hazards models were used to compare death/deterioration or heart transplantation on the waitlist between cohorts. Kaplan–Meier and multivariable Cox proportional hazards model were used to evaluate one-year post-transplant survival and evaluate difference in outcomes based on annual transplant center volume.

Results

The waitlist cohort included a total of 228 patients (25% BiVAD). Waitlist outcomes between device types were similar. The transplanted cohort included a total of 352 patients (25% BiVAD). There was a trend towards worse one-year post-transplant survival in patients bridged with TAH versus BiVAD (log-rank p-value = 0.072) that persisted after adjusting for age, gender, policy, and removing dual-organ recipients (HR 1.94 (0.94, 3.98) p-value = 0.07). There was a difference in one-year post-transplant survival amongst TAH-bridged patients when stratified by annual transplant center volume (log-rank p-value = 0.013). One-year post-transplant survival between TAH-supported patients from high annual transplant volume centers and BiVAD-supported patients was similar (p-value = 0.815).

Conclusions

BiVAD and TAH are reasonable support strategies with TAH implantation at high-volume transplant centers (51+ transplants/year) having similar 1-year post-transplant survival to BiVAD-supported patients.

背景:持久的双心室支持可能是终末期双心室衰竭患者接受心脏移植的必要桥梁。本研究比较了使用持续流、持久双心室辅助装置(BiVAD)和全人工心脏(TAH)支持的患者的候选结果和移植后结果:我们使用 UNOS 注册表分析了 2010 年 10 月 1 日至 2020 年 10 月 31 日期间首次接受移植手术的成人(≥18 岁)患者,他们在被列入名单或接受移植手术时使用 TAH 或 BiVAD,随访至 2022 年 3 月 31 日。采用多变量比例子分布危险模型和特定病因 Cox 比例危险模型来比较不同队列之间的死亡/病情恶化或等待名单上的心脏移植情况。Kaplan-Meier 模型和多变量 Cox 比例危险模型用于评估移植后一年的存活率,并根据移植中心的年工作量评估结果的差异:候选队列共包括228名患者(25%为BiVAD)。不同设备类型的候选结果相似。移植组共包括 352 名患者(25% 为 BiVAD)。与 BiVAD 相比,使用 TAH 进行桥接的患者移植后一年生存率呈下降趋势(对数秩 p 值 = 0.072),在调整年龄、性别、政策和去除双器官受者后,这一趋势依然存在(HR 1.94 (0.94, 3.98) p 值 = 0.07)。根据移植中心的年工作量进行分层后,TAH桥接患者的移植后一年生存率存在差异(对数秩p值=0.013)。年移植量大的移植中心的 TAH 支持患者与 BiVAD 支持患者的移植后一年生存率相似(P 值 = 0.815):结论:BiVAD和TAH是合理的支持策略,在高移植量中心(每年51例以上移植)植入TAH的患者与BiVAD支持的患者移植后1年生存率相似。
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引用次数: 0
Impact of convective clearance on intra-dialytic potassium removal in chronic dialysis patients 对流清除率对慢性透析患者透析内排钾的影响。
IF 2.2 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2024-10-08 DOI: 10.1111/aor.14883
David A. Jaques, Roohi Chhabra, Priyanka Khatri, Andrew Davenport

Introduction

Hyperkalemia is frequently encountered and associated with cardio-vascular mortality in chronic hemodialysis (HD) patients. While online hemodiafiltration (OL-HDF) is thought to offer clinical benefit over high-flux HD, the impact of convective clearance on intra-dialytic potassium removal is unknown.

Methods

Chronic dialysis patients undergoing outpatient HD or OL-HDF at a single center attached to a university hospital were recruited in a prospective observational study. Spent dialysate along with clinical and biological variables were collected during a single mid-week session.

Results

We included 141 patients, with 21 treated with HD and 120 with OL-HDF. Mean age was 65.7 ± 15.6 years with 87 (61.7%) men. Mean intra-dialytic potassium removal was 69.9 ± 34.2 mmol. Patients on OL-HDF and HD have similar intra-dialytic potassium removal, with mean values of 69.1 ± 34.2 and 74.3 ± 35.0, respectively. In multivariate analysis, factors associated with intra-dialytic potassium removal were (decreasing order of effect size): dialysate potassium (β −15.5, p < 0.001), pre-HD serum potassium (β 9.1, p < 0.001), and session time (β 7.8, p = 0.003). In OL-HDF patients, substitution flow was not associated with potassium removal.

Conclusion

In chronic dialysis patients, convective therapy provided by OL-HDF does not affect potassium removal when compared with high-flux HD. Moreover, the importance of convective volume is not associated with potassium clearance in OL-HDF. Overall, session length and serum-to-dialysate potassium gradient are the main determinants of potassium clearance regardless of dialysis modality. Those results should inform clinicians on the optimal therapy in chronic dialysis patients in the era of OL-HDF.

简介:慢性血液透析(HD)患者经常出现高钾血症,并与心血管疾病死亡有关。虽然在线血液透析滤过(OL-HDF)被认为比高通量血液透析(HD)更具临床优势,但对流清除对透析内钾清除的影响尚不清楚:方法:在一项前瞻性观察研究中,招募了在一所大学附属医院的单个中心接受门诊 HD 或 OL-HDF 治疗的慢性透析患者。结果:我们纳入了 141 名患者,其中 21 人接受了透析治疗:我们共纳入了 141 名患者,其中 21 人接受了 HD 治疗,120 人接受了 OL-HDF 治疗。平均年龄为 65.7 ± 15.6 岁,男性 87 人(61.7%)。透析中平均排钾量为(69.9 ± 34.2)毫摩尔。OL-HDF 和 HD 患者的血钾去除率相似,平均值分别为 69.1 ± 34.2 和 74.3 ± 35.0。在多变量分析中,与透析内排钾量相关的因素有(按影响大小递减):透析液钾(β -15.5,p 结论:透析液钾(β -15.5,p 结论:透析液钾(β -15.5,p 结论:透析液钾(β -15.5,p在慢性透析患者中,与高通量 HD 相比,OL-HDF 提供的对流疗法不会影响钾的去除。此外,对流容量的重要性与 OL-HDF 的钾清除率无关。总之,无论采用哪种透析方式,疗程长短和血清-透析液钾梯度是决定钾清除率的主要因素。这些结果将为临床医生在 OL-HDF 时代对慢性透析患者进行最佳治疗提供参考。
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引用次数: 0
Anti-factor Xa and activated partial thromboplastin time strategies for unfractionated heparin dosing after HeartMate 3 left ventricular assist device implantation HeartMate 3 左心室辅助装置植入术后抗因子 Xa 和活化部分凝血活酶时间对非小分肝素剂量的影响。
IF 2.2 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2024-10-08 DOI: 10.1111/aor.14885
Iris Feng, Paul A. Kurlansky, Tanner R. Powley, Melissa A. Hynds, Christine G. Yang, Andrew Eisenberger, Jonathan M. Hastie, Lauren D. Sutherland, Melana Yuzefpolskaya, Paolo C. Colombo, Gabriel T. Sayer, Nir Y. Uriel, Yoshifumi Naka, Koji Takeda

Background

No clear guidelines exist for perioperative anticoagulation management after durable left ventricular assist device insertion. In this study, we sought to compare outcomes between anti-factor Xa (FXa) and activated partial thromboplastin time (aPTT) in monitoring unfractionated heparin (UFH) dosing after HeartMate 3 (HM3) insertion.

Methods

This is a single-center retrospective review of patients who received UFH after HM3 insertion between 01/2020–12/2022. Post-operative UFH dose was titrated by aPTT goal 45–60 sec (n = 53) or FXa goal 0.1–0.2 U/mL (n = 59). Baseline differences between cohorts were balanced by inverse probability treatment weighting.

Results

At baseline, unadjusted FXa patients were more likely to be white (47.5% vs. 35.8%, p < 0.001), INTERMACS 1–2 (69.5% vs. 47.2%, p = 0.013), have history of coronary artery disease (66.1% vs. 43.4%, p = 0.026), and lower eGFR (54.1 vs. 63.7 mL/min/1.73 m2, p = 0.029) compared to the aPTT group. After adjusting for several bleeding/thrombosis risk factors, 97.5% of FXa and 91.0% of aPTT patients reached therapeutic levels with comparable UFH duration and maximum dose. Moreover, in-hospital mortality (2.5% vs. 3.1%, p = 0.842), major bleeding events (4.2% vs. 9.2%, p = 0.360), and thromboembolic events (21.8% vs. 10.1%, p = 0.151) remained without significant differences between FXa and aPTT cohorts. There was a high degree of variability in FXa (r2 = 0.20) and aPTT (r2 = 0.22) values for any given UFH dose.

Conclusions

No differences in frequency of bleeding or thromboembolic events were observed in this study between FXa versus aPTT cohorts after HM3 implantation. More longitudinal studies are warranted to determine whether or not one assay is superior to the other.

背景:耐久性左心室辅助装置植入术后围手术期抗凝管理尚无明确指南。在本研究中,我们试图比较抗因子 Xa (FXa) 和活化部分凝血活酶时间 (aPTT) 在监测插入 HeartMate 3 (HM3) 后的非分叶肝素 (UFH) 剂量方面的效果:这是一项单中心回顾性研究,研究对象是 2020 年 1 月至 2022 年 12 月期间植入 HM3 后接受 UFH 治疗的患者。术后 UFH 剂量根据 aPTT 目标 45-60 秒(53 例)或 FXa 目标 0.1-0.2 U/mL(59 例)进行滴定。通过逆概率治疗加权平衡了组间基线差异:基线时,与 aPTT 组相比,未经调整的 FXa 患者更可能是白人(47.5% 对 35.8%,P 2,P = 0.029)。在调整了几个出血/血栓形成风险因素后,97.5% 的 FXa 患者和 91.0% 的 aPTT 患者在 UFH 持续时间和最大剂量相当的情况下达到了治疗水平。此外,院内死亡率(2.5% vs. 3.1%,p = 0.842)、大出血事件(4.2% vs. 9.2%,p = 0.360)和血栓栓塞事件(21.8% vs. 10.1%,p = 0.151)在 FXa 和 aPTT 两组患者中仍无显著差异。对于任何给定的 UFH 剂量,FXa 值(r2 = 0.20)和 aPTT 值(r2 = 0.22)的变异性都很大:本研究未观察到 HM3 植入后 FXa 和 aPTT 组间出血或血栓栓塞事件发生频率的差异。需要进行更多的纵向研究,以确定一种检测方法是否优于另一种检测方法。
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引用次数: 0
Ethical considerations of cognitive enhancement technologies: Expanding the discussion on hippocampal cognitive prostheses 认知增强技术的伦理考虑:扩大对海马认知假体的讨论。
IF 2.2 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2024-10-05 DOI: 10.1111/aor.14886
Hsin-Hung Chen, Lien-Chung Wei
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引用次数: 0
Response to letter “Ethical considerations of cognitive enhancement technologies: Expanding the discussion on hippocampal cognitive prostheses” 对 "认知增强技术的伦理考量:扩大关于海马认知假体的讨论"。
IF 2.2 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2024-10-04 DOI: 10.1111/aor.14881
Yasemin J. Erden, Philip A. E. Brey
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引用次数: 0
期刊
Artificial organs
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