Artificial organs最新文献

Background: Left ventricular assist device (LVAD) driveline infections significantly impact patient outcomes. This study aimed to identify their risk factors.

Methods: We analyzed LVAD data from our institutional Intermacs database (January 1, 2008-December 31, 2023), combining primary implants and pump exchanges. Patient characteristics were summarized as frequencies for categorical variables and median (IQR) for continuous variables. The nature of repeated infection events was handled by the Andersen-Gill method within a multivariable Cox proportional hazards model for cause-specific hazard of driveline infections, accounting for death and heart transplant as competing risks.

Results: Our cohort included 1026 LVAD implants. Median patient age was 57.7, and 79.6% were male. Cumulative driveline infection rates at 1, 2, 3, 4, and 5 years were 11.9%, 19.6%, 29.3%, 38.9%, and 40.1%, respectively, with a median time to infection of 13.8 months. Severe diabetes (HbA1c ≥ 8) increased driveline infection risk by 52% (HR = 1.52, p = 0.031). Pulsatile-flow, fully magnetically levitated, and axial-flow LVADs had a 245%, 70%, and 44% higher risk of driveline infections compared to partial magnetically levitated LVADs (HR = 3.45, p = 0.003; HR = 1.70, p = 0.066; HR = 1.44, p = 0.087, respectively). Paradoxically, patients 40 or above had over 58% lower risk of driveline infections than those under 40 (HR < 0.42, p < 0.001). In addition, coronary artery disease was associated with 56% lower risk of driveline infections (HR = 0.44, p = 0.001).

Conclusions: Driveline infections remain prevalent in LVAD patients, especially those with severe diabetes. The lower driveline infection risk in older patients, those with coronary artery disease, and partially magnetically levitated LVADs warrants further investigation.

Background: Microaxial devices provide effective short-term hemodynamic support in patients with cardiogenic shock or during high-risk procedures. However, there is a paucity of data regarding device-associated valvular complications. We sought to pool existing data to understand its incidence, management, and outcomes.

Methods: An electronic search was conducted in October 2024 to identify studies reporting microaxial device-associated valvular complications that did not resolve with device explantation. A total of 26 case reports and case series, representing 27 patients, were included. Patient-level data were extracted for analysis.

Results: The median age was 50 years [IQR 34-65], and 78% (21/27) were male. The indications for microaxial support were cardiogenic shock (85.2%, 23/27), coronary bypass grafting (7.4%, 2/27), and high-risk percutaneous coronary intervention (7.4%, 2/27). The most commonly used devices were the Impella 5.0 (41%, 11/27) and Impella CP (22%, 6/27). Aortic regurgitation (AR) developed in 67% of patients (18/27). Mitral regurgitation (MR) developed in 33% (9/27) of patients, all of which were severe. The median duration of microaxial support was 10 [3-15] days. Overall, 74% (20/27) of patients underwent surgical management, 11% (3/27) underwent transcatheter treatment, and 15% (4/27) were managed nonoperatively. In-hospital/30-day mortality was 11% (3/27), including two deaths among patients with MR (22%) and one in a patient with AR (5.6%) with a pre-existing bioprosthetic aortic valve (p = 0.19). When considering the patients with only native valves and excluding the bioprosthetic aortic valve, mortality was significantly higher among MR patients compared to those with AR (MR: 22%; AR: 0%, p = 0.04). At a median follow-up of 183 [30-365] days, overall survival was 89% (24/27).

Conclusion: AR was more common than MR; however, all MR cases were severe. MR may be associated with worse outcomes. Surgical management appears to be the most frequently employed strategy for valvular injury.

Background: Right ventricular (RV) failure is a life-threatening condition contributing to morbidity and mortality in several pathological conditions, particularly in postcardiotomy shock, advanced heart failure, pulmonary embolism, and severe respiratory disease. Temporary mechanical circulatory support has gained increasing attention in refractory conditions, with dual-lumen cannulation strategies specifically designed to facilitate such a support modality, decompress the right atrium or ventricle while preserving antegrade pulmonary blood flow and allowing, in case of need, concomitant RV and respiratory support.

Materials and methods: A narrative review was conducted through PubMed, identifying English-language, peer-reviewed articles published between January 2011 and September 2025. The search combined the term "dual lumen pulmonary artery cannula" with related keywords including "pulmonary artery cannulation", "right atrium to pulmonary artery cannulation", "percutaneous right ventricular assist", "temporary RVAD", "oxygenated RVAD", and "right-sided mechanical circulatory support". Eligible studies included case reports, series, cohort studies, and reviews. Structured institutional resources were also evaluated to complement evidence with practical insights.

Results: Twenty-one publications were identified, of which 13 met the inclusion criteria. Reports consistently highlighted the rationale for RV unloading, clinical indications across postcardiotomy shock, LVAD-related dysfunction, pulmonary embolism, and ARDS, and described standardized insertion through the right internal jugular vein with imaging guidance. Complications included cannula malposition, thromboembolism, bleeding, and infection, while support durations typically ranged from 7 to 14 days, although its incidence is lower with jugular access compared with femoral approaches and open chest procedures. Weaning rates ranged between 40% and 70% of cases, with early initiation of support associated with improved survival.

Conclusions: Dual-lumen right atrium/ventricle-to-pulmonary artery cannulation represents a feasible and physiologically advantageous option for temporary isolated RV or concomitant RV and respiratory support. Current evidence, however, is limited to small observational studies, underscoring the need for multicenter registries, uniform nomenclature, and prospective trials to establish standardized protocols and clarify its role relative to alternative right-sided support strategies.

Background: Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) therapy have been associated with increased bleeding risk in left ventricular assist device (LVAD) patients receiving warfarin and aspirin. In 2019, our institution stopped routinely prescribing aspirin to patients with a HeartMate 3 (HM3) LVAD.

Methods: This single-center retrospective cohort study evaluates the risk of major bleeding with SSRI/SNRI use in HM3 LVAD patients not receiving aspirin. The primary outcome was the incidence of a major bleeding event, defined as an INTERMACS type 2, 3a, 3b, or 5 bleed, and was analyzed using a multivariable Cox proportional hazard regression model with age, gender, chronic kidney disease stage 3-5, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, history of a gastrointestinal bleed, and warfarin time in therapeutic range as covariates.

Results: Of the included 101 patients, 60 (59%) received an SSRI/SNRI. A major bleeding event occurred in 11 (18%) patients in the SSRI/SNRI group and 6 (15%) patients in the non-SSRI/SNRI group, which was not significantly different following multivariate adjustment (HR 1.04, 95% CI 0.32-3.37, p = 0.43).

Conclusions: Further studies in larger populations are needed to confirm the lack of association between SSRI/SNRI use and bleeding in HM3 LVAD patients not receiving aspirin.

Background: Obesity and advanced heart failure (HF) increasingly intersect in clinical practice, yet their combined influence on outcomes following durable left ventricular assist device (LVAD) implantation remains uncertain.

Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA 2020, searching six databases to June 2025. Twenty-six cohort studies encompassing 14 100 adults (4982 obese; 9118 non-obese) met inclusion criteria. Pooled odds ratios (ORs) and risk ratios (RRs) were generated using random-effects models for mortality and adverse events.

Results: Obese LVAD recipients were younger, more often female, and had higher prevalences of diabetes, hypertension, and sleep apnea than non-obese patients. Short-term mortality did not differ significantly between groups (OR 0.80, 95% CI 0.59-1.08). Similarly, follow-up mortality at ≥ 1 year showed no significant difference, although obese patients tended to have lower risk (RR 0.81, 95% CI 0.56-1.17). In contrast, obesity was associated with a distinct complication profile: higher risks of device-related infection (RR 1.48, 95% CI 1.26-1.75), pump thrombosis/device malfunction (OR 1.57, 95% CI 1.37-1.81), and right heart failure (RR 1.23, 95% CI 1.08-1.39). Rates of stroke, arrhythmia, respiratory failure, and major bleeding did not differ significantly between obese and non-obese patients.

Conclusions: Obesity does not confer excess short-term or long-term mortality after durable LVAD implantation but is associated with substantially higher risks of infection, pump thrombosis, and right heart failure. These findings suggest that obesity alone should not preclude LVAD candidacy, while underscoring the need to recognize and manage the increased morbidity burden in this population and to further investigate outcomes in contemporary, device-specific cohorts.

Background: The 2018 UNOS heart allocation reform significantly altered the waiting list priority for recipients of durable left ventricular assist devices (LVADs). We sought to compare the characteristics of patients who were bridge-to-transplant (BTT) or bridge-to-candidacy (BTC) with a durable LVAD before and after the UNOS allocation change.

Methods: Data was retrieved from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support. Adult patients implanted with a continuous-flow, fully magnetically levitated (CF-ML) LVAD as a BTT or BTC from August 2017 to December 2021 were included. The cohort was divided into PRE and POST allocation changes.

Results: A total of 2275 patients were implanted with a CF-ML LVAD as a BTT or BTC [PRE 687 (30.2%), POST 1588 (69.8%)]. Patients with LVADs implanted POST allocation change were more likely to have diabetes (9.1% vs. 4.9%, p < 0.001), pulmonary hypertension (24.4% vs. 11.4%, p < 0.001), cerebrovascular disease (6.2% vs. 4.1%, p = 0.05), and chronic lung disease (10.6% vs. 3.8%, p < 0.001). Postoperatively, the PRE cohort was more likely to develop early ischemic strokes (4.8% vs. 2.8%, p = 0.01), late gastrointestinal bleeding (7.1% vs. 5.0%, p < 0.01), late device malfunction (1.9% vs. 0.8%, p < 0.01), and late hemorrhagic stroke (1.5% vs. 0.7%, p = 0.01). Early and late readmissions were significantly more common for the PRE cohort. Ninety-day and one-year survival did not differ between cohorts.

Conclusion: Despite a more significant comorbidity burden, patients who were supported with an LVAD as BTT after the allocation change were less likely to be re-hospitalized or have device-related adverse events.

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and irreversible lung disease with limited treatment options. Although extracellular vesicles (EVs), such as exosomes, have shown therapeutic potential, their effectiveness and the best method of delivery are still under investigation. This study explored the therapeutic impact of exosomes derived from adipose-derived mesenchymal stem cells (ADMSCs-Exo) in a rat model of bleomycin-induced pulmonary fibrosis.

Methods: Thirty Wistar rats were randomly divided into six groups: (1) Healthy control (Co), (2) Fibrosis control (Co/F), (3 and 4) Exosome inhalation groups treated with 250 or 500 μg/kg doses, and (5 and 6) Exosome injection groups receiving the same doses. Treatment effects were evaluated through lung tissue histopathology and analysis of key inflammatory biomarkers.

Results: The inhalation of ADMSCs-Exo at both doses significantly reduced levels of C-reactive protein (CRP), fibrinogen, pro-inflammatory cytokines, and histopathological signs of lung fibrosis compared to the fibrosis control group (p < 0.05). Notably, the inhalation route showed better therapeutic outcomes than systemic injection.

Conclusion: The results suggest that inhalation delivery of ADMSCs-derived exosomes may provide a more effective and targeted strategy for treating pulmonary fibrosis compared to systemic administration.