Artificial organs最新文献

Background: Many cardiac surgical procedures use cardiopulmonary bypass (CPB), which in neonates requires the heart-lung machine (HLM) to be positioned close to the patient due to their small circulating blood volume. The absence of an MR-compatible blood pump to be used in CPB remains a key challenge for studying perioperative brain injury mechanisms in this high-risk group. This study aims to take the first step toward MR-conditional HLMs by developing hardware, verifying pump hydraulics, and ensuring MR compatibility.

Methods: This study presents three MR-conditional blood pump prototypes: a roller pump, a non-occlusive roller pump, and a centrifugal pump. MR compatibility was assessed by monitoring for imaging interference during scanning. Hydraulic performance was evaluated with pressure-flow diagrams using a mock circulation test bench.

Results: None of the prototypes interfered with MR imaging, and although SNR was reduced by -8.43% ± 7.96%, image quality remained sufficient for reliable assessment of relevant brain regions. Roller and non-occlusive pumps maintained stable flow across pressure heads, with reductions of -4.46 ± 8.02 and -119.33 ± 18.22 mL/min, respectively. The centrifugal pump exhibited pressure-dependent performance (slope -2.21 ± 0.45 mmHg/[L/min]). All pumps generated non-pulsatile flow (SHE < 1000 erg/cm³).

Conclusion: All three pumps meet basic MR-conditionality and flow requirements, supporting their potential for use in MRI-guided studies during neonatal cardiac surgery.

Background: We sought to estimate left ventricular assist device use (LVAD) with waitlist and post-transplant survival trends in patients supported on durable LVAD in relation to the UNOS donor heart allocation policy revision.

Methods: Adult patients implanted with HeartMate II LVAD, HeartWare HVAD, or HeartMate 3 LVAD, and listed for isolated heart transplantation between October 18, 2013, and June 16, 2023, were identified in the UNOS database and were stratified into pre- and post-policy revision groups. Patients on temporary circulatory support, right, or biventricular assist devices, total artificial hearts, recipients of donation after circulatory death (DCD) hearts, and those undergoing simultaneous multiorgan transplants were excluded. Waitlist and post-transplant survival were compared between the groups.

Results: Policy revision was associated with a decrease in LVAD use both at the time of listing (pre: 28% vs. post: 24.5%, p < 0.01) and at the time of transplant (pre: 45.8% vs. post: 31.7%, p < 0.01). For those listed with an LVAD, more patients eventually underwent transplantation (pre: 89.6% vs. post: 94.3%, p < 0.01) following the policy change. Overall waitlist and post-transplant survival among patients supported on LVAD worsened following the policy change, both showing statistical significance (p < 0.01).

Conclusion: In the post-policy era, a decline in durable LVAD utilization was observed, along with worse waitlist and post-transplant outcomes among LVAD-supported patients.

AI holds significant promise for guiding clinical decisions in end-stage organ failure, where treatment options now include medical management, transplantation, mechanical support devices, and palliative care. This paper discusses current applications of AI in healthcare, emphasizing the complex decision-making necessary for patients with organ failure. It outlines how AI can support risk stratification, patient selection, and outcome prediction, particularly in transplantation practices that increasingly rely on robust data to inform care pathways. By analyzing large datasets from electronic health records, imaging, and patient-reported outcomes, AI can help physicians forecast long-term survival and quality of life, and potentially assist clinicians in modifying treatment strategies before adverse trajectories take hold. There is a need for standardized, high-quality data, rigorous validation, and transparent algorithms to mitigate biases that could exacerbate disparities in care. Ethical considerations demand attention to equitable access, patient privacy, and the preservation of the human element in patient-clinician relationships. Patients generally view AI with cautious optimism, recognizing its potential to augment care but also voicing concerns about data protection and the risk of losing compassionate, personal care. Importantly, AI can help with "alignment," or fitting treatment recommendations to patients' values, and promote sustainable and patient-centered outcomes. Ultimately, the successful integration of AI into daily practice requires multidisciplinary collaboration among developers, clinicians, ethicists, and regulators. Deep stakeholder engagement, continuous algorithmic refinement, and user-friendly design are pivotal to ensuring that AI serves as a practical decision-support tool that complements, rather than replaces, clinical expertise and shared decision-making.

Background: Magvad LLC is developing an innovative total artificial heart (TAH) based on a single nutating (nonrotating, "wobbling") disc pump design to provide up to 8 L/min pulsatile flow at 100 mmHg pressure in children and adults with end-stage heart failure (HF). We present an early-stage in vitro study to demonstrate proof-of-concept of a nutating disc mechanism for future cardiovascular applications.

Methods: A commercially available single nutating disc water meter (Recordall, Badger Meter 25-3/4″) was modified and connected to a motor via a shaft coupler and controlled via software to regulate disc "wobbles" per minute. The nutating disc pump was integrated into static and HF-tuned dynamic mock loops and operated at shaft rotational speeds of 25-225 rpm.

Results: Pressure-flow (H-Q) curves demonstrated the pump generated 7 L/min flow at 100 mmHg (225 rpm). Pump flow, motor work, hemodynamic work, and pump efficiency increased with increasing wobble speed. The pump restored hemodynamics in the dynamic HF mock loop by increasing mean arterial flow and pressure, augmenting pulsatility, and decreasing venous pressure with increasing wobble speed.

Conclusions: These results demonstrate proof-of-concept and very early-stage feasibility of a single nutating disc to function as a novel low-speed volume displacement pulsatile flow mechanism for future cardiovascular applications including the development of an innovative TAH.

Background: Ventricular septal defects are catastrophic complications of acute myocardial infarction associated with poor prognosis and high in-hospital mortality. Transaxillary microaxial flow pump (tMAFP) support may provide hemodynamic stabilization and serve as an effective bridge to delayed surgical repair with improved survival outcomes. We aimed to describe perioperative management and outcomes of surgical post-infarct ventricular septal defects (PIVSD) repair with and without tMAFP bridging, hypothesizing that tMAFP support would facilitate delayed repair with favorable operative and survival outcomes.

Methods: We retrospectively reviewed 34 patients diagnosed with PIVSD at a single tertiary center between January 2018 and May 2025, stratified by the use of tMAFP. This report focuses on the surgical repair subgroup, describing perioperative management and outcomes with or without tMAFP bridging.

Results: Of 20 surgical patients, nine were bridged with tMAFP. These patients had a longer stabilization period before repair (median 14 vs. 3 days), shorter cardiopulmonary bypass times, higher preoperative mobility, and no in-hospital mortality, compared with five deaths among 11 patients repaired without tMAFP bridging. None in the tMAFP group required postoperative VA-ECMO, and no device-related complications were observed.

Conclusions: In this retrospective cohort study, tMAFP support allowed delayed surgical repair in PIVSD with favorable perioperative outcomes and survival.

Background: Left-ventricular assist devices (LVADs) are a major therapeutic option in advanced heart failure (adHF), improving survival rates and quality of life (QoL). Complications, however, can alter their prognosis. Specialized telemonitoring could facilitate LVAD follow-ups and improve outcomes. This study aimed to evaluate the usefulness of telemonitoring for LVAD patients.

Methods: Patients, followed up with a web application (SateliaLVAD), were included in a national retrospective study at nine tertiary hospitals in France. Characteristics and detected hospitalization risk alerts data were collected. The risk of hospitalization was categorized based on a clinical algorithm (green: no risk, orange: heightened risk, and red: emergent contact with patient and possible hospitalization).

Results: In total, 161 patients were included (male: 82.0%, mean age: 62.2 years). Indications for LVAD were mainly ischemic cardiomyopathy (82.0%) and bridge to transplant (50.3%). The mean follow-up duration lasted 19.9 [1-45] months with 76 (47.2%) patients continuing telemonitoring. Compliance was high (79.0%). The main reason for cessation was death (30.6%). Total hospitalization risk alerts detected by telemonitoring were: orange alerts (n = 8265, 72.3%) and red alerts (n = 1613, 14.1%) with 48.5% of cases resolved (orange: 50.8% vs. red: 54.8%). The most frequent type of resolved alert was for a measured risk of cardiac decompensation (orange: 2227 vs. red: 382).

Conclusion: To our knowledge, this is the first extensive study to describe the follow-up of LVAD patients by a dedicated telemonitoring application. Telemonitoring as a specific follow-up tool may be feasible for this subpopulation. Future randomized studies on specific prospective evaluations such as survival and QoL are needed.

Objective: This study aimed to determine the more suitable method for constructing parathyroid organoids.

Methods: Parathyroid organoids were established using two different culture conditions, and organoid morphology and ATP activity were assessed to evaluate their performance. Organoid identity and function were confirmed by STR profiling, histology, immunofluorescence, and ELISA. Organoids were further treated with different calcium concentrations, and changes in morphology, ATP activity, intracellular calcium, CaSR expression, and PTH secretion were examined.

Results: Organoids cultured in VEGF-121- and angiotensin-negative medium showed no noticeable morphological change from Day 1 to Day 3, and ATP activity declined over the same period. In contrast, organoids in VEGF-121+ and angiotensin-positive medium exhibited increased number and ATP activity over the same period. These organoids shared the same mutation profile and structural features as the original tissues and expressed PTH, GCM2, CaSR, and CHGA. PTH secretion remained stable across passages. Low calcium had minimal impact on morphology, viability, and PTH release but reduced intracellular calcium levels and CaSR expression. High calcium promoted ATP activity and elevated intracellular calcium, while suppressing PTH secretion and upregulating CaSR expression.

Conclusions: VEGF-121+ and angiotensin-positive medium better supported the generation and maintenance of functional parathyroid organoids. This provides an in vitro model for further investigation into parathyroid-related signaling and applications in regenerative medicine.

Background: The effects of dobutamine on outcomes in patients experiencing out-of-hospital cardiac arrest (OHCA), treated with extracorporeal cardiopulmonary resuscitation (ECPR), remain unclear. In this study, we aimed to evaluate the association between dobutamine use within 24 h and clinical outcomes in patients with OHCA who underwent ECPR.

Methods: A post hoc analysis was conducted on the registry data from the SAVE-J II study (2013-2018). To address potential confounding variables related to dobutamine administration, 1:3 propensity score matching was employed using the patients' baseline characteristics. Following the matching, the dobutamine and non-dobutamine groups were compared, focusing on in-hospital mortality and neurological outcomes assessed using the cerebral performance category (CPC) scale.

Results: Of the 2157 registered cases, 581 cases of cardiogenic OHCA treated with targeted temperature management were included in this analysis. Eighty-eight patients who received dobutamine were compared with 264 who did not after propensity score matching. The in-hospital mortality rate was 60.2% in the dobutamine group, compared with 58.3% in the non-dobutamine group (p = 0.80). The proportion of patients with a CPC score of 3-5 at hospital discharge was 79.5% in the dobutamine group, compared with 78.0% in the non-dobutamine group (p = 0.88). A Kaplan-Meier analysis demonstrated no significant differences in survival rates between the two groups (42.1 vs. 43.6%, log-rank p = 0.79).

Conclusion: In patients with OHCA who underwent ECPR, dobutamine administration within 24 h was not significantly associated with in-hospital mortality and neurological outcomes.

Purpose: With the rising prevalence of heart disease and the limited availability of heart transplants, the demand for Left Ventricular Assist Devices (LVADs) is growing. While LVADs significantly improve the quality of life for heart failure patients, conventional models operate at a fixed speed, failing to adapt to varying blood flow demands. The Power Ratio Control (PRC) method offers a promising approach to adjusting blood flow according to activity levels dynamically, improving LVAD adaptability. This research investigates the application of PRC to enhance LVAD performance.

Method: To the best of our knowledge, this study presents the first implementation of PRC on the HeartMate 3. We also develop a model to incorporate clinically relevant parameters and peripheral components into an advanced model. This framework simulates real-world conditions, integrating dynamic factors like preload, contractility, and heart rate variations to evaluate the device's performance.

Results: Results show that PRC significantly improves HeartMate 3's dynamic response to physiological changes, allowing it to mimic the behavior of a healthy heart closely. Under PRC, the LVAD achieves better fluid responsiveness, stable cardiac output (CO), and efficient adaptation to varying activity levels. These findings highlight the potential clinical benefits of PRC, offering a more personalized approach to heart failure management.

Conclusion: This research represents a significant advancement in LVAD technology, pioneering the use of PRC in the HeartMate 3 and enhancing modeling accuracy. These innovations underscore the potential for adaptive control strategies to improve LVAD performance, paving the way for broader future advancements in mechanical circulatory support.