ASAIO Journal最新文献

Impella support before continuous-flow left ventricular assist device (LVAD) implantation may injure the aortic valve, potentially accelerating aortic regurgitation (AR) progression, resulting in poor outcomes. A single-center retrospective analysis of 384 patients implanted with durable LVADs between 2011 and 2025 was performed. Patients were separated into prior Impella support (group 1, n = 87) and those without (group 2, n = 297). Outcomes included aortic valve intervention at LVAD implantation, AR prevalence at baseline, within 30 days, and 6 months, and mortality at 30 days and 1 year. Aortic valve intervention occurred in 10.3% of group 1 vs. 5.0% of group 2 (p = 0.071). Group 1 had higher baseline AR (24% vs. 15%, p = 0.041) and more moderate or worse AR at 30 days (3.4% vs. 0.3%, p = 0.041) and 6 months (6.8% vs. 0.6%, p = 0.014). Impella duration did not correlate with aortic valve intervention (median 8 vs. 6 days, p = 0.198). Mortality at 30 days (2% vs. 4%, p = 0.958) and 1 year (7% vs. 13%, p = 0.116) was similar. Impella use before durable LVAD was associated with increased AR progression at 30 days and 6 months. This suggests those with preoperative Impella should have the aortic valve assessed at the time of removal and consider intervention if significant.

Posttransplant lymphoproliferative disorder (PTLD) is the second most common malignancy in thoracic transplant recipients and is associated with poor survival. Accurate risk prediction is essential for prevention and management. Adult (≥18 years) heart, lung, and heart-lung transplant recipients were extracted from the Scientific Registry of Transplant (SRTR) and the United Network of Organ Sharing (UNOS) databases. A total of 160 donor and recipient pretransplant variables, including demographics, laboratory tests, induction therapy, and human leukocyte antigens (HLA), were analyzed. Risk scores were developed using the FasterRisk algorithm and compared with statistical and machine learning models. Among 89,139 thoracic recipients, the model achieved cross-validated areas under the curve of 0.776, 0.711, and 0.689 for 1, 3, and 5 year PTLD risk prediction, respectively. Steroid induction and previous malignancy were associated with an increased PTLD risk. Younger age (18-27 years at 1 year; 18-23 years at 5 years) was also linked to higher risk. In contrast, positive Epstein-Barr virus (EBV) status, heart transplantation (compared with lung or combined heart-lung), African American ethnicity, and basiliximab induction were associated with a lower risk. The proposed risk scores enhance understanding of PTLD risk factors and enable individualized prediction during the first 5 years after thoracic transplantation.

Extracorporeal membrane oxygenation (ECMO) may be a life-saving intervention for patients with respiratory or cardiac failure or cardiac arrest. Storing wet-preprimed ECMO circuits can reduce the time to initiate ECMO, but safety concerns remain regarding contamination, plasticization, and oxygenator degradation. A scoping review of the literature was conducted using PubMed, EMBASE, and Cochrane Libraries from inception to March 2025. Eligible studies investigated wet-preprimed ECMO circuits for complications of wet-preprimed ECMO circuits. Thirty-two studies met the inclusion criteria. Twenty-three studies reported the risk of bacterial and plasticizer effects over time. Bacterial contamination occurred earlier during storage but once a sterile circuit had been established, the circuit remained sterile. Plasticizer migration was observed to peak after wet priming and decreased over time. Crystalloid priming reduced leaching compared with protein-based fluids, whereas coated tubing further minimized degradation. Oxygenator integrity decreased over time with crystalloid priming. Impairment of gas exchange and increasing transmembrane resistance with increasing storage time were seen. Wet-preprimed ECMO circuits can be safely stored for up to 30 days if sterility is maintained. Large research gaps exist, including priming fluid choice, plasticization migration risks, oxygenator integrity, and duration of safe storage beyond 30 days.

The prognosis in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) receiving veno-arterial extracorporeal life support (VA-ECLS) and Impella ( ie , ECPELLA) support remains unsatisfactory. The difference in therapeutic strategy and mortality between left ventricular assist device (LVAD) and non-LVAD centers remains unknown, especially in Japan. Patients with AMI-CS who received Impella support between 2020 and 2023 were prospectively registered in the Japanese registry for Percutaneous Ventricular Assist Device (J-PVAD). The difference in 30 day mortality in patients receiving ECPELLA support between LVAD and non-LVAD centers was retrospectively investigated. A total of 1,549 patients (median 69 years; LVAD center 21.1%) were included. The prevalence of Impella upgrade and LVAD implantation was significantly higher in LVAD center than non-LVAD center. The 30 day mortality was lower in LVAD center than non-LVAD center (45.5% vs . 54.5%, p = 0.002). Multivariable analysis demonstrated that LVAD center and Impella upgrade were independent predictors for lower 30 day mortality with adjusted hazard ratios of 0.791 (95% confidence interval: 0.658-0.953, p = 0.013) and 0.483 (95% confidence interval: 0.339-0.690, p < 0.001), respectively, instead of LVAD implantation. Impella upgrade was more frequent in LVAD center and associated with a lower 30 day mortality among patients with AMI-CS receiving ECPELLA support.

Axillary and subclavian artery cannulation for veno-arterial extracorporeal membrane oxygenation (V-A ECMO) offers clinical advantages but introduces complex flow dynamics within the aortic arch. This study employed patient-specific computational fluid dynamics (CFD) models derived from 10 computed tomography (CT)-based geometries to simulate ECMO flow via either the right axillary artery or left axillary artery access under varying levels of cardiac dysfunction. Three distinct flow behaviors were observed-descending-directed, arch-split, and retrograde aortic valve (AV)-directed patterns-depending on access site, support level, and aortic geometry. Right axillary artery access more frequently resulted in retrograde flow, particularly in type III arch configurations. In contrast, left axillary artery cannulation promoted antegrade or arch-split flow, independent of arch morphology. These findings suggest that left axillary artery access may provide more favorable antegrade flow hemodynamics in V-A ECMO, particularly when native cardiac output is impaired. Computational fluid dynamics modeling offers valuable insights to guide individualized cannulation strategies based on patient anatomy and cardiac function.

High-frequency oscillatory ventilation (HFOV) is used in neonates with hypoxic respiratory failure both as a primary mode and as a rescue mode of ventilation. It is unknown to what degree the use of HFOV provides a measurable benefit to infants with congenital diaphragmatic hernia (CDH) receiving extracorporeal life support (ECLS). We sought to determine whether pre-ECLS use of HFOV compared to conventional mechanical ventilation (CMV) was associated with differences in mortality. Neonates who underwent ECLS for CDH were identified within the Extracorporeal Life Support Organization (ELSO) Registry. Patients were categorized as those on HFOV versus on CMV immediately before initiating ECLS. Patients were matched 1:1 for severity based on pre-ECLS covariates using the propensity score (PS) for ventilator choice. There were 2,892 infants with an overall mortality of 47.3%. Conventional ventilation was used before ECLS in 677 (23.4%) and HFOV in 2,215 (76.6%). Of these, 1,354 infants were matched (1:1) based on ventilator choice (677 CMV and 677 HFOV). High-frequency oscillatory ventilation was associated with 49% higher odds of mortality based on 677 PS matched pairs (odds ratio [OR] = 1.492, 95% confidence interval [CI]: 1.200-1.856, p < 0.001). Patients who received pre-ECLS mechanical ventilation with HFOV were noted to have higher mortality in neonates with CDH compared to CMV.

Pediatric hemodialysis is a life-saving treatment for children with chronic kidney diseases. Central venous catheters (CVCs) are the most commonly used vascular access, despite being commonly subject to complications leading to inadequate hemodialysis and catheter replacement. The available CVCs feature various design elements reflecting ongoing efforts to achieve optimal performance. Computational fluid dynamics (CFD) can contribute to analyze the flow dynamics within the CVCs. The aim of this study is to investigate the design parameters that most influence the flow performance of CVCs. A design of experiment (DOE) was set up to assess the CFD of two CVC models of 6.5F and 8F size. Blood flow rates, shear stress, residence time, and platelet lysis index were evaluated. The results showed how the proximal side holes were the most influential geometrical features, influencing both the flow rates ( r > 0.64) and the shear stress of the CVCs (| r | > 0.5). At increased flow rate, the side holes were found to be competing with the tip in terms, especially, of residence time inside the CVC. The findings of this DOE show how CFD can contribute to understand the influence of design parameters and potentially guide the development of optimized pediatric-specific CVC models.