ASAIO Journal最新文献

Delays in mechanical circulatory support (MCS) for cardiogenic shock can be critical. However, timely access to a hybrid operating room or C-arm fluoroscopy for urgent axillary Impella 5.5 (Abiomed, Danvers, MA) implantation remains a barrier. To address this, we developed a fluoroscopy-free axillary Impella 5.5 implantation technique using transesophageal echocardiography (TEE) guidance. From January 2023 to November 2024, 19 adults underwent the procedure. A preoperative flowchart ensured appropriate selection, with the right axillary artery as the preferred access. Transesophageal echocardiography-guided pigtail advancement, valve crossing, and device positioning. All implantations (100%) were successful without conversion to fluoroscopy-guided or ECMO. There were no strokes or major complications. All patients had optimal positioning and rapid hemodynamic improvement. These findings support the feasibility and safety of TEE-guided, fluoroscopy-free Impella 5.5 implantation. It offers a significant benefit for earlier implantation of MCS in patients with cardiogenic shock, especially in settings where limited or delayed access to fluoroscopic imaging resources is a barrier to timely intervention.

Del Nido Cardioplegia (DNC) is widely used in nontransplant cardiac surgery, but its role as a preservation solution in cardiac transplantation is unclear. We conducted a retrospective observational study of 61 patients undergoing heart transplant between January 2015 and December 2023. Only recipients with locally procured donor hearts were included. Recipients were grouped according to the type of preservative solution: DNC (n = 33) versus control (crystalloid + cold blood cardioplegia; n = 28). Patients in the DNC group were older and more frequently received hearts from donation after circulatory death. The Del Nido Cardioplegia group had lower troponin-T release at 48 hours (median [interquartile range {IQR}]: 1,062 [820] vs. 700 [345]; p = 0.03). Compared with the DNC, control group was related with longer ischemic (median [IQR]: 65 [55-83] vs. 80 [70.2-92.7] minutes; p = 0.002) and bypass times (median [IQR]: 90 [73.5-112] vs. 108 [97-118] minutes; p = 0.001). On-pump blood glucose levels and need for electrical defibrillation were lower with DNC. In heart transplantation using locally procured grafts, DNC appears to be a feasible preservation strategy. Del Nido Cardioplegia was associated with shorter operative times and lower troponin release in our initial experience. Further studies should be performed to confirm these promising results.

Heart transplantation using donation after circulatory death (DCD) has recently re-emerged alongside donation after brain death (DBD). This technique can potentially increase the number of available cardiac grafts. However, its clinical outcomes remain limited. We compared data from patients who received grafts from DCD versus DBD between 2012 and 2023. During this period, 131 adult patients underwent isolated heart transplantation. Of these, 25 (19%) were DCD donors. Donation after circulatory death donors were predominantly local (66% vs . 42%; p = 0.027). Donation after circulatory death graft recipients had fewer ventricular assist devices (12% vs . 35%; p = 0.025) and were less frequently urgent (12% vs . 39%; p = 0.009). Donation after circulatory death grafts had shorter myocardial ischemia and extracorporeal circulation times than DBD grafts (70 min [63.5-91] vs . 168 [83-219]; p < 0.001); (90 min [78-103) vs . 120 [96-148], p < 0.001). We observed no significant differences in the incidence of primary graft failure (16% vs . 22%; p = 0.526) or hospital mortality (8% vs . 14%; p = 0.410) between both groups. In conclusion, cardiac DCD demonstrates hospital outcomes comparable to those of cardiac DBD. Further long-term follow-up of these patients is necessary to determine their rejection, graft vascular disease, and mortality outcomes.

Venopulmonary arterial (VPA) extracorporeal membrane oxygenation (ECMO) is emerging as an alternative to traditional venovenous (VV) ECMO for respiratory failure. This study compares rates of hemolysis and acute kidney injury (AKI) between VPA and VV ECMO. We retrospectively analyzed 142 patients (VPA: n = 84, VV: n = 58) who underwent ECMO from 2019 to 2023. Plasma-free hemoglobin (pfHb) was measured as a marker for hemolysis and AKI was assessed using daily creatinine levels. Mixed-effects linear regression and Cox proportional hazards models were used to assess associations between ECMO modality, hemolysis, and AKI. No significant differences in pfHb, creatinine, or AKI incidence were observed between VV and VPA ECMO ( p > 0.05). Extracorporeal membrane oxygenation modality was not a significant predictor of pfHb levels ( p = 0.376), creatinine levels ( p = 0.337), or time to AKI (hazard ratio [HR] = 0.94, 95% confidence interval [CI] = 0.39-2.30; p = 0.898). Centrimag pumps were associated with lower pfHb compared with Cardiohelp (29% reduction, p = 0.002). Increased pump speed correlated with elevated pfHb (27% increase per 1,000 RPM, p = 0.003). Venopulmonary arterial and VV ECMO demonstrate similar hemolysis and AKI profiles. Pump type and speed significantly influence hemolysis, emphasizing the importance of optimal ECMO configuration and management in minimizing complications.

Currently, no clinical modality reliably assists clinicians in selecting the optimal transcatheter aortic valve replacement (TAVR) device orientation. This is critical for the growing population of young bicuspid aortic valve (BAV) TAVR candidates, who are at high risk for post-procedural complications. We aim to develop a predictive computational modeling workflow to identify which TAVR device and orientation will minimize the risk of paravalvular leakage (PVL), coronary obstruction, and flow-induced thrombogenicity. We compared the risk of post-TAVR complications across more than 30 device orientation combinations by virtually implanting self-expandable and balloon-expandable TAVR devices in three BAV patients. PVL severity varied significantly with device orientation, reaching up to 22.03 mL/beat with certain self-expandable devices. For self-expandable devices, orientations that ensured the shortest distance between the taller skirt region and PVL regions minimized PVL. A shorter frame height in balloon-expandable devices was insufficient to cover PVL regions in certain patients. Pearson correlation demonstrated a negative relationship between device oversizing and PVL. The risk of flow-induced thrombogenicity was positively correlated with PVL severity. A patient-specific computational modeling workflow can identify the optimal TAVR device and orientation, minimizing life-threatening post-TAVR complications and facilitating future reinterventions for young BAV TAVR candidates.

Normothermic machine perfusion (NMP) has emerged as a valuable preservation technique in liver transplantation, offering improved graft assessment and viability. Traditionally, liver grafts undergo a second cooling phase before implantation, which may contribute to cellular damage through ischemia-reperfusion injury. In this "How To Do It" article, we describe our surgical technique to avoid re-cooling following NMP. Specifically, after retrieval from the perfusion device, the graft is directly inserted into the surgical field and undergoes a standardized portal flush with 1 L of 5% albumin at room temperature before reperfusion. This method maintains physiological temperature, potentially reducing reperfusion stress and enhancing graft function. We detail step-by-step procedural aspects, including organ handling, vascular anastomoses, and intraoperative considerations, supported by our clinical outcomes.