ASAIO Journal最新文献

The Fontan circulation is a palliative treatment for univentricular heart disease but is prone to progressive hemodynamic failure. To address this, a novel cavopulmonary assist device (CPAD) with dual inlets from the superior and inferior caval veins was developed. This study examines how varying inflow ratios (IRs) affect the CPAD's hydraulic performance, hemocompatibility, and flow estimation accuracy. Hydraulic performance, represented by the pressure head-flow (H-Q) characteristics, was experimentally and numerically assessed at different IRs. Hemolysis was evaluated experimentally at the nominal operating point (4 L/min, 2,500 RPM) for IRs of 1:1 and 1:3 (n = 5). Additionally, hemocompatibility-related metrics were determined numerically. Furthermore, the robustness of conventional flow estimation methods, based on motor current, pump speed, and viscosity, under varying IRs was examined. In vitro and in silico results indicated low variations in both hydraulic performance (ΔH < 2.2 mm Hg) and hemolysis(22.4% in measured Normalized Index of Hemolysis [NIH]; 4.9% in predicted damage index [DI]) across all investigated IRs. The flow estimation model based on motor current, rotational speed, and fluid viscosity showed high accuracy regardless of the IR, with root mean square error (RMSE) less than 0.148 L/min and R² greater than 0.99. The analyzed double-inflow CPAD performed reliably across the investigated IRs, supporting its suitability for a broad patient population and enabling precise flow monitoring.

This study aimed to evaluate the feasibility and safety of a novel percutaneous left ventricular assist device CorVad 6.0, for mechanical circulatory support in an ovine model, focusing on device performance, hemocompatibility, and end-organ effects. The CorVad 6.0, which is a microaxial flow pump incorporating an integrated axial-flux motor, was implanted in six healthy sheep via descending aortic access. Animals were supported for 4 weeks, with pump speeds titrated to maintain flows of 1.5-5.0 L/min. All six animals survived the 4 week study period. The CorVad 6.0 was successfully implanted in all subjects with no device-related complications, demonstrating stable operation and a predictable flow response to speed changes. Key hematological and biochemical parameters, including plasma-free hemoglobin, remained within acceptable ranges throughout the study, showing no evidence of significant hemolysis or end-organ dysfunction. Macroscopic and histological analyses of the heart, liver, kidneys, and brain revealed no device-related pathological abnormalities. The CorVad 6.0 demonstrates stable hemodynamic performance and a favorable biocompatibility during a 4 week implantation period. Further study investigating chronic heart failure modes is needed.

We describe an innovative application of a modified three-arm veno-venous bypass (VVB) in the management of a complex case of recurrent renal cell carcinoma (RCC) invading the inferior vena cava (IVC) and left renal vein confluence. The patient, with a solitary kidney following right nephrectomy, underwent radical tumor resection and IVC reconstruction. To preserve renal function and minimize ischemic injury, we employed an extracorporeal circuit traditionally used in liver transplantation, adapting it to include an additional cannula in the left renal vein. This configuration allowed continuous renal venous drainage during IVC clamping, limiting kidney warm ischemia to only 14 minutes. The extracorporeal circuit included jugular and femoral venous drainage limbs connected to a centrifugal pump and a third limb providing direct renal outflow, effectively maintaining hemodynamic stability and renal perfusion. Postoperative recovery was uneventful, with transient minimal creatinine elevation and no acute kidney injury. This case demonstrates the versatility of extracorporeal venous bypass circuits in complex onco-vascular surgery and highlights the potential for broader applications of organ support technologies in preserving organ function during major vascular reconstruction. The proposed configuration represents a valuable adjunct in surgeries involving solitary kidneys and prolonged caval occlusion, bridging concepts from transplant and extracorporeal support domains.

The Impella 5.5 is a large-bore transaortic microaxial flow pump used to treat patients with cardiogenic shock (CS). We sought to assess the hemodynamic and clinical response to Impella 5.5 in patients with CS and identify predictors of clinical deterioration. We reviewed 265 patients who underwent Impella 5.5 implantation from 2020 to 2024 at two institutions to identify patients in CS. Patients with preoperative extracorporeal life support (ECLS) were excluded and a total of 177 patients made up the final study cohort. Fifty patients (28%) deteriorated while on support and needed escalation to ECLS and/or died in-hospital, while 127 (72%) were successfully bridged to heart replacement therapy (HRT) or discharged without need for escalation of device support. Creatinine, lactate, white blood cell count, central venous pressure, and tricuspid regurgitation (TR) severity were all significantly higher in those with clinical deterioration, while pulmonary artery pulsatility index (PAPi) was lower. Rates of stroke, renal failure, and tracheostomy were significantly higher in those who deteriorated. After adjusting for age and sex, both TR and PAPi <2.5 were associated with clinical deterioration. Overall outcomes with Impella 5.5 in CS patients are encouraging; poor baseline right ventricular function appears to be a predictor of worse outcomes with Impella 5.5 in this population.

This study compared the incidence of intracranial hemorrhage (ICH) among three previously identified acute respiratory distress syndrome (ARDS) subphenotypes: fibrotic, dry, and wet. This retrospective, multicenter observational study used a Japanese database of adult patients with severe ARDS supported with venovenous extracorporeal membrane oxygenation (VV ECMO). The Fine-Gray competing risk models were applied with inverse probability of treatment weighting (IPTW) to evaluate the impact of ARDS subphenotypes on ICH incidence. Of 536 patients included in the analysis, 185 (34.5%) were classified as fibrotic, 185 (34.5%) as dry, and 166 (31.0%) as wet. Intracranial hemorrhage occurred in 3.7% (20/536) of patients during VV ECMO support and was associated with significantly higher mortality compared with patients without ICH (65.0% [13/20] vs. 27.5% [142/516]; p < 0.001). Intracranial hemorrhage incidence was 8.7% (16/185), 0.5% (1/185), and 1.8% (3/166) in the fibrotic, dry, and wet groups, respectively, with a significantly higher incidence in the fibrotic group (p < 0.001). The fibrotic type was independently associated with a higher ICH risk compared with the other two types (hazard ratio: 4.33, 95% confidence interval: 1.47-12.69; p = 0.015). Severe ARDS cases classified as fibrotic had a significantly higher ICH risk during VV ECMO, highlighting the need for increased vigilance in this subgroup.

Extracorporeal membrane oxygenation (ECMO) represents an established modality of intraoperative circulatory and respiratory support during lung transplantation (LTx). Systemic anticoagulation with unfractionated heparin (UFH) remains essential to prevent circuit thrombosis; however, the optimal monitoring strategy during this procedure remains uncertain. Conventional assays, including antifactor Xa activity (anti-Xa), activated partial thromboplastin time (aPTT), aPTT ratio (aPTTr), and activated clotting time (ACT), demonstrate variable sensitivity and reliability, particularly at low UFH concentrations where ACT is often inadequate. This study aimed to evaluate the interrelationship between standard coagulation monitoring methods and to assess the feasibility of using viscoelastic testing, specifically the ROTEM INTEM/HEPTEM clotting time ratio (I/Hr), as a bedside alternative to ACT. A total of 79 patients undergoing LTx with intraoperative ECMO support were analyzed. Unfractionated heparin was administered in all cases, and coagulation parameters were assessed preoperatively, before ECMO cannulation, and during ECMO support. A strong correlation was observed between I/Hr and anti-Xa, with satisfactory agreement with aPTT and aPTTr. Bland-Altman analysis confirmed narrower limits of agreement for I/Hr-derived versus ACT-derived anti-Xa predictions. These findings support I/Hr as a reliable and practical bedside surrogate for UFH monitoring during ECMO-assisted LTx.

The current study aimed to assess the national practice patterns of extracorporeal membrane oxygenation (ECMO) use during the early posttransplant period. We included patients in the United Network for Organ Sharing (UNOS) database aged greater than 18 years who underwent lung transplantation (LT) between January 1, 2017 and December 31, 2022 (n = 14,999). The study group was divided based on the need for ECMO at 72 hours after LT, as recorded in the database. We analyzed recipient, donor, and procedure-related variables as potential predictors of need for ECMO. One year survival was the primary outcome variable. The overall incidence of ECMO use after LT was 9% (1,357/14,999), with increasing yearly incidence (6.5%-10.7%). Several recipient variables were independently associated with post-LT ECMO use. Additionally, older donors, donation after circulatory death donors, use of machine perfusion, longer ischemia time, and bilateral LT were additional predictors. Patients with post-LT ECMO use had significantly higher 1 year mortality (30.5% vs. 9%, p < 0.001). It is concluded that post-LT ECMO use was independently associated with worse 1 year mortality. Extracorporeal membrane oxygenation is being increasingly deployed among patients with severe allograft dysfunction. The increase in incidence of post-LT ECMO use appears to be fueled by progressively higher-risk donors and recipients. Patients with post-LT ECMO use continue to experience markedly worse outcomes.