ASAIO Journal最新文献

Patients supported on ventricular assist devices (VADs) benefit from rehabilitation while awaiting heart transplantation to recover from surgery, prevent deconditioning, and, in most cases, optimize transplant candidacy. With bleeding and neurological dysfunction as the most common VAD complications, the importance of rehabilitation dramatically increases when a patient on a VAD also suffers from a neurological injury. The rehabilitation needs for cardiac conditioning and neurological reeducation are not the same. Patients with severe neurological deficits require intense rehabilitation that often includes base-of-support challenges, usage of bolsters and balls, partial weight-bearing treadmill training, and assumption of various body positions in prone, kneeling, or quadruped for neuromotor reeducation. However, some devices are more conducive to rehabilitation than others. For children supported by the CentriMag in particular, rehabilitation is challenged by short cannula tubing, an external motor, a large interface, and an intensive care unit (ICU) admission. We report a safe and successful physical therapy course of a pediatric stroke patient with a diagnosis of Ebstein's anomaly supported by a CentriMag right VAD (RVAD) while awaiting heart transplant in the ICU.

The emerging ex vivo machine perfusion (MP) enables the extension of ex situ intervals, potentially expanding the heart transplant (OHT) donor pool. From October 18, 2018, to June 30, 2023, isolated OHT using donation after brain death (DBD) from extended distances (>500 miles) were identified in the United Network for Organ Sharing database, and categorized into cold storage (non-MP, N = 1,212) and MP group (N = 152). The MP utilization rate for DBD hearts from extended distances surged from 0% in 2018 to 27.7% in 2023. Recipient characteristics including listing status were similar except for history of cardiac surgery (non-MP, 32% vs. MP, 41%, p = 0.019). The travel distance was longer in MP group (696 vs. 894 miles, p < 0.001), as was donor organ preservation time (4.42 vs. 6.27 hours, p < 0.001). One-year survival was similar between groups (non-MP, 93.0 ± 0.8% vs. MP, 90.5 ± 2.9%, p = 0.23). In multivariable Cox hazards models, MP was not associated with mortality (hazard ratio, 1.19; p = 0.60). Among MP cohort, survival was comparable between hearts transported between 500-999 miles (N = 112) and those over 1,000 miles (N = 40). The utilization of MP for DBD heart recovery allows for safe DBD recovery from extended distance with comparable survival to cold storage.

Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart anomaly that often leads to systemic heart failure, necessitating mechanical circulatory support or transplantation. We report a case of a 54 year old male diagnosed with dextrocardia and ccTGA (I, D, D), who had been suffering from congestive heart failure for over 7 years. Despite receiving intensive treatment, his condition deteriorated. Preoperative evaluation revealed significant systemic right ventricular dysfunction with severe valvular regurgitation and pulmonary hypertension. The surgical approach included tricuspid and aortic bioprosthetic valve replacement, mitral valve annuloplasty, and right thoracic ventricular assist device (VAD) implantation. The patient recovered well postoperatively and was discharged on postoperative day 39 with New York Heart Association (NYHA) class I. This case demonstrates the feasibility of using VAD in right heart ccTGA as a bridge to transplantation or destination therapy, emphasizing the importance of meticulous preoperative planning and intraoperative management for successful outcomes.

This study aimed to assess platelet activation following implantation of the Aeson bioprosthetic total artificial heart (A-TAH). We monitored plasma levels of platelet activation markers in patients receiving A-TAH support (n = 16) throughout the follow-up period. Before implantation, soluble CD40 ligand (sCD40L) levels averaged 3,909.06 pg/ml (standard deviation [SD] = 3,772.37), remaining stable postimplantation at 3,964.56 pg/ml (SD = 2,198.85) during months 1-3 and at 3,519.27 pg/ml (SD = 1,647.04) during months 3-6. Similarly, P-selectin (sP-sel) levels were 35,235.36 pg/ml (SD = 14,940.47) before implantation, stabilizing to 33,158.96 pg/ml (SD = 9,023.11) (1-3 months) and 31,022.58 pg/ml (SD = 9,249.95) (3-6 months). Preimplantation platelet factor 4 (PF4) measured 2,593.47 ng/ml (SD = 2,167.85), remaining consistent at 2,136.10 ng/ml (SD = 1,264.47) (1-3 months) and 1,991.26 ng/ml (SD = 1,234.16) (3-6 months). Levels of neutrophil-activating peptide 2 (NAP2) were also steady, measuring 785.63 ng/ml (SD = 605.26) preimplantation, 935.10 ng/ml (SD = 517.73) at 1-3 months, and 907.21 ng/ml (SD = 501.96) at 3-6 months postimplantation. Importantly, neither aspirin nor heparin treatment affected these platelet biomarker levels. No correlation was observed between platelet activation marker levels and clinical outcomes such as pericardial effusion, nor with the timing of aspirin initiation and drain removal. Our findings confirm that A-TAH does not trigger platelet activation. The lack of association between aspirin, platelet activation, and clinical outcomes suggests the possibility of discontinuing antiplatelet therapy following A-TAH implantation in the future.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for cardiogenic shock (CS) in adults, with age-influencing outcomes. Data from the Chinese Extracorporeal Life Support (CSECLS) Organization registry (January 2017-July 2023) were analyzed to assess in-hospital mortality in VA-ECMO for CS. Patients ≤65 years were categorized as young, and those >65 as elder. The primary outcome was in-hospital mortality, with secondary outcomes including ECMO weaning, 30 day survival, and complications. Of 5,127 patients, the young group (73.4%) had a median age of 51.0 (40.0-58.0) years, and the elder group (26.6%) had a median age of 71.0 (68.0-75.0) years. The in-hospital mortality was lower in the younger group (45.1%) compared with the elder group (52.6%, p < 0.001). The young group also had higher ECMO weaning rates (79.4% vs. 74.8%, p < 0.001) and 30 day survival (59.1% vs. 51.3%, p < 0.001). Bleeding, renal, and pulmonary complications were more frequent in young patients, though not statistically significant. Young patients undergoing VA-ECMO for CS generally have better outcomes than older patients, though careful selection is crucial to manage complications.

Intra-aortic balloon pumps (IABPs) are commonly used circulatory support devices. Mesenteric ischemia is a serious and poorly studied complication of IABP use. Here, we examine six cases of mesenteric ischemia associated with IABPs from a single urban academic medical center. We examine patient, device, and radiographic characteristics, and hypothesize several mechanisms behind IABP-associated mesenteric ischemia including anatomic-to-device length mismatch, atheroembolism, and mechanical obstruction. We highlight the high morbidity and mortality of such complication and the need for future studies to examine risk factors that may predispose IABP-treated patients to the development of mesenteric ischemia.

Extracorporeal membrane oxygenation (ECMO) provides critical cardiac support, but predicting outcomes remains a challenge. We enrolled 1,748 adult venoarterial (VA)-ECMO patients at the National Taiwan University Hospital between 2010 and 2021. The overall mortality rate was 68.2%. Machine learning with the random survival forest (RSF) model demonstrated superior prediction for in-hospital mortality (area under the curve [AUC]: 0.953, 95% confidence interval (CI): 0.925-0.981), outperforming the Sequential Organ Failure Assessment (SOFA; 0.753 [0.689-0.817]), Acute Physiology and Chronic Health Evaluation (APACHE) II (0.737 [0.672-0.802]), Survival after Venoarterial ECMO (SAVE; 0.624 [0.551-0.697]), ENCOURAGE (0.675 [0.606-0.743]), and Simplified Acute Physiology Score (SAPS) III (0.604 [0.533-0.675]) scores. Failure to achieve 25% clearance at 8 hours and 50% at 16 hours significantly increased mortality risk (HR: 1.65, 95% CI: 1.27-2.14, p < 0.001; HR: 1.25, 95% CI: 1.02-1.54, p = 0.035). Based on the RSF-derived variable importance, the RESCUE-24 Score was developed, assigning points for lactic acid clearance (10 for <50% at 16 hours, 6 for <25% at 8 hours), SvO2 <75% (3 points), oliguria <500 ml (2 points), and age ≥60 years (2 points). Patients were classified into low risk (0-2), medium risk (3-20), and high risk (≥21). The medium- and high-risk groups exhibited significantly higher in-hospital mortality compared with the low-risk group (HR: 1.93 [1.46-2.55] and 5.47 [4.07-7.35], p < 0.002, respectively). Kaplan-Meier analysis confirmed that improved lactic acid clearance at 8 and 16 hours was associated with better survival (log-rank p < 0.001). The three groups of the RESCUE-24 Score also showed significant survival differences (log-rank p < 0.001). In conclusion, machine learning can help identify high-risk populations for tailored management. Achieving optimal lactic acid clearance within 24 hours is crucial for improving survival outcomes.

Venovenous (VV) extracorporeal membrane oxygenation (ECMO) supports end-organ oxygen delivery in patients with refractory respiratory failure. Physical therapy (PT) while on ECMO provides conceptual benefits of strength and conditioning. Physical therapy can additionally be used to facilitate improvements in functional status of pulmonary reserve while VV ECMO is used to bridge to lung transplant or recovery. We report the case of a patient initially supported with VV ECMO that due to a course complicated by refractory hypoxia, cardiac arrest, and cardiogenic shock, was successfully supported with parallel, independent VV ECMO circuits, allowing for ongoing PT, to bridge to lung transplant, decannulation, and hospital discharge.