ASAIO Journal最新文献

Despite the increasing prevalence of advanced heart failure among older patients, current guidelines remain cautious regarding the safety of heart transplantation (HT) in elderly recipients. This study aimed to evaluate early and late outcomes in older HT recipients. We retrospectively analyzed all patients aged ≥18 years who underwent HT at our center between January 2012 and December 2022, comparing early and late outcomes of recipients ≥65 years (group 1) vs. those <65 (group 2). Groups 1 and 2 comprised 73 (female = 10, median age = 67 years, interquartile range [IQR] = 66-69) and 212 patients (female = 58, median age = 54 years, IQR = 46-60), respectively. Group 1 presented a higher burden of cardiovascular (CV) risk factors and impaired renal function (p < 0.001); additionally, they more often received older donors (p < 0.001) with a higher incidence of coronary artery disease (p = 0.041). Group 1 experienced a significantly higher rate of postoperative complications and in-hospital mortality (n = 21, 28.8%; p < 0.001). At a median follow-up time of 4.2 years (IQR = 1.3-6.9), group 1 showed lower survival rates (p < 0.001) (1 year = 68%, 95% confidence interval [CI] = 58-80; 5 year = 62%, 95% CI = 51-74). In our experience, HT in patients aged ≥65 years shows worse early and late outcomes; however, among elderly recipients, modifiable factors such as donor age and perioperative complications significantly influence survival and may be targeted to improve clinical results.

The instantaneous left ventricular assist device (LVAD) flow waveform of the HeartWare ventricular assist device (HVAD) device was previously used to assess hemodynamic parameters, which is not possible with the HeartMate 3 (HM3). The purpose of this study was to assess the ability of pulsed wave Doppler interrogation of the outflow graft (PWOG) and of a novel noninvasive pump data acquisition system (HM3 Snoopy) to obtain noninvasive flow waveforms (NIFW) and to determine whether these predict hemodynamic changes. The study was conducted using a fluid-filled, biventricular failure mock loop model with a flow probe (FP) placed around the distal outflow. Five different pump speeds, two distinct hematocrits, and preload and afterload changes were used to create 56 unique hemodynamic states. Noninvasive flow waveform parameters were assessed for correlation against FP-derived parameters. Subsequently, NIFW parameters were assessed for their predictive capabilities for preload and afterload changes. There was moderate correlation between NIFW and FP-derived systolic waveform parameters (r range: 0.43-0.81), and strong correlation for diastolic parameters (r range: 0.87-0.99). Flow waveform amplitude as obtained by echocardiography was the best preload predictor (r2 = 0.67). A multiple linear regression model of NIFW parameters provided adequate prediction of afterload (r2 = 0.85). HeartMate 3 Snoopy and PWOG are promising tools for generating flow waveform surrogates and detecting hemodynamic changes.

An important goal in the development of an artificial womb is the avoidance of the use of heparin, due to the presumed risk of intracranial hemorrhage in premature infants. We developed the Experimental Oxygenator (Exp-Ox), featuring a small surface area and low priming volume, as an oxygenator to support the clinical application of the EXTra-uterine Environment for Neonatal Development (EXTEND) system. This study evaluated the durability and hemocompatibility of the Exp-Ox during prolonged use (exceeding 14 days) in premature lambs in the EXTEND system without systemic anticoagulation (heparin-free study) compared to the standard heparin-based EXTEND system (heparin study). Twelve animals (91-93 days gestational age) completed the study: six in the heparin and six in the heparin-free study. Oxygen and CO2 transfer per weight remained stable overall in both studies, with no significant differences observed in oxygen transfer efficiency between the studies (p = 0.61). The quantitative clot burden of the Exp-Ox on computed tomography scan images ranged from 3.91-29.94% to 1.28-11.77% in the heparin and heparin-free studies, respectively (p = 0.15, nonsignificant difference), with no correlation to study duration or oxygen transfer efficiency. The Exp-Ox sustained function and hemocompatibility for over 14 days in the EXTEND system without systemic anticoagulation.

Aortic surgery carries high risks and complication rates, particularly when extracorporeal life support (ECLS) is required. We compared outcomes of patients receiving post-cardiotomy ECLS after surgeries involving or not involving the thoracic aorta, with a focus on emergency operations. This retrospective multicenter study included adults requiring veno-arterial (V-A) ECLS for post-cardiotomy shock. In-hospital outcomes and long-term survival were analyzed. Among 2,058 patients, 382 (18.6%) underwent aortic and 1,676 (81.4%) non-aortic surgery. Patients undergoing aortic operations were younger (63.0, interquartile range [IQR]: 54.4-70 years; non-aortic: 65.0, IQR: 55-72 years; p = 0.020), with more emergencies (n = 126, 33.1%; non-aortic: n = 402, 24.3%; p < 0.001), longer cross-clamp times (148, IQR: 101-203 mins; non-aortic: 90, IQR: 59-133 mins; p < 0.001) and more postoperative bleeding events (n = 234, 62.4%; non-aortic: n = 922, 56.0%; p = 0.024). Stroke was more frequent after aortic surgery (n = 60, 15.8%; non-aortic: n = 157, 9.4%; p < 0.001), especially in emergency cases (n = 27, 21.6%; p = 0.034). In-hospital mortality was greater after aortic surgery (n = 258, 67.5%; non-aortic: n = 986, 58.8%; p = 0.002), with 49.9% (n = 189) on-ECLS mortality. Neurological injury caused death in 8.9% (n = 22) of patients undergoing aortic and 4.0% (n = 36) non-aortic operations. Post-discharge survival was similar ( p = 0.32), and emergency status did not affect mortality in the aortic group ( p = 0.643). Veno-arterial extracorporeal life support after aortic surgery is associated with higher bleeding, stroke, and in-hospital mortality compared with non-aortic surgery, independent of emergency status.

Heart transplantation (HTx) from controlled donation after circulatory death (c-DCD) is a promising alternative to donation after brain death (DBD), though warm ischemia remains a concern. Thoraco-abdominal normothermic regional perfusion (TANRP) enables in situ functional assessment, but preserving grafts during transport under optimal hypothermic conditions is still a challenge. We describe the first clinical application of a novel temperature-controlled cold static preservation system-Pertravel (Aferetica s.r.l., Bologna, Italy)-in a c-DCD heart transplant. A 62 year old male donor underwent withdrawal of life-sustaining therapy (WLST) followed by 130 minutes of TANRP. After confirming graft viability, the heart was explanted and preserved in the Pertravel system during transport. The recipient, a 66 year old male with end-stage dilated cardiomyopathy, underwent transplantation after 161 minutes of cold ischemia. The Pertravel system maintained stable hypothermia, with no macroscopic graft damage observed. Postoperative recovery was uneventful, with excellent hemodynamic performance, normal echocardiographic findings, and no evidence of acute rejection on serial biopsies. This case demonstrates the feasibility and safety of the Pertravel system for c-DCD heart preservation. Its stable temperature control, ease of use, and favorable outcomes support further investigation in broader clinical settings.

Extracorporeal membrane oxygenation (ECMO) for trauma is underreported in Latin America. We conducted a cohort study in four centers from Argentina (2015-2024), including all adults with polytrauma (defined as Injury Severity Score [ISS] ≥ 16) who developed acute respiratory distress syndrome (ARDS) with refractory respiratory failure and received veno-venous ECMO. Extracorporeal membrane oxygenation-related complications, in-hospital mortality, and prognostic performance of established scores were assessed retrospectively; long-term health-related quality of life (QoL) was assessed prospectively. Thirty-one patients were analyzed. Bleeding occurred in 25.8% (major in 16.1%); oxygenator/circuit thrombosis in 22.6%. In-hospital mortality was 38.7% (95% confidence interval [CI]: 22-58). Discrimination was modest: area under the ROC curve (AUROC; 95% CI) of 0.62 (0.42-0.82) for ISS, 0.55 (0.33-0.76) for Acute Physiology and Chronic Health Evaluation II (APACHE II), and 0.53 (0.32-0.73) for respiratory ECMO survival prediction (RESP)-score. Among 19 survivors, 11 (57.9%) completed follow-up a median of 7 years after discharge; EuroQol 5-Dimension 3-Level (EQ-5D-3L) utility had a median of 0.743 (bootstrap 95% CI: 0.653-0.831), and Katz Index was 6, indicating preserved independence despite frequent pain/anxiety. Extracorporeal membrane oxygenation achieved 59% in-hospital survival with durable functional status, but the limited prognostic performance of established predictive models highlights the need for trauma-specific tools and structured rehabilitation and follow-up. Limitations include a small sample size and substantial loss of follow-up, restricting precision and generalizability.

Heart transplantation (HT) is the definitive therapy for end-stage heart failure. Patients unwilling to receive blood product transfusions are often considered ineligible for HT due to the significant perioperative bleeding risk. "Bloodless" HT-that is, without use of blood product transfusions-provides the opportunity to extend this critical intervention to such patients. Here we describe our center's peri-transplant blood conservation protocol that supported successful bloodless HT in two patients unwilling to receive blood product transfusions. One of these patients represents the first described case of temporary mechanical circulatory support as a bridge to bloodless HT, which is of particular importance given the increasing use of such support before HT more broadly. Clinical management decisions and interventions that decreased blood loss, minimized bleeding risk, and stimulated erythropoiesis are highlighted. Utilization of similar strategies may allow for expansion of bloodless HT to centers that have previously not offered this therapy.