Advance care planning in the treatment of implantable left ventricular assist device: a republication of the review published in Japanese Journal of Artificial Organs
AbstractAdvance care planning (ACP) is essential in managing serious and chronic illnesses to ensure that patients receive care aligned with their personal values, goals, and preferences. This review focuses on integrating ACP in the treatment of patients receiving implantable left ventricular assist devices (VADs). The heart failure palliative care team developed a unique advance directive form and pamphlet to facilitate ACP discussions, emphasizing not only medical treatment preferences but also patients ’ values and life goals.The study highlights the distinction between bridge to transplantation (BTT) and destination...
Source: Journal of Artificial Organs - April 13, 2024 Category: Transplant Surgery Source Type: research
Management of aortic valve insufficiency in patients with continuous-flow left ventricular assist device: a republication of the review published in Japanese Journal of Artificial Organs
AbstractSince 2011, implantable ventricular assist devices have been a standard treatment for severe heart failure alongside heart transplantation in Japan. However, the limited availability of donors has led to a prolonged wait for transplants, now averaging 1719 days, intensifying the issue of aortic insufficiency in patients with continuous flow ventricular assist devices. These devices limit the opening of the aortic valve, leading to sustained closure and increased shear stress, which accelerates valve degradation. Risk factors for aortic insufficiency include having a smaller body surface area, being of advanced ag...
Source: Journal of Artificial Organs - April 10, 2024 Category: Transplant Surgery Source Type: research
Impact of inflammation and steroids on anti-coagulation in children supported on a ventricular assist device
AbstractCritically ill pediatric patients supported on ventricular assist devices (VADs) are increasingly being anticoagulated on bivalirudin, but with difficulty monitoring anticoagulation. Activated partial thromboplastin time (aPTT) has recently been shown to poorly correlate with bivalirudin plasma concentrations, while dTT had excellent correlation. However, aPTT is the more common monitoring test and dTT testing is rarely used. In addition, effects of frequent clinical VAD scenarios (such as inflammation) on the accuracy of aPTT and dTT testing remains uncertain. We reviewed the effects of clinical scenarios (infecti...
Source: Journal of Artificial Organs - April 6, 2024 Category: Transplant Surgery Source Type: research
Patient management important for long-term support beyond 5 years in the BTT: republication of the article published in the Japanese Journal of Artificial Organs
This article outlines the important aspects of patient management for long-term support. Th is review was created based on a translation of the Japanese review written in theJapanese Journal of Artificial Organs in 2023 (Vol. 52, No. 1, pp. 62 –66), with some modifications. (Source: Journal of Artificial Organs)
Source: Journal of Artificial Organs - March 29, 2024 Category: Transplant Surgery Source Type: research
Left ventricular assist device temporary explantation as a strategy for infection control in a pediatric patient
We report a case of temporary Berlin Heart EXCOR ® explantation in a pediatric patient with idiopathic dilated cardiomyopathy who suffered an uncontrollable inflow cannulation site infection while on bridge-to-transplantation. Despite failure to thrive and catheter-related infections, once free of the device, the patient was cured of infection us ing systemic antibiotics and surgical debridement. The patient underwent EXCOR® reimplantation after four months, and is awaiting heart transplantation in stable condition. A life-threatening ventricular assist device-related infection may require device explantation under condi...
Source: Journal of Artificial Organs - March 23, 2024 Category: Transplant Surgery Source Type: research
Effect of proactive combination therapy with peritoneal dialysis and hemodialysis on technique survival and mortality
ConclusionUse of combination therapy in the induction phase might prolong the duration of combination therapy, but is not necessarily effective for prolonging peritoneal dialysis technique survival. (Source: Journal of Artificial Organs)
Source: Journal of Artificial Organs - March 22, 2024 Category: Transplant Surgery Source Type: research
Utilizing a long sheath to minimize atheroma manipulation (minimal manipulation approach) during Zone 1 and 2 thoracic endovascular aortic repair with a shaggy aorta
AbstractWe have adopted a simple and reproducible approach, “minimal manipulation approach,” since January 2021 in five patients to minimize the risk of thromboembolic events during Zone 1 and 2 thoracic endovascular aortic repair (TEVARs) with shaggy aorta. The approach consists of two parts: ① Use of a 65-cm-long sheath (dry seal) to deliver the endo grafts without touching the protruding atheroma. Covering the atheroma with the first endograft delivered at Zone 3 to the mid-descending aorta (paving the aorta), and second endograft insertion and deployment through the paved aorta with first endograft. ② Protectio...
Source: Journal of Artificial Organs - March 21, 2024 Category: Transplant Surgery Source Type: research
Predictive role of regional thigh tissue oxygen saturation monitoring during cardiopulmonary bypass in lung injury after cardiac surgery
This study investigated the association of regional oxygen saturation (rSO2) during CPB with postoperative outcomes, including respiratory function. Patients who underwent cardiac surgery with CPB from 2015 to 2019 were included. Near-infrared spectroscopy was used to monitor rSO2 at the forehead, abdomen, and thighs throughout the surgery. Postoperative markers associated with CPB were assessed for correlations with PaO2/FiO2 (P/F) ratios at intensive care unit (ICU) admission. Postoperative lung injury (LI) was defined as moderate or severe ARDS based on the Berlin criteria, and its incidence was 29.9% (20/67). On multip...
Source: Journal of Artificial Organs - March 18, 2024 Category: Transplant Surgery Source Type: research
Left ventricular assist devices: yesterday, today, and tomorrow
AbstractThe shortcomings of expense, power requirements, infection, durability, size, and blood trauma of current durable LVADs have been recognized for many years. The LVADs of tomorrow aspire to be fully implantable, durable, mitigate infectious risk, mimic the pulsatile nature of the native cardiac cycle, as well as minimize bleeding and thrombosis. Power draw, battery cycle lifespan and trans-cutaneous energy transmission remain barriers to completely implantable systems. Potential solutions include decreases in pump electrical draw, improving battery lifecycle technology and better trans-cutaneous energy transmission,...
Source: Journal of Artificial Organs - March 7, 2024 Category: Transplant Surgery Source Type: research
Successful management of HeartMate 3 in a patient with arrhythmogenic right ventricular cardiomyopathy
AbstractThe management of right heart failure during durable left ventricular assist device (LVAD) support remains an unsolved issue so far. We had a 44-year-old male patient who was diagnosed with arrhythmogenic right ventricular cardiomyopathy and received HeartMate 3 LVAD (Abbott, USA) implantation as a bridge-to-transplant indication. The pump speed was adjusted as low as 4500 rpm to avoid the left ventricular narrowing and interventricular septal leftward shift. Riociguat was administered to decrease the afterload of the right ventricle and increase the preload of the left ventricle, in addition to the combination o...
Source: Journal of Artificial Organs - February 24, 2024 Category: Transplant Surgery Source Type: research
Prevalence of bleeding events in real-world Japanese registry for Percutaneous Ventricular Assist Device
ConclusionThis study represents the first 3-year survival and the safety profile focused on bleeding adverse events from the J-PVAD registry. The results show that the real-world frequency of bleeding adverse events for patients who received Impella was an expected range from previous reports, and future real-world studies should aim to expand this data set to improve outcomes and adverse events. (Source: Journal of Artificial Organs)
Source: Journal of Artificial Organs - February 24, 2024 Category: Transplant Surgery Source Type: research
Contributing factors to heparin resistance during cardiopulmonary bypass
AbstractSince the risk factors for heparin resistance (HR) before cardiopulmonary bypass (CPB) have not been fully clarified, this study investigated the contributing factors for HR after the initial unfractionated heparin (UFH) dose of 500 IU/kg. We retrospectively analyzed the data of 371 patients who underwent CPB surgery, with the initial UFH dose of 500 IU/kg, between May 2017 and December 2021. We defined HR as the failure to achieve activated clotting time (ACT) of > 480 s after the initial UFH dose of 500 IU/kg. HR was observed in 36 patients (9.7%) (HR group), while HR was not observed in 335 patients...
Source: Journal of Artificial Organs - February 17, 2024 Category: Transplant Surgery Source Type: research
3D porous structure imaging of membranes for medical devices using scanning probe microscopy and electron microscopy: from membrane science points of view
AbstractThe evolution of hemodialysis membranes (dialyzer, artificial kidney) was remarkable, since Dow Chemical began manufacturing hollow fiber hemodialyzers in 1968, especially because it involved industrial chemistry, including polymer synthesis and membrane manufacturing process. The development of hemodialysis membranes has brought about the field of medical devices as a major industry. In addition to conventional electron microscopy, scanning probe microscopy (SPM), represented by atomic force microscopy (AFM), has been used in membrane science research on porous membranes for hemodialysis, and membrane science cont...
Source: Journal of Artificial Organs - February 5, 2024 Category: Transplant Surgery Source Type: research
