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ASAIO Journal
Journal Prestige (SJR): 0.771  Citation Impact (citeScore): 2 Number of Followers: 2  Hybrid journal (It can contain Open Access articles)ISSN (Print) 1058-2916 - ISSN (Online) 1538-943X Published by LWW Wolters Kluwer  [330 journals]
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- Meet the Authors
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No abstract available
PubDate: Thu, 26 Oct 2023 00:00:00 GMT-
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- Coolers Are for Heinekens, Not Hearts
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Authors: Eckman; Peter M.; Lodewyks, Carly L.
Abstract: No abstract available
PubDate: Thu, 26 Oct 2023 00:00:00 GMT-
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- Anatomical Compliance of Cavopulmonary Assist Device Designs: A Virtual
Fitting Study in Fontan Patients-
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Authors: Karner; Barbara; Escher, Andreas; Schorn, Therese; Narayanaswamy, Krishnaraj; Sachweh, Jörg; Laufer, Günther; Hübler, Michael; Zimpfer, Daniel; Granegger, Marcus
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Several device designs for cavopulmonary mechanical circulatory support (MCS) are under investigation, however, challenged by the Fontan population’s heterogeneity in size, cardiovascular and thoracic anatomy. This study aimed to preclinically assess the anatomical compliance of proposed device designs in silico. Representative double- and single-outlet cavopulmonary assist device (CPAD) designs were virtually implanted into CT imaging data of 10 patients previously palliated with total cavopulmonary connection (TCPC) for functionally univentricular hearts. Anatomical device compatibility was characterized concerning pump proximity to cardiovascular, respiratory and thoracic structures, as well as pump in- and outflow graft configuration. In 10 Fontan patients with a median age of 10.4 years (interquartile range [IQR] 5.0–15.3 years) and a median body surface area of 1.09 m2 (IQR 0.76–1.28 m2), implantation of a double-outlet CPAD was feasible in 1 patient (10%). In all other, adverse device intersection with the trachea and (neo-)aorta, or posterior pulmonary artery outflow graft kinking were observed. A single-outlet design permitted enhanced device mobilization adapting to individual anatomical conditions, resulting in device fit in nine of 10 patients (90%). Despite vast anatomical variations among single ventricle patients, a single-outlet device design may provide intracorporeal cavopulmonary MCS to a broad spectrum of failing Fontan patients.
PubDate: Thu, 26 Oct 2023 00:00:00 GMT-
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- The Promise of Regenerative Medicine in the Reconstruction of Auricular
Cartilage Deformities-
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Authors: Seifi; Mehrdad; Motamed, Sadrollah; Rouientan, Abdolreza; Bohlouli, Mahboubeh
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There are many physiologic and psychologic challenges associated with ear cartilage deformities which are incredibly distasteful to patients, particularly children. The development of regenerative medicine (RM) sciences has opened up a new window for the reconstruction of auricular cartilage because it allows the creation of a structure similar to the auricular in appearance and function. As part of this review, we discuss the role that each RM tool, including tissue engineering, cells, and biomolecules, plays in developing engineered auricular tissue. In previous studies, it was shown that the simultaneous use of natural and synthetic biomaterials as well as three-dimensional printing techniques could improve the biological and mechanical properties of this tissue. Another critical issue is using stem cells and differentiated cartilage cells to produce tissue-specific cellular structures and extracellular matrix. Also, the importance of choosing a suitable animal model in terms of handling and care facilities, physiologic similarities to humans, and breed uniformity in the preclinical assessments have been highlighted. Then, the clinical trials registered on the clinicaltrials.gov website, and the commercialized product, called AuriNovo, have been comprehensively explained. Overall, it is important to provide engineered auricular cartilage structures with acceptable safety and efficacy compared with standard methods, autologous cartilage transplantation, and prosthetic reconstruction in RM.
PubDate: Sun, 13 Aug 2023 00:00:00 GMT-
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- Pulmonary Vasodilator Therapy in Pediatric Patients on Ventricular Assist
Device Support: A Single-Center Experience and Proposal for Use-
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Authors: Schramm; Jennifer E.; Dykes, John C.; Hopper, Rachel K.; Feinstein, Jeffrey A.; Rosenthal, David N.; Kameny, Rebecca J.
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Pediatric precapillary pulmonary hypertension can develop in response to systemic atrial hypertension. Systemic atrial decompression following ventricular assist device (VAD) implantation may not sufficiently lower pulmonary vascular resistance (PVR) to consider heart transplant candidacy. Prostacyclins have been used in adult VAD patients with success, but pediatric data on safety and efficacy in this population are limited. We sought to describe our center’s experience to show its safety and to present our current protocol for perioperative use. We reviewed our use of prostacyclin therapy in pediatric patients on VAD support with high PVR from 2016 to 2021. Of the 17 patients who met inclusion, 12 survived to transplant and 1 is alive with VAD in situ. All patients survived posttransplant. With continuous intravenous (IV) epoprostenol or treprostinil therapy, there were no bleeding complications or worsening of end-organ function. A significant reduction was observed in vasoactive inotropic scores by 49% in the first 24 hours post-prostacyclin initiation. The proportion of patients surviving to transplant in this high-risk cohort is favorable. In conclusion, prostacyclins may be safe to use in patients with elevated PVR as part of their VAD and transplant course and may provide a transplant option in those otherwise not candidates.
PubDate: Tue, 08 Aug 2023 00:00:00 GMT-
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- Extracorporeal Life Support for Cardiogenic Shock in Adult Congenital
Heart Disease—An ELSO Registry Analysis-
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Authors: Rali; Aniket S.; Garry, Jonah D.; Dieter, Raymond A.; Schlendorf, Kelly H.; Bacchetta, Matthew D.; Zalawadiya, Sandip K.; Mishra, Kelly; Trahanas, John; Frischhertz, Benjamin P.; Lindenfeld, Joann; Olson, Taylor L.; Cedars, Ari M.; Anders, Marc M.; Tonna, Joseph E.; Dolgner, Steven J.; Alvis, Bret D.; Menachem, Jonathan N.
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There are minimal data on the use of venoarterial extracorporeal membrane life support (VA-ECLS) in adult congenital heart disease (ACHD) patients presenting with cardiogenic shock (CS). This study sought to describe the population of ACHD patients with CS who received VA-ECLS in the Extracorporeal Life Support Organization (ELSO) Registry. This was a retrospective analysis of adult patients with diagnoses of ACHD and CS in ELSO from 2009–2021. Anatomic complexity was categorized using the American College of Cardiology/American Heart Association 2018 guidelines. We described patient characteristics, complications, and outcomes, as well as trends in mortality and VA-ECLS utilization. Of 528 patients who met inclusion criteria, there were 32 patients with high-complexity anatomy, 196 with moderate-complexity anatomy, and 300 with low-complexity anatomy. The median age was 59.6 years (interquartile range, 45.8–68.2). The number of VA-ECLS implants increased from five implants in 2010 to 81 implants in 2021. Overall mortality was 58.3% and decreased year-by-year (β= –2.03 [95% confidence interval, –3.36 to –0.70], p = 0.007). Six patients (1.1%) were bridged to heart transplantation and 21 (4.0%) to durable ventricular assist device. Complications included cardiac arrhythmia/tamponade (21.6%), surgical site bleeding (17.6%), cannula site bleeding (11.4%), limb ischemia (7.4%), and stroke (8.7%). Utilization of VA-ECLS for CS in ACHD patients has increased over time with a trend toward improvement in survival to discharge.
PubDate: Sun, 06 Aug 2023 00:00:00 GMT-
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- Smaller Return Cannula in Venoarterial Extracorporeal Membrane Oxygenation
Does Not Increase Hemolysis: A Single-Center, Cohort Study-
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Authors: Joyce; Patrick R.; Hodgson, Carol L.; Bellomo, Rinaldo; Gregory, Shaun D.; Raman, Jaishankar; Stephens, Andrew F.; Taylor, Kieran; Paul, Eldho; Wickramarachchi, Avishka; Burrell, Aidan
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The aim of this study was to explore the association between arterial return cannula diameter and hemolysis during peripheral VA ECMO. We identified 158 adult patients who received peripheral VA ECMO at our institution from the national ECMO database (EXCEL) between January 2019 and July 2021. We classified patients into a small cannula group (15 Fr diameter, n = 45) and a large cannula group (≥17 Fr diameter, n = 113), comparing incidences of clinical hemolysis and plasma free hemoglobin (pfHb). Moderate hemolysis is defined as having pfHb 0.05–0.10 g/L and severe hemolysis as having pfHb>0.10 g/L sustained for at least two consecutive readings or leading to a circuit change. There were no significant differences in rates of moderate hemolysis between small and large cannula groups (1 vs. 6; p = 0.39) and severe hemolysis (0 vs. 3; p = 0.27), nor was the pfHb level significantly different at 4 hours (0.086 ± 0.096 vs. 0.112 ± 0.145 g/L; p = 0.58) and at 24 hours (0.042 ± 0.033 vs. 0.051 ± 0.069 g/L; p = 0.99). There were no increased rates of hemolysis when comparing small versus large arterial return cannula diameter in peripheral VA ECMO.
PubDate: Sun, 06 Aug 2023 00:00:00 GMT-
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- Palliative Care Utilization in Patients Requiring Extracorporeal Membrane
Oxygenation: An Observational Study-
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Authors: Peeler; Anna; Davidson, Patricia M.; Gleason, Kelly T.; Stephens, R. Scott; Ferrell, Betty; Kim, Bo Soo; Cho, Sung-Min
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Palliative care (PC) is a model of care centered around improving the quality of life for individuals with life-limiting illnesses. Few studies have examined its impact in patients on extracorporeal membrane oxygenation (ECMO). We aimed to describe demographics, clinical characteristics, and complications associated with PC consultation in adult patients requiring ECMO support. We analyzed data from an ECMO registry, including patients aged 18 years and older who have received either venoarterial (VA)- or venovenous (VV)-ECMO support between July 2016 and September 2021. We used analysis of variance and Fisher exact tests to identify factors associated with PC consultation. Of 256, 177 patients (69.1%) received VA-ECMO support and 79 (30.9%) received VV-ECMO support. Overall, 115 patients (44.9%) received PC consultation while on ECMO. Patients receiving PC consultation were more likely to be non-white (47% vs. 53%, p = 0.016), have an attending physician from a medical versus surgical specialty (65.3% vs. 39.6%), have VV-ECMO (77.2% vs. 30.5%, p < 0.001), and have longer ECMO duration (6.2 vs. 23.0, p < 0.001). Patients were seen by the PC team on an average of 7.6 times (range, 1–35), with those who died having significantly more visits (11.2 vs. 5.6, p < 0.001) despite the shorter hospital stay. The average time from cannulation to the first PC visit was 5.3 ± 5 days. Congestive heart failure in VA-ECMO, coronavirus disease 2019 infection in VV-ECMO, and non-white race and longer ECMO duration for all patients were associated with PC consultation. We found that despite the benefits of PC, it is underused in this population.
PubDate: Sun, 06 Aug 2023 00:00:00 GMT-
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- Therapeutic Hypothermia for Refractory Hypoxemia on Venovenous
Extracorporeal Membrane Oxygenation: An In Silico Study-
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Authors: Joyce; Christopher J.; Udy, Andrew; Burrell, Aidan; Brown, Alastair
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Patients with respiratory failure may remain hypoxemic despite treatment with venovenous extracorporeal membrane oxygenation (VV-ECMO). Therapeutic hypothermia is a potential treatment for such hypoxia as it reduces cardiac output () and oxygen consumption. We modified a previously published mathematical model of gas exchange to investigate the effects of hypothermia during VV-ECMO. Partial pressures were expressed as measured at 37°C (α-stat). The effect of hypothermia on gas exchange was examined in four clinical scenarios of hypoxemia on VV-ECMO, each with different physiological derangements. All scenarios had arterial partial pressure of oxygen (PaO2) ≤ 46 mm Hg and arterial oxygen saturation of hemoglobin (SaO2) ≤ 81%. Three had high with low extracorporeal blood flow to ratio (). The problem in the fourth scenario was recirculation, with normal . Cooling to 33°C increased SaO2 to> 89% and PaO2 to> 50 mm Hg in all scenarios. Mixed venous oxygen saturation of hemoglobin as % () increased to> 70% and mixed venous partial pressure of oxygen in mm Hg () increased to> 34 mm Hg in scenarios with low . In the scenario with high recirculation, and increased, but to < 50% and < 27 mm Hg, respectively. This in silico study predicted cooling to 33°C will improve oxygenation in refractory hypoxemia on VV-ECMO, but the improvement will be less when the problem is recirculation.
PubDate: Tue, 01 Aug 2023 00:00:00 GMT-
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- Predicting Hemodynamic Changes During Intra-Aortic Balloon Pump Support
With a Longitudinal Evaluation-
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Authors: Castagna; Francesco; Viswanathan, Shankar; Chalhoub, George; Ippolito, Paul; Ovalle Ramos, Julio Andres; Vukelic, Sasa; Sims, Daniel B.; Madan, Shivank; Saeed, Omar; Jorde, Ulrich P.
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The use of intra-aortic balloon pump (IABP) has decreased in recent years due to negative outcome studies in cardiogenic shock complicating acute myocardial infarction, despite its favorable adverse-event profile. Acute hemodynamic response studies have identified potential super-responders with immediate improvements in cardiac index (CI) in heart failure patients. This single-center retrospective study aimed to predict CI and mean arterial pressure (MAP) changes throughout the entire duration of IABP support. The study analyzed 336 patients who received IABP between 2016 and 2022. Linear mixed-effect regression models were used to predict CI and MAP improvement during IABP support. The results showed that CI and MAP increases during the first days of support, and changes during IABP support varied with time and were associated with baseline parameters. Longitudinal CI change was associated with body surface area, baseline CI, baseline pulmonary artery pulsatility index, baseline need for pressors, and diabetes. Longitudinal MAP change was associated with baseline MAP, baseline heart rate, need for pressors, or inotropes. The study recommends considering these parameters when deciding if IABP is the most appropriate form of support for a specific patient. Further prospective studies are needed to validate the findings.
PubDate: Wed, 26 Jul 2023 00:00:00 GMT-
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- Fibrin and Drainage Insufficiency on Extracorporeal Support: What Came
First'-
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Authors: Antonini; Marta Velia; Circelli, Alessandro
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No abstract available
PubDate: Wed, 26 Jul 2023 00:00:00 GMT-
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- Using Cardiohelp, Quadrox, and Nautilus Extracorporeal Membrane
Oxygenators as Vascular Access for Hemodialysis, Continuous Renal
Replacement Therapy, and Plasmapheresis: A Brief Technical Report-
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Authors: Odish; Mazen F.; Garimella, Pranav S.; Crisostomo, Hermogenes; Yi, Cassia; Owens, Robert L.; Pollema, Travis
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The use of intermittent hemodialysis (iHD), and continuous renal replacement therapy (CRRT), along with extracorporeal membrane oxygenation (ECMO) in patients with acute kidney injury (AKI) and end-stage renal disease (ESRD) is very common. In this technical report, we describe the methods to perform these dialytic therapies safely and effectively using the ECMO circuit in lieu of a separate dialysis catheter. Specifically, we describe in detail how to connect these kidney replacement therapy modalities to a Quadrox, Nautilus, and Cardiohelp HLS (combined oxygenator and pump) oxygenator. The dialysis (iHD or CRRT) inlet is attached to the post-oxygenators Luer-Lock, whereas the return is attached to the pre-oxygenator Luer-Lock, both with a dual lumen pigtail. We also discuss the technical aspects of performing plasmapheresis in conjunction with ECMO and iHD or CRRT. Finally, we highlight the fact that the reported technique does not require modifying the ECMO cannulas/tubing which helps maximize safety.
PubDate: Sun, 02 Jul 2023 00:00:00 GMT-
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- Computed Tomography Is Predictive of Significant Neurologic Injury in
Children Supported on Extracorporeal Membrane Oxygenation-
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Authors: Custer; Chasity; Singh, Sumit; Sanford, Ethan; Nandy, Karabi; Raman, Lakshmi; Busch, David R.; Morriss, M. Craig
Abstract:
No abstract available
PubDate: Tue, 13 Jun 2023 00:00:00 GMT-
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- Fibrin Sheath After Extracorporeal Membrane Oxygenation: Is It All About
Inferior Vena Cava Collapse'-
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Authors: Pavlov; Marin
Abstract: No abstract available
PubDate: Tue, 13 Jun 2023 00:00:00 GMT-
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- Bivalirudin Superiority in Pediatric Berlin Hearts: Too Early to Draw
Conclusions'-
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Authors: Seelhammer; Troy G.; Wieruszewski, Patrick M.; Laudanski, Krzysztof
Abstract: No abstract available
PubDate: Mon, 22 May 2023 00:00:00 GMT-
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- Anticoagulation Stability With Bivalirudin: Positioning the Horse Before
the Cart-
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Authors: Chen; Justin K.; Salerno, David M.; Law, Sabrina; Freniere, Victoria; Neunert, Cindy
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No abstract available
PubDate: Mon, 22 May 2023 00:00:00 GMT-
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- Bacteria in Extracorporeal Membrane Oxygenation Circuit Clots of a Patient
With Persistent Bacteremia: A Case Report-
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Authors: Drop; Joppe G.; Verhage, Latisha; van Westreenen, Mireille; Wildschut, Enno D.; de Hoog, Matthijs; van Beusekom, Heleen; van Ommen, C. Heleen
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A neonate with pulmonary hypertension was supported with extracorporeal membrane oxygenation (ECMO). During ECMO support, the patient developed Enterococcus faecalis bacteremia, treated with targeted antibiotics. Despite the maximum dose of antibiotics, routine blood cultures remained positive throughout the ECMO treatment. A circuit change was performed due to buildup of thrombotic material and disseminated intravascular coagulation (DIC) inside the circuit. Thrombus formation was more extensive in the first than the second circuit. Gram-positive diplococci were present in all initial circuit clots and gram-positive masses surrounded by fibrin were found inside thrombi of the second circuit. Scanning electron microscopy (SEM) revealed a dense fibrin network with embedded red blood cells and bacteria in the first circuit. In the second circuit, SEM analysis revealed scattered micro thrombi. Polymerase chain reaction for identification of bacteria in the thrombus of the first circuit showed the same bacteria as found in blood cultures and did not achieve a sufficient signal in the second circuit. This case report shows that bacteria can nestle in thrombi of an ECMO circuit and that there is a rationale for a circuit change in a patient with persistent positive blood cultures and DIC.
PubDate: Wed, 17 May 2023 00:00:00 GMT-
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- The Impact of Ex Situ Heart Perfusion in Pediatric Transplantation: An
Analysis of the United Network for Organ Sharing Registry: RETRACTION-
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Abstract: No abstract available
PubDate: Tue, 25 Apr 2023 00:00:00 GMT-
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- A Paradigm Shift in Heart Preservation: Improved Post-transplant Outcomes
in Recipients of Donor Hearts Preserved With the SherpaPak System-
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Authors: Shudo; Yasuhiro; Leacche, Marzia; Copeland, Hannah; Silvestry, Scott; Pham, Si M.; Molina, Ezequiel; Schroder, Jacob N.; Sciortino, Christopher M.; Jacobs, Jeffrey P.; Kawabori, Masashi; Meyer, Dan M.; Zuckermann, Andreas; D’Alessandro, David A.
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Traditional ice storage has been the historic standard for preserving donor’s hearts. However, this approach provides variability in cooling, increasing risks of freezing injury. To date, no preservation technology has been reported to improve survival after transplantation. The Paragonix SherpaPak Cardiac Transport System (SCTS) is a controlled hypothermic technology clinically used since 2018. Real-world evidence on clinical benefits of SCTS compared to conventional ice cold storage (ICS) was evaluated. Between October 2015 and January 2022, 569 US adults receiving donor hearts preserved and transported either in SCTS (n = 255) or ICS (n = 314) were analyzed from the Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN-Heart) registry. Propensity matching and a subgroup analysis of>240 minutes ischemic time were performed to evaluate comparative outcomes. Overall, the SCTS cohort had significantly lower rates of severe primary graft dysfunction (PGD) (p = 0.03). When propensity matched, SCTS had improving 1-year survival (p = 0.10), significantly lower rates of severe PGD (p = 0.011), and lower overall post-transplant MCS utilization (p = 0.098). For patients with ischemic times>4 hours, the SCTS cohort had reduced post-transplant MCS utilization (p = 0.01), reduced incidence of severe PGD (p = 0.005), and improved 30-day survival (p = 0.02). A multivariate analysis of independent risk factors revealed that compared to SCTS, use of ice results in a 3.4-fold greater chance of severe PGD (p = 0.014). Utilization of SCTS is associated with a trend toward increased post-transplant survival and significantly lower severe PGD and MCS utilization. These findings fundamentally challenge the decades-long status quo of transporting donor hearts using ice.
PubDate: Wed, 05 Apr 2023 00:00:00 GMT-
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