ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs

Accurate activity classification is essential for the advancement of closed-loop control for left ventricular assist devices (LVADs), as it provides necessary feedback to adapt device operation to the patient's current state. Therefore, this study aims at using deep neural networks (DNNs) to precisely classify activity for these patients. Recordings from 13 LVAD patients were analyzed, including heart rate, LVAD flow, and accelerometer data, classifying activities into six states: active, inactive, lying, sitting, standing, and walking...

Advancements in left ventricular assist device (LVAD) technologies have significantly lowered morbidity and mortality in patients with end-stage heart disease; however, they still carry significant risks. Though infrequent, intraabdominal injury during driveline tunneling can be catastrophic. Laparoscopic visualization can reduce these risks, especially benefiting patients with lower body mass indexes and thin abdominal walls. We present two cases of laparoscopic driveline tunneling. The laparoscopic procedure begins poststernotomy and preheparin administration to mitigate bleeding risks...

The efficacy and safety of extracorporeal membrane oxygenation (ECMO) support during transcatheter aortic valve replacement (TAVR) remains unknown. We conducted a meta-analysis to compare benefit and risk of ECMO in TAVR patients. Bibliographic databases were searched from inception to January 1, 2024. Included studies involved patients ≥18 years old undergoing TAVR and using ECMO emergently or prophylactically. Mortality and procedure success were primary outcomes. Peri- or postoperative complications were the secondary outcomes...

Low pulse pressure (PP) in venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is a marker of cardiac dysfunction and has been associated with acute brain injury (ABI) as continuous-flow centrifugal pump may lead to endothelial dysregulation. We retrospectively analyzed adults (≥18 years) receiving "peripheral" VA-ECMO for cardiogenic shock in the Extracorporeal Life Support Organization Registry (January 2018-July 2023). Acute brain injury (our primary outcome) included central nervous system (CNS) ischemia, intracranial hemorrhage, brain death, and seizures...

The vortex that forms in the aortic sinus plays a vital role in optimizing blood flow. Disruption of the vortex can result in flow stagnation and activate thrombus formation in the aortic root, especially when aortic valve flow is reduced as during left ventricular assist device (LVAD) support. Our goal in this study was to visualize vortex formation in an experimental model of the aortic root as flow is progressively reduced. A mock circulatory loop that reproduces heart failure hemodynamics was combined with a HeartMate II LVAD and velocity measured in a transparent aortic root with a bioprosthetic valve...

We sought to develop and validate a new risk stratification score for mortality for children supported with a ventricular assist device (VAD). This retrospective, multicenter study used data from patients undergoing VAD implantation between April 2018 and February 2023 at 44 participating institutions in the Advanced Cardiac Therapies Improving Outcomes (ACTION) network. Multivariable Cox proportional-hazards modeled mortality after VAD implantation. A total of 1,022 patients were enrolled. The 1 year mortality was 19% (95% confidence interval [CI]: 16-23)...

Prior studies assessing the effects of Impella 5.5 support duration on posttransplant outcomes have been limited to single-center case reports and series. This study evaluates the impact of Impella 5.5 support duration on outcomes following heart transplantation using the United Network for Organ Sharing database. Adult heart transplant recipients who were directly bridged to primary isolated heart transplantation with Impella 5.5 were included. The cohort was stratified into two groups based on the duration of Impella support: less than or equal to 14 and greater than 14 days...

Thoracoabdominal normothermic regional perfusion (TA-NRP) is increasingly implemented in donation after circulatory determination of death (DCD). Thoracoabdominal normothermic regional perfusion allows thoracic and abdominal organs to be perfused with warm, oxygenated blood after declaration of death, interrupting ischemia. Evidence is accumulating supporting the use of TA-NRP to improve the outcome of grafts from DCD donors. Thoracoabdominal normothermic regional perfusion may restore and maintain a near-physiological environment during procurement...

We present the case of a 62-year-old man with severe coronary artery disease who presented to the hospital in refractory ventricular fibrillation cardiac arrest. He showed signs of life despite prolonged resuscitation. We thus decided to initiate extracorporeal cardiopulmonary resuscitation (ECPR). The patient had a known total occlusion of his infrarenal aorta that had been surgically bypassed with a bifemoral-axillary graft. We successfully initiated ECPR via the surgical graft, establishing blood flow to the central circulation through the axillary artery in a peripheral configuration while ensuring blood flow to the left leg via the femoral-femoral graft...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

In the initial phases of veno-venous extracorporeal membrane oxygenation (VV ECMO) support for severe acute respiratory distress syndrome (ARDS), ultraprotective controlled mechanical ventilation (CMV) is typically employed to limit the progression of lung injury. As patients recover, transitioning to assisted mechanical ventilation can be considered to reduce the need for prolonged sedation and paralysis. This study aimed to evaluate the feasibility of transitioning to pressure support ventilation (PSV) during VV ECMO and to explore variations in respiratory mechanics and oxygenation parameters following the transition to PSV...

We assessed the prognostic potential of Galectin-3 in a sample of 159 heart failure patients who received a left ventricular assist device (LVAD) implant from 2012 to 2020. Clinical outcomes included hemodynamic data, right heart failure (RHF), hemocompatibility-related adverse events (HRAEs), and mortality. Galectin-3 was compounded into Michigan-RVF and EUROMACS-RHF risk scores and compared to the noncompounded risk scores. Right heart failure was significantly correlated with Galectin (p = 0.004) on a continuous spectrum...

Absolute blood volume can be calculated from the increase in relative blood volume after an infusion of a well-defined volume bolus of ultrapure dialysate into the extracorporeal circulation. Several working groups have applied this method in research and clinical practice. A critical analysis of differing blood volume data between working groups revealed methodologic problems of the measurement procedure and some important technical aspects. This paper presents a statement to standardize the method.

Thrombotic complications during and after extracorporeal membrane oxygenation (ECMO) are commonly observed clinically. The incidences of cannula-associated deep vein thrombosis (CaDVT) post-ECMO support have predominantly focused on Caucasian demographics. This study aims to determine the incidence and risk factors for CaDVT in Vietnamese patients following ECMO decannulation. The retrospective study from January 2019 to February 2020 observed ECMO weaning patients and screened for CaDVT using Doppler ultrasonography...

As technology in mechanical circulatory support continues to advance, so does the utilization of durable left ventricular assist devices (LVADs). We present the first reported case of HeartMate 3 (HM3) LVAD bend relief disconnection causing laceration of the outflow graft. Our patient is a 34 year old male with end-stage heart failure status post-HM3 implantation with recent debridement of a driveline infection who presented with weakness and sanguineous drainage 5 days after an episode of heavy lifting associated with a palpable substernal pop...

No abstract text is available yet for this article.

Thermodilution methods to determine cardiac output (CO) may be affected by veno-venous extracorporeal membrane oxygenation (ECMO). We compared CO estimations by pulmonary arterial thermodilution using a pulmonary arterial catheter (COPAC), transpulmonary thermodilution (COTPTD), and three-dimensional echocardiography (3DEcho) (CO3DEcho) in 18 patients under veno-venous ECMO. Comparisons between CO3DEcho and COPAC, and COTPTD were performed using correlation statistics and Bland-Altman analysis. Blood flow on ECMO support ranged from 4...

The impact of cardiac resynchronization therapy (CRT) in patients receiving durable left ventricular assist device (LVAD) implantation remains unclear and there is no consensus regarding postoperative management. We sought to determine the impact of postoperative management of CRT on clinical outcomes following LVAD implantation. A total of 789 patients underwent LVAD implantation at our institution from 2007 to 2022 including 195 patients (24.7%) with preoperative CRT. Patients with preoperative CRT were significantly older and more frequently received an LVAD as destination therapy compared to patients without preoperative CRT...

Cell-free hemoglobin (CFH) is used to detect hemolysis and was recently suggested to trigger acute lung injury. However, its role has not been elucidated in severe acute respiratory distress syndrome (ARDS) patients undergoing extracorporeal membrane oxygenation (ECMO). We investigated the association of carboxyhemoglobin (COHb) and haptoglobin-two indirect markers of hemolysis-with mortality in critically ill patients undergoing veno-venous ECMO (VV-ECMO) with adjusted and longitudinal models (primary aim)...