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A Comparative Content Analysis of Digital Channels for Ventricular Assist Device Patients, Caregivers, and Healthcare Practitioners. ASAIO J 2020; 65:855-863. [PMID: 30575626 DOI: 10.1097/mat.0000000000000924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This article seeks to review and analyze the emergence of digital channels designed for ventricular assist device (VAD) patients, caregivers, and practitioners and to understand how such digital channels support the user experience of VAD implantation. Following a content analysis methodology, the authors investigated 16 digital channels designed for VAD patients, caregivers, and practitioners, with data being analyzed thematically. Competitor Positioning Matrix diagrams were created to visually represent the landscape of digital channels that support VAD stakeholders. These matrices identified opportunities and potential areas for improvement in future VAD digital channel design, with an emphasis on interactivity coupled with intelligence and focus along the various stages of the VAD patient journey. Innovation in digital channels has the potential to reduce burden on all users by enabling communication, self-management, and remote monitoring. Digital channels can be information enhanced for point of care, function as a decision support tools or be used to empower patient-caregiver pairs to be more sufficient with self-management, while enabling communication with their practitioner.
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Movafaghi S, Wang W, Bark DL, Dasi LP, Popat KC, Kota AK. Hemocompatibility of Super-Repellent surfaces: Current and Future. MATERIALS HORIZONS 2019; 6:1596-1610. [PMID: 31903188 PMCID: PMC6941870 DOI: 10.1039/c9mh00051h] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Virtually all blood-contacting medical implants and devices initiate immunological events in the form of thrombosis and inflammation. Typically, patients receiving such implants are also given large doses of anticoagulants, which pose a high risk and a high cost to the patient. Thus, the design and development of surfaces with improved hemocompatibility and reduced dependence on anticoagulation treatments is paramount for the success of blood-contacting medical implants and devices. In the past decade, the hemocompatibility of super-repellent surfaces (i.e., surfaces that are extremely repellent to liquids) has been extensively investigated because such surfaces greatly reduce the blood-material contact area, which in turn reduces the area available for protein adsorption and blood cell or platelet adhesion, thereby offering the potential for improved hemocompatibility. In this review, we critically examine the progress made in characterizing the hemocompatibility of super-repellent surfaces, identify the unresolved challenges and highlight the opportunities for future research on developing medical implants and devices with super-repellent surfaces.
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Affiliation(s)
- Sanli Movafaghi
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Wei Wang
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - David L Bark
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Lakshmi P Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Ketul C Popat
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Arun K Kota
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA
- Department of Chemical & Biological Engineering, Colorado State University, Fort Collins, CO 80523, USA
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Chan JL, Patel DC, Megna D, Dimbil SJ, Levine R, Moriguchi J, Czer LS, Kobashigawa JA, Arabia F, Esmailian F. Use of durable mechanical circulatory support on outcomes of heart-kidney transplantation. Interact Cardiovasc Thorac Surg 2019; 27:773-777. [PMID: 29846594 DOI: 10.1093/icvts/ivy156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 04/10/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Previous studies have demonstrated that preheart transplant mechanical circulatory support (MCS) can lead to a small but significant increase in mortality. However, data on outcomes of patients with MCS who require simultaneous heart-kidney transplant are limited. METHODS A retrospective review of simultaneous heart-kidney transplantations (HKTxs) performed at a single institution over a 5-year period was performed. Patients were divided based on the preoperative use of durable MCS. Renal graft-related end points were evaluated, including glomerular filtration rate following transplantation, prevalence of delayed renal graft function and freedom from antibody and cellular-mediated graft rejection. Patient-specific outcomes, including survival and frequency of non-fatal major adverse cardiac events at 1 year, were additionally assessed. RESULTS During the study period, 50 HKTxs were performed, 14 of which had preoperative MCS. HKTx patients with and without MCS implantations had a similar prevalence of delayed graft function (57.1% vs 50.0%; P = 0.757). A numerical trend was observed towards a reduced glomerular filtration rate 1-month post-transplant in patients without an MCS device (81.2 ± 32.8 vs 64.4 ± 27.5; P = 0.072), but no significant difference was observed at 6 and 12 months. No significant difference was observed on the need for post-transplant renal replacement therapy, non-fatal major adverse cardiac events, freedom from graft rejection and overall survival at 1 year. CONCLUSIONS The use of preoperative MCS in patients undergoing combined HKTx was not found to affect renal graft function post-transplantation and does not seem to be associated with increase in morbidity or mortality.
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Affiliation(s)
- Joshua L Chan
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA.,Division of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Deven C Patel
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA.,Division of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dominick Megna
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA.,Division of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Ryan Levine
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | | | | | | - Francisco Arabia
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA.,Division of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Fardad Esmailian
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA.,Division of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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El-Sayed Ahmed MM, Thomas M, Jacob S, Makey IA, Landolfo KP, Pham SM, Belli EV. Triple bridge of mechanical circulatory support to heart transplantation listing: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19834816. [PMID: 30858974 PMCID: PMC6404238 DOI: 10.1177/2050313x19834816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 01/29/2019] [Indexed: 11/17/2022] Open
Abstract
A 60-year-old male patient presented to an outside hospital with severe
cardiogenic shock. A triple bridge of mechanical circulatory support was
utilized to transition him to heart transplantation listing. Initially, coronary
artery disease was percutaneously treated and Impella 2.5 was used as mechanical
circulatory support for 5 days followed by the second Impella 2.5 for 4 days.
Veno-arterial extracorporeal membrane oxygenation support was deployed for
16 days. This was exchanged for HeartWare ventricular assist device support as
the third stage of mechanical circulatory support to heart transplantation
listing. The patient experienced acute renal failure which was managed by
continuous renal replacement therapy then intermittent hemodialysis with
eventual complete recovery of the renal function. He was discharged home 56 days
after HeartWare ventricular assist device implantation with stable hemodynamic,
intact neurologic status and fully recovered renal function. Currently, the
patient is listed for heart transplantation.
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Affiliation(s)
- Magdy Mohamed El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Kevin P Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Erol V Belli
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
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Altara R, Giordano M, Nordén ES, Cataliotti A, Kurdi M, Bajestani SN, Booz GW. Targeting Obesity and Diabetes to Treat Heart Failure with Preserved Ejection Fraction. Front Endocrinol (Lausanne) 2017; 8:160. [PMID: 28769873 PMCID: PMC5512012 DOI: 10.3389/fendo.2017.00160] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/23/2017] [Indexed: 12/12/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a major unmet medical need that is characterized by the presence of multiple cardiovascular and non-cardiovascular comorbidities. Foremost among these comorbidities are obesity and diabetes, which are not only risk factors for the development of HFpEF, but worsen symptoms and outcome. Coronary microvascular inflammation with endothelial dysfunction is a common denominator among HFpEF, obesity, and diabetes that likely explains at least in part the etiology of HFpEF and its synergistic relationship with obesity and diabetes. Thus, pharmacological strategies to supplement nitric oxide and subsequent cyclic guanosine monophosphate (cGMP)-protein kinase G (PKG) signaling may have therapeutic promise. Other potential approaches include exercise and lifestyle modifications, as well as targeting endothelial cell mineralocorticoid receptors, non-coding RNAs, sodium glucose transporter 2 inhibitors, and enhancers of natriuretic peptide protective NO-independent cGMP-initiated and alternative signaling, such as LCZ696 and phosphodiesterase-9 inhibitors. Additionally, understanding the role of adipokines in HFpEF may lead to new treatments. Identifying novel drug targets based on the shared underlying microvascular disease process may improve the quality of life and lifespan of those afflicted with both HFpEF and obesity or diabetes, or even prevent its occurrence.
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Affiliation(s)
- Raffaele Altara
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- KG Jebsen Center for Cardiac Research, Oslo, Norway
- Department of Pathology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
- *Correspondence: Raffaele Altara,
| | - Mauro Giordano
- Department of Medical, Surgical, Neurological, Metabolic and Geriatrics Sciences, University of Campania “L. Vanvitelli”, Caserta, Italy
| | - Einar S. Nordén
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- KG Jebsen Center for Cardiac Research, Oslo, Norway
- Bjørknes College, Oslo, Norway
| | - Alessandro Cataliotti
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- KG Jebsen Center for Cardiac Research, Oslo, Norway
| | - Mazen Kurdi
- Faculty of Sciences, Department of Chemistry and Biochemistry, Lebanese University, Hadath, Lebanon
| | - Saeed N. Bajestani
- Department of Pathology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
- Department of Ophthalmology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - George W. Booz
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
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