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Sun CY, Zhou LF, Song L, Lan LJ, Han XW, Zhang GR, Mo YW, Zheng SQ, Chen YG, Fu X. How to Reduce the Risk of Arteriovenous Fistula Dysfunction by Observing Prepump Arterial Pressure during Hemodialysis: A Multicenter Retrospective Study. Blood Purif 2021; 50:800-807. [PMID: 33530090 DOI: 10.1159/000512352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Prepump arterial (Pa) pressure indicates the ease or difficulty with which the blood pump can draw blood from the vascular access (VA) during hemodialysis. Some studies have suggested that the absolute value of the Pa pressure to the extracorporeal blood pump flow (Qb) ratio set on the machine (|Pa/Qb|) can reflect the dysfunction of VA. This study was conducted to explore the impact of arteriovenous fistula (AVF) dysfunction and to explore the clinical reference value of |Pa/Qb|. METHODS We retrospectively identified adults who underwent hemodialysis at 3 hospitals. Data were acquired from electronic health records. We evaluated the pattern of the association between |Pa/Qb| and AVF dysfunction during 1 year using a Cox proportional hazards regression model with restricted cubic splines. Then, the patients were grouped based on the results, and hazard ratios were compared for different intervals of |Pa/Qb|. RESULTS A total of 490 patients were analyzed, with an average age of 55 (44, 66) years. There were a total of 85 cases of AVF dysfunction, of which 50 cases were stenosis and 35 cases were thrombosis. There was a U-shaped association between |Pa/Qb| and the risk of AVF dysfunction (p for nonlinearity <0.001). |Pa/Qb| values <0.30 and >0.52 increased the risk of AVF dysfunction. Compared with the group with a |Pa/Qb| value between 0.30 and 0.52, the groups with |Pa/Qb| <0.30 and |Pa/Qb| >0.52 had a 4.04-fold (p = 0.002) and 3.41-fold (p < 0.001) greater risk of AVF dysfunction, respectively. CONCLUSIONS The appropriate range of |Pa/Qb| is between 0.30 and 0.52. When |Pa/Qb| is <0.30 or >0.52, the patient's AVF function or Qb setting should be reevaluated to prevent subsequent failure.
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Affiliation(s)
- Chun-Yan Sun
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Li-Fang Zhou
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li Song
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li-Juan Lan
- Blood Purification Center, Shenzhen People's Hospital, Shenzhen, China
| | - Xiao-Wei Han
- Division of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Guan-Rong Zhang
- Information and Statistical Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ya-Wen Mo
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shu-Qian Zheng
- Division of Nephrology, Guangzhou Nansha Central Hospital, Guangzhou, China
| | - Ying-Gui Chen
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xia Fu
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China, .,School of Nursing, Southern Medical University, Guangzhou, China,
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Ganushchak YM, Körver EP, Maessen JG. Is there a "safe" suction pressure in the venous line of extracorporeal circulation system? Perfusion 2020; 35:521-528. [PMID: 32627671 PMCID: PMC7416326 DOI: 10.1177/0267659120936453] [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] [Indexed: 11/30/2022]
Abstract
Successes of extracorporeal life support increased the use of centrifugal pumps.
However, reports of hemolysis call for caution in using these pumps, especially
in neonatology and in pediatric intensive care. Cavitation can be a cause of
blood damage. The aim of our study was to obtain information about the
cavitation conditions and to provide the safest operating range of centrifugal
pumps. A series of tests were undertaken to determine the points at which pump
performance decreases 3% and gas bubbles start to appear downstream of the pump.
Two pumps were tested; pump R with a closed impeller and pump S with a semiopen
impeller. The performance tests demonstrated that pump S has an optimal region
narrower than pump R and it is shifted to the higher flows. When the pump
performance started to decrease, the inlet pressure varies but close to
−150 mmHg in the test with low gas content and higher than −100 mmHg in the
tests with increased gas content. The same trend was observed at the points of
development of massive gas emboli. Importantly, small packages of bubbles
downstream of the pump were registered at relatively high inlet pressures. The
gaseous cavitation in centrifugal pumps is a phenomenon that appears with
decreasing inlet pump pressures. There are a few ways to increase inlet pump
pressures: (1) positioning the pump as low as possible in relation to the
patient; (2) selecting appropriate sized venous cannulas and their careful
positioning; and (3) controlling patient’s volume status.
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Affiliation(s)
- Yuri M Ganushchak
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Erik Pj Körver
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
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Sun CY, Mo YW, Lan LJ, Han XW, Song L, Zhang GR, Zhou LF, Zheng SQ, Chen YG, Liu SX, Liang XL, Fu X. It is time to implement prepump arterial pressure monitoring during hemodialysis: A retrospective multicenter study. J Vasc Access 2020; 21:938-944. [PMID: 32345102 DOI: 10.1177/1129729820917266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Prepump arterial pressure (Pa) indicates the ease or difficulty with which the blood pump can draw blood from vascular access (inflow) during hemodialysis. The absolute prepump arterial pressure to blood pump speed (Qb) ratio (|Pa/Qb|) may reflect the dysfunction of other vascular accesses. There is no consensus on the impact of |Pa/Qb| on arteriovenous fistula dysfunction. This study aimed to demonstrate the impact of |Pa/Qb| on arteriovenous fistula dysfunction. METHODS In this retrospective analysis, 490 hemodialysis patients with arteriovenous fistula from three hospitals were enrolled. Data were extracted from the I-Diapro database and hospital case systems. The absolute values for |Pa/Qb| and other data collected in the first month of enrollment were used to predict arteriovenous fistula dysfunction and determine the |Pa/Qb| cutoff value. Based on this value, patients were grouped, and 1-year arteriovenous fistula function was analyzed. Patients were followed until arteriovenous fistula dysfunction, until access type replacement, or for 12 months. RESULTS The area under the receiver operating characteristic curve for fistula dysfunction over 1 year was 0.65, with an optimal |Pa/Qb| value, sensitivity, and specificity of 0.499, 60.7%, and 72.6%, respectively. |Pa/Qb| > 0.499 was associated with earlier intervention (317.37 ± 7.68 vs 345.96 ± 3.64 days), lower survival (p < 0.001), and a 3.26-fold greater risk of arteriovenous fistula dysfunction (p < 0.001) than |Pa/Qb| ⩽ 0.499. CONCLUSIONS |Pa/Qb| was an independent risk factor for arteriovenous fistula dysfunction. Nurses should emphasize |Pa/Qb| monitoring and properly set blood pump speed according to this ratio to protect arteriovenous fistula function. |Pa/Qb| > 0.499 might be a predictive measure of arteriovenous fistula dysfunction.
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Affiliation(s)
- Chun-Yan Sun
- School of Nursing, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ya-Wen Mo
- School of Nursing, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li-Juan Lan
- Blood Purification Center, Shenzhen People's Hospital, Shenzhen, China
| | - Xiao-Wei Han
- Division of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Li Song
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guan-Rong Zhang
- Information and Statistical Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li-Fang Zhou
- School of Nursing, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shu-Qian Zheng
- School of Nursing, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangzhou Nansha Central Hospital, Guangzhou, China
| | - Ying-Gui Chen
- School of Nursing, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuang-Xin Liu
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xin-Ling Liang
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xia Fu
- School of Nursing, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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How I manage drainage insufficiency on extracorporeal membrane oxygenation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:151. [PMID: 32295631 PMCID: PMC7161276 DOI: 10.1186/s13054-020-02870-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/02/2020] [Indexed: 11/10/2022]
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Ganushchak YM, Kurniawati ER, Maessen JG, Weerwind PW. Peripheral cannulae selection for veno-arterial extracorporeal life support: a paradox. Perfusion 2019; 35:331-337. [PMID: 31709887 PMCID: PMC7263036 DOI: 10.1177/0267659119885586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Explosive penetration of veno-arterial extracorporeal life support in everyday practice has drawn awareness to complications of peripheral cannulation, resulting in recommendations to use smaller size cannulae. However, using smaller cannulae may limit the effectiveness of extracorporeal support and thereby the specific needs of the patient. Selection of proper size cannulae may therefore pose a dilemma, especially since pressure-flow characteristics at different hematocrits are lacking. This study evaluates the precision of cannula pressure drop prediction with increase of fluid viscosity from water flow-pressure charts by M-number, dynamic similarity law, and via fitted parabolic equation. Thirteen commercially available peripheral cannulae were used in this in vitro study. Pressure drop and flow were recorded using water and a water-glycerol solution as a surrogate for blood, at ambient temperature. Subsequently, pressure-flow curves were modeled with increased fluid viscosity (0.0031 N s m-2), and then compared by M-number, dynamic similarity law, and fitted parabolic equation. The agreement of predicted and measured values were significantly higher when the M-number (concordance correlation = 0.948), and the dynamic similarity law method (concordance correlation = 0.947) was used in comparison to the fitted parabolic equation (concordance correlation = 0.898, p < 0.01). The M-number and dynamic similarity based model allow for reliable prediction of peripheral cannula pressure drop with changes of fluid viscosity and could therefore aid in well-thought-out selection of cannulae for extracorporeal life support.
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Affiliation(s)
- Yuri M Ganushchak
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Eva R Kurniawati
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Patrick W Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University Medical Center+, Maastricht, The Netherlands
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Born F, König F, Chen J, Günther S, Hagl C, Thierfelder N. Generation of microbubbles in extracorporeal life support and assessment of new elimination strategies. Artif Organs 2019; 44:268-277. [DOI: 10.1111/aor.13557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/08/2019] [Accepted: 08/09/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Frank Born
- Department of Cardiac Surgery, Grosshadern Medical Center Ludwig Maximilian University of Munich Munich Germany
| | - Fabian König
- Department of Cardiac Surgery, Grosshadern Medical Center Ludwig Maximilian University of Munich Munich Germany
- Institute of Medical and Polymer Engineering Technical University of Munich Garching Germany
| | - Jinchi Chen
- Institute of Medical and Polymer Engineering Technical University of Munich Garching Germany
| | - Sabina Günther
- Department of Cardiac Surgery, Grosshadern Medical Center Ludwig Maximilian University of Munich Munich Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Grosshadern Medical Center Ludwig Maximilian University of Munich Munich Germany
| | - Nikolaus Thierfelder
- Department of Cardiac Surgery, Grosshadern Medical Center Ludwig Maximilian University of Munich Munich Germany
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Ježek F, Strunina S, Carlson BE, Hozman J. A simulation study of left ventricular decompression using a double lumen arterial cannula prototype during a veno-arterial extracorporeal membrane oxygenation. Int J Artif Organs 2019; 42:748-756. [PMID: 31244372 DOI: 10.1177/0391398819858084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Veno-arterial extracorporeal membrane oxygenation can be vital to support patients in severe or rapidly progressing cardiogenic shock. In cases of left ventricular distension, left ventricular decompression during veno-arterial extracorporeal membrane oxygenation may be a crucial factor influencing the patient outcome. Application of a double lumen arterial cannula for a left ventricular unloading is an alternative, straightforward method for left ventricular decompression during extracorporeal membrane oxygenation in a veno-arterial configuration. OBJECTIVES The purpose of this article is to use a mathematical model of the human adult cardiovascular system to analyze the left ventricular function of a patient in cardiogenic shock supported by veno-arterial extracorporeal membrane oxygenation with and without the application of left ventricular unloading using a novel double lumen arterial cannula. METHODS A lumped model of cardiovascular system hydraulics has been coupled with models of non-pulsatile veno-arterial extracorporeal membrane oxygenation, a standard venous cannula, and a drainage lumen of a double lumen arterial cannula. Cardiogenic shock has been induced by decreasing left ventricular contractility to 10% of baseline normal value. RESULTS The simulation results indicate that applying double lumen arterial cannula during veno-arterial extracorporeal membrane oxygenation is associated with reduction of left ventricular end-systolic volume, end-diastolic volume, end-systolic pressure, and end-diastolic pressure. CONCLUSIONS A double lumen arterial cannula is a viable alternative less invasive method for left ventricular decompression during veno-arterial extracorporeal membrane oxygenation. However, to allow for satisfactory extracorporeal membrane oxygenation flow, the cannula design has to be revisited.
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Affiliation(s)
- Filip Ježek
- Department of Pathophysiology, First Faculty of Medicine, Charles University, Prague 2, Czech Republic.,Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Svitlana Strunina
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Brian E Carlson
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Jiří Hozman
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
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Wang S, Kunselman AR, Ündar A. Impact of cannula size and line length on venous line pressure in pediatric VA-/VV-ECLS circuits. Artif Organs 2018; 43:E165-E177. [PMID: 30589448 DOI: 10.1111/aor.13416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 11/29/2022]
Abstract
The objective of this study was to do an in vitro evaluation of venous line pressure using different venous line lengths and venous cannula sizes in pediatric venoarterial extracorporeal life support (VA-ECLS) and venovenous ECLS (VV-ECLS) circuits. The pediatric VA-ECLS circuit consisted of a Xenios i-cor diagonal pump, a Maquet Quadrox-i pediatric oxygenator, a Medtronic Biomedicus arterial cannula, a Biomedicus venous cannula, and 1/4″ ID arterial and venous tubing. The pediatric VV-ECLS circuit was similar, except it included a Maquet Avalon ELITE bi-caval dual lumen cannula. Circuits were primed with lactated Ringer's solution and packed red blood cells (hematocrit 40%). Trials were conducted at various flow rates (VA-ECLS: 250-1250 mL/min, VV-ECLS: 250-2000 mL/min) using different venous tubing lengths (2, 4, and 6 feet) and cannula sizes (VA-ECLS: A8Fr/V10Fr, A10Fr/V12Fr and A12Fr/V14Fr, VV-ECLS: 13Fr, 16Fr, 19Fr, 20Fr and 23Fr) at 36°C. Real-time pressure and flow data were recorded for analysis. The use of a small-caliber venous cannula significantly increased the venous line pressure in the 2 pediatric circuits (P < 0.01). Shorter venous tubing lengths significantly reduced the venous line pressure at high flow rates (P < 0.01). The VV-ECLS circuit had larger negative pre-pump pressure drops (7.2 to -102.2 mm Hg) when compared to the VA-ECLS circuit (0.7 to -60.7 mm Hg). Selecting an appropriate venous cannula and a shorter venous tubing when feasible may significantly reduce the pressure drop of the venous line in pediatric VA-ECLS and VV-ECLS circuits and improve venous drainage.
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Affiliation(s)
- Shigang Wang
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Allen R Kunselman
- Public Health and Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Penn State Health Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Surgery and Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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Wang S, Force M, Kunselman AR, Palanzo D, Brehm C, Ündar A. Hemodynamic Evaluation of Avalon Elite Bi-Caval Dual Lumen Cannulas and Femoral Arterial Cannulas. Artif Organs 2018; 43:41-53. [DOI: 10.1111/aor.13318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shigang Wang
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - Madison Force
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public Health and Sciences; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - David Palanzo
- Department of Perfusion; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - Christoph Brehm
- Department of Heart and Vascular Institute; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - Akif Ündar
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
- Department of Surgery and Bioengineering; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
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Abstract
In this Editor's Review, articles published in 2016 are organized by category and briefly summarized. We aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, the International Society for Mechanical Circulatory Support, the International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We were pleased to publish our second Virtual Issue in April 2016 on "Tissue Engineering in Bone" by Professor Tsuyoshi Takato. Our first was published in 2011 titled "Intra-Aortic Balloon Pumping" by Dr. Ashraf Khir. Other peer-reviewed Special Issues this year included contributions from the 11th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr. Akif Ündar and selections from the 23rd Congress of the International Society for Rotary Blood Pumps edited by Dr. Bojan Biocina. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.
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