Plasma Exchange Before Surgery for Left Ventricular Assist Device Implantation

Medical management of patients with continuous-flow left ventricular assist devices

OPINION STATEMENT

The prevalence of patients living with advanced heart failure continues to rise. For a subset of these patients, continuous-flow left ventricular assist devices (LVADs) are a life-saving therapy. Given the efficacy and durability of contemporary LVAD devices, their use has increased exponentially in recent years. The medical management of patients with an LVAD is an area of expertise for advanced heart failure clinicians, but a general understanding of the initial approach to, and stabilization of, LVAD patients is an important skillset for many health care providers. The rapidly changing field of the medical management of LVAD patients is largely based on clinical experience and limited published data. In this manuscript, we integrate the available published data on the medical management of LVAD patients with the growing clinical experience.

[Preparation of bovine serum albumin immobilized adsorbent for specific adsorption of bilirubin]

Serum bilirubin concentration is greatly elevated in certain diseases such as hyperbilirubinemia and severe hepatitis. Lowering the level of bilirubin is one of the major targets of many therapies such as plasma exchange and hemoperfusion. In this study, a bilirubin specific adsorbent was prepared by covalently immobilizing bovine serum albumin (BSA) onto macroporous poly (glycidyl methacrylate-co-trimethylolpropane trimethacrylate) microspheres. The resulting BSA immobilized adsorbent (BIA) demonstrated good performance in adsorption of bilirubin with an adsorption capacity of 48.7 mg/g. Presence of BSA in bilirubin solution significantly lowered the adsorption capacity of the adsorbent due to the tight binding of bilirubin onto BSA. Adsorption performance of the adsorbent for bilirubin was improved with the elevation of temperature. The adsorbent demonstrated good stability even after 31 d of storage at - 80 degrees C in that there was almost no change in adsorption capacity for bilirubin. These results indicated that the prepared BSA immobilized adsorbent could be an alternative choice for specific adsorption of bilirubin.