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Imaoka S, Nishinaka T, Mizuno T, Umeki A, Murakami T, Tsukiya T, Kawamura M, Miyagawa S. Feasibility of an animal model for long-term mechanical circulatory support with Impella 5.5 implanted through carotid artery access in sheep. J Artif Organs 2024:10.1007/s10047-024-01444-0. [PMID: 38642185 DOI: 10.1007/s10047-024-01444-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/16/2024] [Indexed: 04/22/2024]
Abstract
Impella is a mechanical circulatory support device of a catheter-based intravascular microaxial pump for left ventricular support and unloading. However, nonclinical studies assessing the effects of the extended duration of left ventricular unloading on cardiac recovery are lacking. An animal model using Impella implanted with a less invasive procedure to enable long-term support is required. This study aimed to evaluate the feasibility of an animal model for long-term support with Impella 5.5 implanted through carotid artery access in sheep.Impella 5.5 was implanted in four sheep through the proximal region of the left carotid artery without a thoracotomy, and myocardial injuries were induced by coronary microembolization. Support by Impella 5.5 was maintained for 4 weeks, and the animals were observed. The position of Impella 5.5 and cardiac function was evaluated using cardiac computer tomography at 2 and 4 weeks after implantation.All four animals completed the 4-week study without major complications. The discrepancy in the Impella 5.5 flow rate between the conscious and anesthetized states was observed depending on the device's position. Animals in whom the inflow was above the left ventricular papillary muscle had a relatively high flow rate under the maximum performance level without a suction alarm during the conscious state. Pathological changes in the aortic valve were observed. Cardiac function under the minimum performance level was observed with no remarkable deterioration.The animal model with myocardial injuries supported for 4 weeks by Impella 5.5 implanted through carotid artery access in sheep was feasible.
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Affiliation(s)
- Shusuke Imaoka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan.
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan.
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Akihide Umeki
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Takashi Murakami
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Masashi Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Tanaka S, Nishinaka T, Umeki A, Murakami T, Imaoka S, Mizuno T, Tsukiya T, Ono M. Hemodynamic Evaluation of Asynchronous Speed Modulation of a Continuous-Flow Left Ventricular Assist Device in an Acute-Myocardial Injury Sheep Model. Ann Biomed Eng 2024; 52:364-375. [PMID: 37851145 DOI: 10.1007/s10439-023-03383-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
Asynchronous rotational-speed modulation of a continuous-flow left ventricular assist device (LVAD) can increase pulsatility; however, the feasibility of hemodynamic modification by asynchronous modulation of an LVAD has not been sufficiently verified. We evaluated the acute effect of an asynchronous-modulation mode under LVAD support and the accumulated effect of 6 consecutive hours of driving by the asynchronous-modulation mode on hemodynamics, including both ventricles, in a coronary microembolization-induced acute-myocardial injury sheep model. We evaluated 5-min LVAD-support hemodynamics, including biventricular parameters, by switching modes from constant-speed to asynchronous-modulation in the same animals ("acute-effect evaluation under LVAD support"). To determine the accumulated effect of a certain driving period, we evaluated hemodynamics including biventricular parameters after weaning from 6-hour (6 h) LVAD support by constant-speed or asynchronous-modulation mode ("6h-effect evaluation"). The acute-effect evaluation under LVAD support revealed that, compared to the constant-speed mode, the asynchronous-modulation mode increased vascular pulsatility but did not have significantly different effects on hemodynamics, including both ventricles. The 6 h-effect evaluation revealed that the hemodynamics did not differ significantly between the two groups except for some biventricular parameters which did not indicate negative effects of the asynchronous-modulation mode on both ventricles. The asynchronous-modulation mode could be feasible to increase vascular pulsatility without causing negative effects on hemodynamics including both ventricles. Compared to the constant-speed mode, the asynchronous-modulation mode increased pulsatility during LVAD support without negative effects on hemodynamics including both ventricles in the acute phase. Six hours of LVAD support with the asynchronous-modulation mode exerted no negative effects on hemodynamics, including both ventricles, after weaning from the LVAD.
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Affiliation(s)
- Shun Tanaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan.
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Akihide Umeki
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Takashi Murakami
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Shusuke Imaoka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo , Tokyo, 113-8654, Japan
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Inatomi A, Nishinaka T, Umeki A, Tsukiya T, Katagiri N, Fujii M, Kobayashi F, Imaoka S, Tanaka S, Mizuno T, Murakami T. Feasibility study of an artificial placenta system consisting of a loop circuit configuration extracorporeal membrane oxygenation with a bridge circuit in the form of the umbilical arterial-venous connection. J Artif Organs 2023; 26:287-296. [PMID: 36227380 DOI: 10.1007/s10047-022-01370-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/02/2022] [Indexed: 11/25/2022]
Abstract
We developed a new artificial placenta (AP) system consisting of a loop circuit configuration extracorporeal membrane oxygenation (ECMO) with a bridge circuit designed to be applied to the fetus in the form of an umbilical arterial-venous connection. We aimed to evaluate the feasibility of the AP system by performing a hydrodynamic simulation using a mechanical mock circulation system and fetal animal experiment. The effect of the working condition of the AP system on the fetal hemodynamics was evaluated by hydrodynamic simulation using a mechanical mock circulation system, assuming the weight of the fetus to be 2 kg. The AP system was introduced to two fetal goats at a gestational age of 135 days. The general conditions of the experimental animals were evaluated. The mock simulation showed that in an AP system with ECMO in the form of an umbilical arterial-venous connection in series, it could be difficult to maintain fetal hemodynamics when high ECMO flow was applied. The developed AP system could have high ECMO flow with less umbilical blood flow; however, the possibility of excessive load on the fetal right-sided heart should be noted. In the animal experiment, kid 1 (1.9 kg) was maintained on the AP system for 12 days and allowed to grow to term. In kid 2 (1.6 kg), the AP system could not be established because of the occlusion of the system by a thrombus. The developed AP system was feasible under both in vitro and in vivo conditions. Improvements in the AP system and management of the general fetal conditions are essential.
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Affiliation(s)
- Ayako Inatomi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan.
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan.
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan.
| | - Akihide Umeki
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Nobumasa Katagiri
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Masahiko Fujii
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Futoshi Kobayashi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Syusuke Imaoka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Shun Tanaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
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Tsukiya T, Nishinaka T. Numerical simulation of the leakage flow of the hydrodynamically levitated centrifugal blood pump for extracorporeal mechanical circulatory support systems. J Artif Organs 2023; 26:176-183. [PMID: 35907152 DOI: 10.1007/s10047-022-01351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/07/2022] [Indexed: 10/16/2022]
Abstract
Extracorporeal centrifugal pumps are widely used in various forms of mechanical circulatory support, including extracorporeal membrane oxygenation and ventricular assist device. A durable centrifugal pump was developed by implementing a new hydrodynamic bearing design that prevents the impeller from touching to the casing wall and provides sufficient washout through the pump to prevent thrombus formation in the pump. The hydrodynamic bearings of the pump are composed of dual annular paths located on both sides of the impeller. Computational fluid dynamics analyses were performed on the flow field inside the pump to estimate the leakage flow through the gap and its impact on the pump efficiency and biocompatibility. The calculations were performed for motor speeds from 3000 to 5000 rpm and flow rates from 1.0 to 9.0 L/min. The leakage flow increased linearly with increasing pressure head of the pump, and the total leakage flow ranged from 2.0 to 27.3% of the total flow. The average wall shear stresses in the casing bottom ranged from 10.6 to 40.9 Pa. The leakage flow of the centrifugal pump with the hydrodynamically levitated impeller had a measurable impact on hydraulic energy losses while enhancing the washout flow to achieve good anti-thrombogenicity.
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Affiliation(s)
- Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shinmachi, Suita, Osaka, 5648565, Japan.
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shinmachi, Suita, Osaka, 5648565, Japan
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Tanaka S, Nishinaka T, Umeki A, Imaoka S, Murakami T, Mizuno T, Tsukiya T, Ono M. Impact of Asynchronous Rotational Speed Modulation of Continuous Flow Left Ventricular Assist Device on Cardiac Condition. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Tanaka S, Nishinaka T, Umeki A, Fujii M, Imaoka S, Kobayashi F, Inatomi A, Katagiri N, Tsukiya T, Mizuno T, Ono M. Coronary microembolization sheep model by adjusting the number of microspheres based on coronary blood flow. Artif Organs 2023; 47:138-147. [PMID: 35962546 DOI: 10.1111/aor.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND A heart failure (HF) model using coronary microembolization in large animals is indispensable for medical research. However, the heterogeneity of myocardial response to microembolization is a limitation. We hypothesized that adjusting the number of injected microspheres according to coronary blood flow could stabilize the severity of HF. This study aimed to evaluate the effect of microsphere injection based on the left coronary artery blood flow in an animal model. METHODS Microembolization was induced by injecting different numbers of microspheres (polystyrene, diameter: 90 μm) into the left descending coronary artery of the two groups of sheep (400 and 600 times coronary blood flow [ml/min]). Hemodynamic parameters, the pressure-volume loop of the left ventricle, and echocardiography findings were examined at 0.5, 1.5, 3.5, and 6.5 h after microembolization. RESULTS End-diastolic pressure and normalized heart rate increased over time, and were significantly higher in 600 × coronary blood flow group than those in 400 × coronary blood flow group (p = 0.04 and p < 0.01, respectively). The maximum rate of left-ventricular pressure rise and normalized stroke volume decreased over time, and were significantly lower in 600 × coronary blood flow group than those in 400 × coronary blood flow group (p < 0.01 and p < 0.01, respectively). The number of microspheres per coronary blood flow was significantly correlated with the decrease in stroke volume and the maximum rate of left ventricular pressure rise in 6.5 h (r = 0.74, p = 0.01 and r = 0.71, p = 0.02, respectively). CONCLUSIONS Adjusting the number of injected microspheres based on the coronary blood flow enabled the creation of HF models with different degrees of severity.
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Affiliation(s)
- Shun Tanaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akihide Umeki
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masahiko Fujii
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shusuke Imaoka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Futoshi Kobayashi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Ayako Inatomi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Nobumasa Katagiri
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo, Tokyo, Japan
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Ono M, Yamaguchi O, Ohtani T, Kinugawa K, Saiki Y, Sawa Y, Shiose A, Tsutsui H, Fukushima N, Matsumiya G, Yanase M, Yamazaki K, Yamamoto K, Akiyama M, Imamura T, Iwasaki K, Endo M, Ohnishi Y, Okumura T, Kashiwa K, Kinoshita O, Kubota K, Seguchi O, Toda K, Nishioka H, Nishinaka T, Nishimura T, Hashimoto T, Hatano M, Higashi H, Higo T, Fujino T, Hori Y, Miyoshi T, Yamanaka M, Ohno T, Kimura T, Kyo S, Sakata Y, Nakatani T. JCS/JSCVS/JATS/JSVS 2021 Guideline on Implantable Left Ventricular Assist Device for Patients With Advanced Heart Failure. Circ J 2022; 86:1024-1058. [PMID: 35387921 DOI: 10.1253/circj.cj-21-0880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Akira Shiose
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
| | - Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Kenji Yamazaki
- Advanced Medical Research Institute, Hokkaido Cardiovascular Hospital
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Teruhiko Imamura
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Graduate School of Advanced Science and Engineering, Waseda University
| | - Miyoko Endo
- Department of Nursing, The University of Tokyo Hospital
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Koichi Kashiwa
- Department of Medical Engineering, The University of Tokyo Hospital
| | - Osamu Kinoshita
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | - Kaori Kubota
- Department of Transplantation Medicine, Osaka University Graduate School of Medicine
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroshi Nishioka
- Department of Clinical Engineering, National Cerebral and Cardiovascular Center
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center
| | - Takashi Nishimura
- Department of Cardiovascular and Thoracic Surgery, Ehime University Hospital
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Masaru Hatano
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Yumiko Hori
- Department of Nursing and Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Toru Miyoshi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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Ikeda R, Ichihara Y, Yamada Y, Saito S, Nishinaka T, Shinkawa T, Niinami H. Optimization of Left Ventricle Size After VAD Implantation Prevents Incidence of Cerebral Infarction. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Fujii M, Nishinaka T, Inatomi A, Katagiri N, Kobayashi F, Imaoka S, Tanaka S, Mizuno T, Tsukiya T, Umeki A, Matsumiya G. Impact of Left Ventricular Unloading Under Circulatory Support with Venoarterial ECMO in Heart Failure Animal Model. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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10
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Ikeda R, Ichihara Y, Yamada Y, Saito S, Nishinaka T, Niinami H. Reversal and Resumption of Anti-Thrombotic Therapy in VAD-Related Hemorrhage. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Shinkawa T, Nakayama Y, Nishinaka T, Niinami H. Bentall and redo-Konno Operation for an Adult With Aortic Paraprosthetic Leak and Root Aneurysm. World J Pediatr Congenit Heart Surg 2021; 12:142-144. [PMID: 33407029 DOI: 10.1177/2150135120951565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of Bentall and redo-Konno operation. A 39-year-old male with surgical history of Konno operation presented with hemolytic anemia and heart failure. Further evaluations revealed aortic paraprosthetic leak with moderate regurgitation, moderate biventricular outflow tract obstruction, and aortic root aneurysm. During the operation, the old Konno septoplasty patch with organized thrombus and the severely calcified right ventricular patch were replaced, and the aortic root was replaced with a larger mechanical valve in a Valsalva graft. Postoperative images showed appropriately reconstructed biventricular outflow tracts. The Bentall operation with redo-Konno was an excellent option in this situation.
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Affiliation(s)
- Takeshi Shinkawa
- Department of Cardiovascular Surgery, 13131Tokyo Women's Medical University, Tokyo, Japan
| | - Yuki Nakayama
- Department of Cardiovascular Surgery, 13131Tokyo Women's Medical University, Tokyo, Japan
| | - Tomohiro Nishinaka
- Department of Cardiovascular Surgery, 13131Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, 13131Tokyo Women's Medical University, Tokyo, Japan
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Takada T, Nishinaka T, Ichihara Y, Saito S, Imamura Y, Kikuchi N, Hattori H, Suzuki A, Ashihara K, Shiga T, Nunoda S, Hagiwara N, Niinami H. Impact of anatomical position of the inflow cannula on stroke in patients with left ventricular assist devices. Int J Artif Organs 2021; 45:27-34. [PMID: 33472505 DOI: 10.1177/0391398820988297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Stroke is a substantial complication of left ventricular assist device (LVAD) implantation. The relationship between stroke and the anatomical position of the inflow cannula of patients who underwent LVAD implantation was investigated. METHODS We enrolled 15 patients with advanced-stage heart failure who underwent implantation of continuous-flow-LVAD. Data of patients who suffered a stroke within 6 months after LVAD implantation were retrospectively compared to those who remained free of stroke. The distance between the inflow duct and left ventricular (LV) septum (duct-sep distance) and its ratio to LV diastolic diameter (LVDd) were measured from echocardiography at 1 month after LVAD implantation. Receiver operating characteristic curves for the endpoint of stroke using the duct-sep distance to LVDd ratio was created and the cut-off value was calculated. The incidence of stroke during the 6 months after LVAD implantation according to this ratio was estimated using the Kaplan-Meier method. RESULTS At 1 month after LVAD implantation, there were no significant differences in baseline characteristics and echocardiography parameters between the stroke and stroke-free groups. Receiver operating characteristic curve analysis for the endpoint of stroke using the duct-sep distance to LVDd ratio revealed 0.217 as a cut-off value (sensitivity: 80%, specificity: 80%, area under the curve: 0.72). Stroke was more frequent in patients with a duct-sep distance to LVDd ratio ⩾0.217 at 1 month than in those with a lower ratio. CONCLUSION The duct-sep distance to LVDd ratio was associated with the occurrence of stroke, suggesting that inflow cannula position influences the incidence of stroke.
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Affiliation(s)
- Takuma Takada
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tomohiro Nishinaka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yuki Ichihara
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Saito
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yasutaka Imamura
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Noriko Kikuchi
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hidetoshi Hattori
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Shinichi Nunoda
- Department of Therapeutic Strategy for Severe Heart Failure, Tokyo Women's Medical University Graduate School of Medical Science, Shinjuku-ku, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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13
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Ogawa D, Kobayashi S, Yamazaki K, Motomura T, Nishimura T, Shimamura J, Tsukiya T, Mizuno T, Takewa Y, Tatsumi E, Nishinaka T. Evaluation of cardiac beat synchronization control for a rotary blood pump on valvular regurgitation with a mathematical model. Artif Organs 2020; 45:124-134. [PMID: 32813920 DOI: 10.1111/aor.13795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/10/2020] [Accepted: 08/05/2020] [Indexed: 01/17/2023]
Abstract
We have studied the cardiac beat synchronization (CBS) control for a rotary blood pump (RBP) and revealed that it can promote pulsatility and reduce cardiac load. Besides, patients with LVAD support sometimes suffer from aortic and mitral regurgitation (AR and MR). A control method for the RBP should be validated in wider range of conditions to clarify its benefits and pitfalls prior to clinical application. In this study, we evaluated pulsatility and cardiac load reduction obtained with the CBS control on valvular failure conditions with a mathematical model. Diastolic assist could reduce cardiac load on the left ventricle by decreasing external work of the ventricle even in MR cases while it was not so effective in AR cases. Systolic assist can still promote pulsatility in AR and MR cases; however, aortic valve function should be carefully confirmed since pulse pressure can be wider not due to systolic assist but to AR.
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Affiliation(s)
- Daisuke Ogawa
- Sun Medical Technology Research Corp., Nagano, Japan
| | | | | | | | - Takashi Nishimura
- Department of Cardiovascular and Thoracic Surgery, Graduate school of Medicine, Ehime University, Ehime, Japan
| | - Junichi Shimamura
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshiaki Takewa
- Advanced Medical Engineering Research Center, Asahikawa Medical University, Hokkaido, Japan
| | - Eisuke Tatsumi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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14
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Abstract
PURPOSE Immunosuppressant and steroid are inevitable for graft survival after renal transplantation, and their usage is known to be a risk factor for mortality and morbidity after cardiac surgery. We evaluated the long-term clinical outcomes in patients who underwent cardiac surgery after renal transplantation. METHODS We retrospectively reviewed 23 patients who underwent cardiac surgery after renal transplantation with maintained grafts at the time of the cardiac surgery in our institution between June 2000 and June 2018 (19 males, 4 females; mean age, 55 (38-81) years). RESULTS The interval from renal transplantation to cardiac surgery was 80.0 ± 84.6 (0.25-298) months. The mean follow-up period after cardiac surgery was 78.3 (range: 1-216) months. Cumulative survival rates at 1, 5, 7, and 10 years were 95.7%, 95.7%, 87.7%, and 68.2%, respectively. Renal graft survival rates at 1 and 5 years were 86.1% and 79.9%, respectively. CONCLUSIONS This retrospective review suggests that cardiac surgery in kidney transplant patients can result in good survival rates. Thanks to dedicated postoperative and long-term management, approximately 80% of the renal grafts still maintained their function 5 years after cardiac surgery.
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Affiliation(s)
- Masahide Komagamine
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomohiro Nishinaka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuki Ichihara
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoshi Saito
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
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15
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Sawa Y, Matsumiya G, Matsuda K, Tatsumi E, Abe T, Fukunaga K, Ichiba S, Taguchi T, Kokubo K, Masuzawa T, Myoui A, Nishimura M, Nishimura T, Nishinaka T, Okamoto E, Tokunaga S, Tomo T, Tsukiya T, Yagi Y, Yamaoka T. Journal of Artificial Organs 2018: the year in review : Journal of Artificial Organs Editorial Committee. J Artif Organs 2019; 22:1-5. [PMID: 30796540 DOI: 10.1007/s10047-019-01094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Y Sawa
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - G Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - K Matsuda
- Emergency and Critical Care Medicine, University of Yamanashi Hospital, Yamanashi, Japan
| | - E Tatsumi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - T Abe
- Department of Urology, Iwate Medical University School of Medicine, Iwate, Japan
| | - K Fukunaga
- Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| | - S Ichiba
- Department of Surgical Intensive Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - T Taguchi
- Biomaterial Unit, National Institute of Material Science, Ibaraki, Japan
| | - K Kokubo
- Department of Medical Engineering and Technology, Kitasato University School of Allied Health Science, Kanagawa, Japan
| | - T Masuzawa
- Department of Mechanical Engineering, Ibaraki University, Ibaraki, Japan
| | - A Myoui
- Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan
| | - M Nishimura
- Division of Organ Regeneration Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - T Nishimura
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - T Nishinaka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - E Okamoto
- Department of Human Science and Informatics, School of Bioscience and Engineering, Tokai University, Sapporo, Japan
| | - S Tokunaga
- The Department of Cardiovascular Surgery, JCHO Kyushu Hospital, Fukuoka, Japan
| | - T Tomo
- Second Department of Internal Medicine, Faculty of Medicine, Oita University, Oita, Japan
| | - T Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Y Yagi
- Department of Clinical Engineering, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Yamaoka
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
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16
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Hattori H, Suzuki A, Shiga T, Nishinaka T, Saito S, Yamazaki K, Nunoda S, Hagiwara N. Impact of Recurrent Ventricular Tachyarrhythmia on Outcome in Japanese Heart Transplant Candidates With a Left Ventricular Assist Device. Circ J 2018; 82:2305-2310. [PMID: 30012930 DOI: 10.1253/circj.cj-18-0294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recurrent ventricular tachyarrhythmias (VTA) are "A factor" modifiers in the Interagency Registry for Mechanically Assisted Circulatory Support profile. The effect of recurrent VTA on clinical outcome, however, is controversial. We evaluated the impact of recurrent VTA on outcome in Japanese heart transplant candidates with a left ventricular assist device (LVAD). Methods and Results: Sixty-six adult patients with advanced heart failure who were listed for heart transplantation between January 2005 and October 2017 were enrolled in the study. Recurrent VTA (modifier A status) was defined as a sustained ventricular tachycardia or fibrillation that required implantable cardioverter defibrillator shocks or an external defibrillator more than twice weekly. The primary outcome was death from any cause. The secondary outcomes were the first occurrence of VTA and recurrent VTA after LVAD implantation. Sixteen patients (24%) met the criteria for modifier A status, and 15 patients had an LVAD implanted. During a median follow-up of 1,124 days, 21 of 60 patients with an LVAD died. There was a significantly higher mortality rate in LVAD patients with modifier A status than in those who did not meet the modifier A criteria. On multivariate analysis, patients with modifier A status had an increased risk of mortality (HR, 3.43; 95% CI: 1.30-8.61, P=0.001). CONCLUSIONS Recurrent VTA might be a marker for worse outcome in Japanese heart transplant candidates with an LVAD.
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Affiliation(s)
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | | | - Satoshi Saito
- Department of Cardiovascular Surgery, Tokyo Women's Medical University
| | - Kenji Yamazaki
- Department of Cardiovascular Surgery, Tokyo Women's Medical University
| | - Shinichi Nunoda
- Department of Therapeutic Strategy for Severe Heart Failure, Tokyo Women's Medical University Graduate School of Medical Science
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17
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Kikuchi N, Yoshimura A, Suzuki A, Shiga T, Hattori H, Nishinaka T, Saito S, Yamazaki K, Niinami H, Hagiwara N, Nunoda S. 3277Impact of congestion in worsening renal failure after implantation of a centrifugal, continuous-flow left ventricular device. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Kikuchi
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - A Yoshimura
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - A Suzuki
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - T Shiga
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - H Hattori
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - T Nishinaka
- Tokyo Women's Medical University, Cardiovascular surgery, Tokyo, Japan
| | - S Saito
- Tokyo Women's Medical University, Cardiovascular surgery, Tokyo, Japan
| | - K Yamazaki
- Tokyo Women's Medical University, Cardiovascular surgery, Tokyo, Japan
| | - H Niinami
- Tokyo Women's Medical University, Cardiovascular surgery, Tokyo, Japan
| | - N Hagiwara
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - S Nunoda
- Tokyo Women's Medical University, Therapeutic Strategy for Severe Heart Failure, Tokyo, Japan
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18
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Iizuka K, Nishinaka T, Akiyama D, Sumikura H, Mizuno T, Tsukiya T, Takewa Y, Yamazaki K, Tatsumi E. The angle of the outflow graft to the aorta can affect recirculation due to aortic insufficiency under left ventricular assist device support. J Artif Organs 2018; 21:399-404. [PMID: 30039455 DOI: 10.1007/s10047-018-1064-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/17/2018] [Indexed: 11/24/2022]
Abstract
Aortic insufficiency (AI) is a crucial complication during continuous-flow left ventricular assist device (LVAD) support. Our previous clinical study suggested that a larger angle between the outflow graft and the aorta (O-A angle) could cause AI progression. This study examined the effect of the O-A angle on the hemodynamics of AI under LVAD support in an acute animal experimental model. An LVAD was installed in seven calves, with the inflow cannula inserted from the LV apex and with the outflow graft sutured at the ascending aorta. The AI model was made using a temporary inferior vena cava filter inserted from the LV apex and placed at the aortic valve. Cardiac dysfunction was induced by continuous beta-blocker infusion. Hemodynamic values and the myocardial oxygen extraction rate (O2ER) were evaluated at three O-A angles (45°, 90°, and 135°) over three levels of AI (none, Sellers I-II AI, and Sellers III-IV AI). The recirculation rate, defined as the percentage of regurgitation flow to LVAD output, was calculated. Systemic flow tended to decrease with a larger O-A angle. The recirculation rate was significantly increased with a larger O-A angle (22, 23, and 31% at 45°, 90°, and 135° in Sellers III-IV AI, respectively). Coronary artery flow was decreased at a larger O-A angle (86, 76 and 75 mL/min at 45°, 90°, and 135° in Sellers I-II AI, respectively, and 77, 67, and 56 mL/min at 45°, 90°, and 135° in Sellers III-IV AI, respectively). O2ER tended to increase with a larger O-A angle (40, 43, and 49% at 45°, 90°, and 135° in Sellers III-IV AI, respectively). A larger O-A angle can increase the recirculation due to AI and can be disadvantageous to LVAD-AI hemodynamics and myocardial oxygen metabolism.
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Affiliation(s)
- Kei Iizuka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan. .,Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan.
| | - Tomohiro Nishinaka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan
| | - Daichi Akiyama
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Hirohito Sumikura
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Yoshiaki Takewa
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Kenji Yamazaki
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan
| | - Eisuke Tatsumi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
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19
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Nishimura T, Tatsumi E, Nishinaka T, Taenaka Y, Nakata M, Takano H. Prolonged Nonpulsatile Left Heart Bypass Diminishes Vascular Contractility. Int J Artif Organs 2018. [DOI: 10.1177/039139889902200707] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated possible functional changes in the vascular system accompanying the morphological change in prolonged nonpulsatile left heart bypass (LHB). Three adult goats underwent pulsatile LHB. Two weeks postoperatively, the pulsatile ventricular assist device was replaced with a centrifugal pump and nonpulsatile LHB was subsequently conducted for 4 weeks. The mean aortic pulse pressure was 39 and 16 mmHg during the pulsatile and nonpulsatile LHB, respectively. Systemic vascular resistance (SVR) and plasma norepinephrine levels were measured at the end of pulsatile LHB (PUL), and at the end of 1st, 2nd, 3rd, and 4th week of nonpulsatile LHB (NP1w, NP2w, NP3w, NP4w, respectively). At each point, 50 μg/kg nitroglycerin and 1μg/kg norepinephrine were injected and the minimal and maximal values of SVR after injection were calculated as parameters reflecting the vascular tonus and contractility. The SVR and plasma nor epinephrine level did not significantly change during the entire course (SVR: 1106, 895, 982, 920, and 938 dyne·sec·cm−5; norepinephrine level: 0.3, 0.2, 0.1, 0.2, and 0.1 ng/ml; at PUL, NP1w, NP2w, NP3w, and NP4w, respectively). The minimal value of SVR after nitroglycerin injection remained unchanged, indicating that vascular tonus was stable during the entire course (618, 687, 623, 560, 653 dyne·sec·cm−5, respectively). In contrast, the maximal value of SVR after norepinephrine injection at NP3w and NP4w (1695 and 1759 yne·sec·cm−5) became significantly reduced compared to that at PUL (2346 dyne·sec·cm−5). These results indicated that prolonged nonpulsatile left heart bypass did not affect the vascular tonus, but significantly diminished the vascular contractility.
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Affiliation(s)
- T. Nishimura
- Department of Artificial Organs, National Cardiovascular Center Research Institute, Osaka - Japan
| | - E. Tatsumi
- Department of Artificial Organs, National Cardiovascular Center Research Institute, Osaka - Japan
| | - T. Nishinaka
- Department of Artificial Organs, National Cardiovascular Center Research Institute, Osaka - Japan
| | - Y Taenaka
- Department of Artificial Organs, National Cardiovascular Center Research Institute, Osaka - Japan
| | - M. Nakata
- Department of Artificial Organs, National Cardiovascular Center Research Institute, Osaka - Japan
| | - H. Takano
- Department of Artificial Organs, National Cardiovascular Center Research Institute, Osaka - Japan
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20
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Iizuka K, Nishinaka T, Naito N, Akiyama D, Takewa Y, Yamazaki K, Tatsumi E. Left heart pressures can be the key to know the limitation of left ventricular assist device support against progression of aortic insufficiency. J Artif Organs 2018; 21:265-270. [DOI: 10.1007/s10047-018-1027-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/13/2018] [Indexed: 10/18/2022]
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21
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Nakatani T, Sase K, Oshiyama H, Akiyama M, Horie M, Nawata K, Nishinaka T, Tanoue Y, Toda K, Tozawa M, Yamazaki S, Yanase M, Ohtsu H, Ishida M, Hiramatsu A, Ishii K, Kitamura S. Japanese registry for Mechanically Assisted Circulatory Support: First report. J Heart Lung Transplant 2017; 36:1087-1096. [PMID: 28942783 DOI: 10.1016/j.healun.2017.08.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 08/03/2017] [Accepted: 08/09/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In Japan, ventricular assist devices (VADs) have been used for patients with severe heart failure as a bridge to transplantation (BTT) since 1992. However, it was not until 1997, when the Organ Transplant Law was enacted, that medical devices received approval by the national health insurance system for that use. To encourage research and development of innovative medical devices, the Pharmaceuticals and Medical Devices Agency has established a public-private partnership in collaboration with academic societies, hospitals and manufacturers. METHODS The Japanese registry for Mechanically Assisted Circulatory Support (J-MACS) is a prospective registry designed to be harmonized with the Interagency Registry of Mechanically Assisted Circulatory Support (INTERMACS). Participation in J-MACS is mandatory for device manufacturers to meet the conditions of approval as well as for hospitals to obtain authorization for reimbursement from the national health insurance system. RESULTS From June 2010 to April 2015, 476 patients were registered at 31 hospitals. Of these, analysis of primary VAD patients (n = 332) revealed that their overall 360-day survival was 91% (implantable 93%, extracorporeal 84%). CONCLUSIONS This initial report from J-MACS focuses on patients' demographics, device types, survival, competing outcomes, adverse events and successful examples of system failure detection.
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Affiliation(s)
- Takeshi Nakatani
- Principal Investigator, Chair, J-MACS Operating Committee, Maki Hospital, Osaka, Japan.
| | - Kazuhiro Sase
- Co-principal Investigator, J-MACS Operating Committee, Juntendo University, Tokyo, Japan
| | - Hiroaki Oshiyama
- Co-principal Investigator, J-MACS Operating Committee, Medical Technology Association of Japan, Tokyo, Japan
| | - Masatoshi Akiyama
- Investigator, J-MACS Operating Committee, Tohoku University, Miyagi, Japan
| | - Masao Horie
- Investigator, J-MACS Operating Committee, Nipro Corporation, Osaka, Japan
| | - Kan Nawata
- Investigator, J-MACS Operating Committee, The University of Tokyo, Tokyo, Japan
| | - Tomohiro Nishinaka
- Investigator, J-MACS Operating Committee, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshihisa Tanoue
- Investigator, J-MACS Operating Committee, Kyushu University, Fukuoka, Japan
| | - Koichi Toda
- Investigator, J-MACS Operating Committee, Osaka University, Osaka, Japan
| | - Masao Tozawa
- Investigator, J-MACS Operating Committee, Century Medical, Inc., Tokyo, Japan
| | - Shunichi Yamazaki
- Investigator, J-MACS Operating Committee, Sun Medical Technology Research Corp. Nagano, Japan
| | - Masanobu Yanase
- Investigator, J-MACS Operating Committee, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroshi Ohtsu
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Michiko Ishida
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | | | - Kensuke Ishii
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Soichiro Kitamura
- Chair, J-MACS Steering Committee, National Cerebral and Cardiovascular Center, Osaka, Japan
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22
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Ichihara Y, Nishinaka T, Komagamine M, Yamada Y, Yamazaki K. Preservation of von Willebrand factor multimers and function in patients with an EVAHEART centrifugal-type, continuous-flow left ventricular assist device. J Heart Lung Transplant 2017; 36:814-817. [DOI: 10.1016/j.healun.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/27/2017] [Accepted: 04/17/2017] [Indexed: 01/23/2023] Open
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23
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Iizuka K, Nishinaka T, Takewa Y, Yamazaki K, Tatsumi E. The influence of pump rotation speed on hemodynamics and myocardial oxygen metabolism in left ventricular assist device support with aortic valve regurgitation. J Artif Organs 2017; 20:194-199. [DOI: 10.1007/s10047-017-0960-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/13/2017] [Indexed: 11/28/2022]
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24
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Nakatani T, Sase K, Oshiyama H, Akiyama M, Horie M, Nawata K, Nishinaka T, Tanoue Y, Toda K, Tozawa M, Yanase M, Yamazaki S, Ishida M, Hiramatsu A, Kitamura S. Report of Japanese Registry for Mechanically Assisted Circulatory Support (J-MACS) - Non-Pulsatile Implantable LVAS vs. Extracorporeal LVAD as Bridge to Transplantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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25
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Nishinaka T, Nakamoto K, Tokuyama S. Early life stress induces sex-dependent increases in phosphorylated extracellular signal-regulated kinase in brains of mice with neuropathic pain. Eur J Pain 2016; 20:1346-56. [DOI: 10.1002/ejp.860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2016] [Indexed: 12/22/2022]
Affiliation(s)
- T. Nishinaka
- Department of Clinical Pharmacy; School of Pharmaceutical Sciences; Kobe Gakuin University; Kobe Japan
| | - K. Nakamoto
- Department of Clinical Pharmacy; School of Pharmaceutical Sciences; Kobe Gakuin University; Kobe Japan
| | - S. Tokuyama
- Department of Clinical Pharmacy; School of Pharmaceutical Sciences; Kobe Gakuin University; Kobe Japan
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26
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Sawa Y, Matsuda K, Tatsumi E, Matsumiya G, Tsukiya T, Abe T, Fukunaga K, Kishida A, Kokubo K, Masuzawa T, Myoui A, Nishimura M, Nishimura T, Nishinaka T, Okamoto E, Tokunaga S, Tomo T, Yagi Y, Yamaoka T. Journal of Artificial Organs 2015: the year in review : Journal of Artificial Organs Editorial Committee. J Artif Organs 2016; 19:1-7. [PMID: 26896942 DOI: 10.1007/s10047-016-0886-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Y Sawa
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - K Matsuda
- Emergency and Critical Care Medicine, University of Yamanashi Hospital, Yamanashi, Japan
| | - E Tatsumi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - G Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - T Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - T Abe
- Department of Urology, Iwate Medical University School of Medicine, Iwate, Japan
| | - K Fukunaga
- Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| | - A Kishida
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Kokubo
- Department of Medical Engineering and Technology, Kitasato University School of Allied Health Science, Kanagawa, Japan
| | - T Masuzawa
- Department of Mechanical Engineering, Ibaraki University, Ibaraki, Japan
| | - A Myoui
- Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan
| | - M Nishimura
- Division of Organ Regeneration Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - T Nishimura
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - T Nishinaka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - E Okamoto
- Department of Human Science and Informatics, School of Bioscience and Engineering, Tokai University, Sapporo, Japan
| | - S Tokunaga
- The Department of Cardiovascular Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - T Tomo
- Second Department of Internal Medicine, Faculty of Medicine, Oita University, Oita, Japan
| | - Y Yagi
- Department of Clinical Engineering, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Yamaoka
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
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Shimizu M, Nishinaka T, Inai K, Nakanishi T. Outcomes in children with advanced heart failure in Japan: importance of mechanical circulatory support. Heart Vessels 2015; 31:1162-7. [PMID: 26243029 DOI: 10.1007/s00380-015-0722-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 07/24/2015] [Indexed: 11/24/2022]
Abstract
The Japanese organ transplant law was revised in July 2010 in order to enable children aged <15 years to donate organs. However, the waiting time for orthotopic heart transplantation (HTx) is as long as 636 days in children due to a shortage of organ donors. Ventricular assist devices (VADs) have been widely used as a bridge to transplantation in Western countries, whereas experience with VADs is limited in Japan due to a lack of device availability for small children. This study aimed to clarify the clinical profiles and outcomes of children with advanced heart failure in Japan and to investigate the importance of mechanical circulatory support (MCS), VADs, and extracorporeal membrane oxygenation (ECMO) in children. A retrospective chart review of patients with advanced heart failure who were eligible for HTx between January 2006 and May 2015 was performed at the Department of Pediatric Cardiology, Tokyo Woman's Medical University, Japan. Patients were divided into two groups based on need for MCS. Clinical data pre- and post-revision of the Japanese organ transplant law were compared. Preoperative clinical conditions were evaluated based on Interagency Registry for Mechanically Circulatory Support (INTERMACS) profiles. Twenty-two patients were included in the study, 12 of whom required MCS. VADs were implanted in nine patients and ECMO was needed in seven patients. Of the MCS group, 5 deaths occurred in patients with a preoperative INTERMACS profile-1. High total bilirubin was found to be associated with mortality by multivariate logistic regression analysis (OR 7.8, p = 0.02). Wait list mortality was 32 % and no difference in clinical profiles pre- and post-revision of the Japanese organ transplant law was observed. Approximately 55 % of pediatric patients with advanced heart failure required MCS support. Preoperative conditions such as INTERMACS profile-1 and high total bilirubin were associated with poor outcomes. The Japanese organ transplant law revision had no significant influence on patient profiles or outcomes.
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Affiliation(s)
- Mikiko Shimizu
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Tomohiro Nishinaka
- Department of Thoracic Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Inai
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
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28
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Nishinaka T, Ichihara Y, Komagamine M, Umehara N, Katsube K, Iizuka K, Saito S, Nunoda S, Yamazaki K. Japanese Experience of Long-Term Mechanical Circulatory Support With EVAHEART LVAD. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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29
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Nakamoto K, Nishinaka T, Sato N, Aizawa F, Yamashita T, Mankura M, Koyama Y, Kasuya F, Tokuyama S. The activation of supraspinal GPR40/FFA1 receptor signalling regulates the descending pain control system. Br J Pharmacol 2015; 172:1250-62. [PMID: 25362997 PMCID: PMC4337699 DOI: 10.1111/bph.13003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 10/20/2014] [Accepted: 10/24/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND PURPOSE The ω-3 polyunsaturated fatty acids exert antinociceptive effects in inflammatory and neuropathic pain; however, the underlying mechanisms remain unclear. Docosahexaenoic acid-induced antinociception may be mediated by the orphan GPR40, now identified as the free fatty acid receptor 1 (FFA1 receptor). Here, we examined the involvement of supraspinal FFA1 receptor signalling in the regulation of inhibitory pain control systems consisting of serotonergic and noradrenergic neurons. EXPERIMENTAL APPROACH Formalin-induced pain behaviours were measured in mice. Antinociception induced by FFA1 receptor agonists was examined by intrathecal injections of a catecholaminergic toxin, 5-HT lowering drug or these antagonists. The expression of FFA1 receptor protein and c-Fos was estimated by immunohistochemistry, and the levels of noradrenaline and 5-HT in the spinal cord were measured by LC-MS/MS. KEY RESULTS FFA1 receptors colocalized with NeuN (a neuron marker) in the medulla oblongata and with tryptophan hydroxylase (TPH; a serotonergic neuron marker) and dopamine β-hydroxylase (DBH; a noradrenergic neuron marker). A single i.c.v. injection of GW9508, a FFA1 receptor agonist, increased the number of c-Fos-positive cells and the number of neurons double-labelled for c-Fos and TPH and/or DBH. It decreased formalin-induced pain behaviour. This effect was inhibited by pretreatment with 6-hydroxydopamine, DL-p-chlorophenylalanine, yohimbine or WAY100635. Furthermore, GW9508 facilitated the release of noradrenaline and 5-HT in the spinal cord. In addition, GW1100, a FFA1 receptor antagonist, significantly increased formalin-induced pain-related behaviour. CONCLUSION AND IMPLICATIONS Activation of the FFA1 receptor signalling pathway may play an important role in the regulation of the descending pain control system.
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Affiliation(s)
- K Nakamoto
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Kobe Gakuin UniversityKobe, Japan
| | - T Nishinaka
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Kobe Gakuin UniversityKobe, Japan
| | - N Sato
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Kobe Gakuin UniversityKobe, Japan
| | - F Aizawa
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Kobe Gakuin UniversityKobe, Japan
| | - T Yamashita
- Biochemical Toxicology Laboratory, School of Pharmaceutical Sciences, Kobe Gakuin UniversityKobe, Japan
| | - M Mankura
- Faculty of Food Culture, Kurashiki Sakuyo UniversityKurashiki City, Japan
| | - Y Koyama
- Laboratory of Pharmacology, Faculty of Pharmacy, Osaka Ohtani UniversityTonda-bayashi, Japan
| | - F Kasuya
- Biochemical Toxicology Laboratory, School of Pharmaceutical Sciences, Kobe Gakuin UniversityKobe, Japan
| | - S Tokuyama
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Kobe Gakuin UniversityKobe, Japan
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30
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Sawa Y, Matsuda K, Tatsumi E, Matsumiya G, Abe T, Fukunaga K, Kishida A, Kokubo K, Masuzawa T, Myoui A, Nishimura M, Nishimura T, Nishinaka T, Okamoto E, Tokunaga S, Tomo T, Tsukiya T, Yagi Y, Yamaoka T. Journal of Artificial Organs 2014: the year in review. J Artif Organs 2015; 18:1-7. [PMID: 25701365 DOI: 10.1007/s10047-015-0821-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Indexed: 12/18/2022]
Affiliation(s)
| | - Y Sawa
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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31
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Komagamine M, Nishinaka T, Ichihara Y, Nagashima M, Shimizu M, Shinohara T, Nakanishi T, Yamazaki K. Ventricular assist device implantation late after double switch operation for L-transposition of the great arteries. Ann Thorac Surg 2014; 98:e109-11. [PMID: 25441828 DOI: 10.1016/j.athoracsur.2014.07.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 07/03/2014] [Accepted: 07/23/2014] [Indexed: 11/30/2022]
Abstract
We provided a left ventricular assist device (LVAD) for a 22-year-old man with congenital L-transposition of the great arteries after anatomic repair at the age of 7 years. He was hospitalized for progressive low-output syndrome caused by intractable biventricular failure. He received LVAD in his morphologic left ventricle with a concomitant pulmonary valve replacement. After the surgery, critical multiorgan failure with severe right heart failure occurred. It took three postoperative months to normalize all organ function following improvement of morphologic right ventricular function. He has remained stable with LVAD support for 1.5 years.
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Affiliation(s)
- Masahide Komagamine
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomohiro Nishinaka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Yuki Ichihara
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Mitsugi Nagashima
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Mikiko Shimizu
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tokuko Shinohara
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Yamazaki
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
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32
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Ichihara Y, Nishinaka T, Yamada Y, Hoki R, Kashiwamura C, Komagamine M, Tsukui H, Saito S, Nagashima M, Yamazaki K. Impact of vWF Activity in the Long-term Management of Centrifugal Type Continuous-flow LVAD Patients. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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33
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Nishinaka T, Ichihara Y, Komagamine M, Yamada Y, Yamazaki K. Long-Term Mechanical Circulatory Support With EVAHEART Left Ventricular Assist Device. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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34
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Sawa Y, Tatsumi E, Tsukiya T, Matsuda K, Fukunaga K, Kishida A, Masuzawa T, Matsumiya G, Myoui A, Nishimura M, Nishimura T, Nishinaka T, Okamoto E, Tokunaga S, Tomo T, Yagi Y, Yamaoka T. Journal of Artificial Organs 2012: the year in review. J Artif Organs 2013; 16:1-8. [PMID: 23456197 DOI: 10.1007/s10047-013-0690-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Y Sawa
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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35
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Nishinaka T. [Treatment of end-stage heart failure by implantable ventricular assist devices]. Kyobu Geka 2013; 66:43-50. [PMID: 23985404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The strategy for severe heart failure treatment has changed dramatically since 2011 by the initiation of clinical use of implantable continuous flow ventricular assist devices( LVADs) in Japan. The continuous flow LVADs include DeBakey ventricular assist device (VAD), HeartMate II, HeartWare, Dura-Heart, and EVAHEART, although EVAHEART alone is clinically available in Japan currently. Hear-Mate II is the most popular LVAD with more than 10,000 worldwide implants, while its clinical result is superior to implantable pulsatile LVADs. Crucial complications with implantable LVADs include infection, aortic valve insufficiency, thromboembolism, bleeding, and right heart failure during circulatory support. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) has started in the United States, while Japanese Registry for Mechanically Assisted Circulatory Support(JMACS) initiated in Japan in 2010. These registries are essential for clinical evaluation of implantable LVADs as well as research and development in this field. The circulatory support with implantable LVADs is expected to be further contribution for the treatment of for end-stage heart failure patients.
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Affiliation(s)
- Tomohiro Nishinaka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
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36
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Nishinaka T, Yamazaki K, Saito S, Tsukui H, Nakatani T, Kobayashi J, Matsumiya G, Sawa Y, Nishimura T, Ono M, Kyo S, Kitamura S. 238 Long-Term Durable Implantable Centrifugal Blood Pump: EVAHEART Left Ventricular Assist System. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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37
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Komagamine M, Saito S, Nishinaka T, Katsube K, Yamazaki K. [Coronary artery bypass graft for Bland-White-Garland syndrome in an old age; report of a case]. Kyobu Geka 2010; 63:1176-1179. [PMID: 21174671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We report a case of Bland-White-Garland syndrome with advanced age. The patient, a 67-year-old women, presented with a history of congestive heart failure. Coronary catheterization revealed an anomalous origin of the left coronary artery (LCA) from the trunk of the pulmonary artery and huge right coronary aneurysm. Myocardial single photon emission computed tomography (SPECT) showed previous myocardial infarction with reversible ischemia in left anterior descending (LAD) region. We performed LCA direct closure and coronary artery bypass graft. The patient recovered uneventfully without signs of ischemia. Although a bypass graft was patent, left ventricular function had not been improved immediately probably due to the coronary flow pattern changes.
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Affiliation(s)
- Masahide Komagamine
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
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38
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Iizuka K, Saito H, Nishinaka T, Kobayashi Y, Ikeda C, Seta H, Houki R, Masuda N, Miyairi S, Tomari H, Saito S, Yamazaki K. [Re-operation of an aortic pericardial bioprosthesis 23-years after implantation; report of a case]. Kyobu Geka 2010; 63:1169-1172. [PMID: 21174669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 49-year-old female suffered from dyspnea on exertion and jaundice from June, 2009. She had undergone aortic valve replacement with Carpentier-Edwards pericardial bioprosthesis due to active infectious endocarditis 23-years previously. The echocardiography showed severe aortic stenosis with moderate regurgitation. She was diagnosed as having prosthetic valve malfunction. Re-replacement of the aortic valve with mechanical valve was successfully performed. As far as we can see, this is one of the longest-term cases of implantation of pericardial bioprosthesis.
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Affiliation(s)
- Kei Iizuka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
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39
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Affiliation(s)
- Satoshi Saito
- Department of Cardiovascular Surgery, Tokyo Women's Medical University
| | | | - Kenji Yamazaki
- Department of Cardiovascular Surgery, Tokyo Women's Medical University
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40
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Homma A, Taenaka Y, Tatsumi E, Akagawa E, Lee H, Nishinaka T, Takewa Y, Mizuno T, Tsukiya T, Kakuta Y, Katagiri N, Shimosaki I, Hamada S, Mukaibayashi H, Iwaoka W. Development of a compact wearable pneumatic drive unit for a ventricular assist device. J Artif Organs 2009; 11:182-90. [PMID: 19184282 DOI: 10.1007/s10047-008-0433-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 08/30/2008] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to develop a compact wearable pneumatic drive unit for a ventricular assist device (VAD). This newly developed drive unit, 20 x 8.5 x 20 cm in size and weighing approximately 1.8 kg, consists of a brushless DC motor, noncircular gears, a crankshaft, a cylinder-piston, and air pressure regulation valves. The driving air pressure is generated by the reciprocating motion of the piston and is controlled by the air pressure regulation valves. The systolic ratio is determined by the noncircular gears, and so is fixed for a given configuration. As a result of an overflow-type mock circulation test, a drive unit with a 44% systolic ratio connected to a Toyobo VAD blood pump with a 70-ml stroke volume achieved a pump output of more than 7 l/min at 100 bpm against a 120 mmHg afterload. Long-term animal tests were also performed using drive units with systolic ratios of 45% and 53% in two Holstein calves weighing 62 kg and 74 kg; the tests were terminated on days 30 and 39, respectively, without any malfunction. The mean aortic pressure, bypass flow, and power consumption for the first calf were maintained at 90 x 13 mmHg, 3.9 x 0.9 l/min, and 12 x 1 W, and those for the second calf were maintained at 88 x 13 mmHg, 5.0 x 0.5 l/min, and 16 x 2 W, respectively. These results indicate that the newly developed drive unit may be used as a wearable pneumatic drive unit for the Toyobo VAD blood pump.
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Affiliation(s)
- Akihiko Homma
- The Advanced Medical Engineering Center, National Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
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41
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Nishida H, Nishinaka T, Endo M, Koyanagi H, Oshiyama H, Nogawa A, Akutsu T. Clinical Application of a Newly Developed Autoflow Control System for the Terumo Centrifugal Pump: From External Control to Built-in Direct Control. Artif Organs 2008; 20:625-631. [DOI: 10.1111/j.1525-1594.1996.tb04493.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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Nishinaka T, Nishida H, Endo M, Miyagishima M, Ohtsuka G, Koyanagi H. Less Blood Damage in the Impeller Centrifugal Pump: A Comparative Study with the Roller Pump in Open Heart Surgery. Artif Organs 2008; 20:707-710. [DOI: 10.1111/j.1525-1594.1996.tb04508.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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Yamazaki K, Saito S, Nishinaka T, Nakatani T, Kitamura S, Matsumiya G, Sawa Y, Nishimura T, Ono M, Kyo S. A continuous flow blood pump as a feasible alternative to heart transplantation. J Card Fail 2008. [DOI: 10.1016/j.cardfail.2008.07.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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44
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Yamazaki K, Saito S, Nishinaka T, Kurosawa H, Nakatani T, Kobayashi J, Kitamura S, Matsumiya G, Yoshiki S, Nishimura T, Niinami H, Kyo S. 517: Japanese Clinical Trial Results of an Implantable Centrifugal Blood Pump “EVAHEART”. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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45
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Nishinaka T, Taenaka Y, Tatsumi E, Ohnishi H, Homma A, Shioya K, Mizuno T, Tsukiya T, Mushika S, Hashiguchi Y, Suzuki A, Kitamura S. Development of a compact portable driver for a pneumatic ventricular assist device. J Artif Organs 2007; 10:236-9. [PMID: 18071855 DOI: 10.1007/s10047-007-0389-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Accepted: 05/30/2007] [Indexed: 10/22/2022]
Abstract
The Toyobo-National Cardiovascular Center pneumatic ventricular assist device (Toyobo-NCVC VAD) is widely used in Japan; however, the current pneumatic drivers have some drawbacks, including their large size, heavy weight, and high power consumption. These issues cause difficulty with mobility and contribute to an unsatisfactory quality of life for patients. Because it is urgently necessary to improve patients' safety and quality of life, we have developed a compact, low-noise, portable VAD driver by utilizing an electrohydraulic actuator consisting of a brushless DC motor and a regenerative pump. This unit can be actuated for as long as 2 h with two rechargeable lightweight batteries as well as with external AC power. It is compact in size (33 x 25 x 43 cm) and light in weight (13 kg), and the unit is carried on a mobile wheeled cart. In vitro testing with a Toyobo-NCVC VAD demonstrated a sufficient pumping capacity of up to 8 l/min. We conclude that this newly-developed compact portable driver can provide a better quality of life and improved safety for patients using protracted pneumatic VAD support.
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Affiliation(s)
- Tomohiro Nishinaka
- Department of Artificial Organs, National Cardiovascular Center Research Institute, 5-7-1 Fujishirodai, Suita 565-8565, Japan.
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46
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Yamazaki K, Kurosawa H, Saito S, Nishinaka T, Tomioka H, Miyagishima M, Kitamura S, Nakatani T, Kobayashi J, Funatsu T, Sawa Y, Matsumiya G, Niinami H, Nishimura T, Kyo S. 100% 1.5 Year Survival with Complete Pulsatile High Flow Circulatory Support was Achieved in Japanese Feasibility Study of Implantable Centrifugal LVAD “EVAHEART”. J Card Fail 2007. [DOI: 10.1016/j.cardfail.2007.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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Akagawa E, Lee H, Tatsumi E, Homma A, Tsukiya T, Katagiri N, Kakuta Y, Nishinaka T, Mizuno T, Ota K, Kansaku R, Taenaka Y. Effects of mechanical valve orifice direction on the flow pattern in a ventricular assist device. J Artif Organs 2007; 10:85-91. [PMID: 17574510 DOI: 10.1007/s10047-007-0378-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 01/23/2007] [Indexed: 11/24/2022]
Abstract
We have been developing a pneumatic ventricular assist device (PVAD) system consisting of a diaphragm-type blood pump. The objective of the present study was to evaluate the flow pattern inside the PVAD, which may greatly affect thrombus formation, with respect to the inflow valve-mount orientation. To analyze the change of flow behavior caused by the orifice direction (OD) of the valve, the flow pattern in this pump was visualized. Particle image velocimetry was used as a measurement technique to visualize the flow dynamics. A monoleaflet mechanical valve was mounted in the inlet and outlet ports of the PVAD, which was connected to a mock circulatory loop tester. The OD of the inlet valve was set at six different angles (OD = 0 degrees, 45 degrees, 90 degrees, 135 degrees, 180 degrees, and 270 degrees, where the OD opening toward the diaphragm was defined as 0 degrees ) and the pump rate was fixed at 80 bpm to create a 5.0 l/min flow rate. The main circular flow in the blood pump was affected by the OD of the inlet valve. The observed regional flow velocity was relatively low in the area between the inlet and outlet port roots, and was lowest at an OD of 90 degrees. In contrast, the regional flow velocity in this area was highest at an OD of 135 degrees. The OD is an important factor in optimizing the flow condition in our PVAD in terms of preventing flow stagnation, and the best flow behavior was realized at an OD of 135 degrees.
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Affiliation(s)
- Eiki Akagawa
- Department of Artificial Organs, the Advanced Medical Engineering Center, National Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
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48
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Westaby S, Bertoni GB, Clelland C, Nishinaka T, Frazier OH. Circulatory support with attenuated pulse pressure alters human aortic wall morphology. J Thorac Cardiovasc Surg 2007; 133:575-6. [PMID: 17258608 DOI: 10.1016/j.jtcvs.2006.10.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 10/09/2006] [Indexed: 11/24/2022]
Affiliation(s)
- Stephen Westaby
- Oxford Heart Center, John Radcliffe Hospital, Department of Cardiothoracic Surgery, Oxford, Oxfordshire, United Kingdom
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Akagawa E, Lee H, Tatsumi E, Homma A, Tsukiya T, Katagiri N, Kakuta Y, Mizuno T, Nishinaka T, Ota K, Kansaku R, Taenaka Y. FLOW DYNAMIC ANALYSIS IN A PNEUMATIC VENTRICULAR ASSIST DEVICE: EFFECTS OF VALVE ORIFICE DIRECTION ON STAGNATION REGION. ASAIO J 2006. [DOI: 10.1097/00002480-200603000-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nishinaka T, Schima H, Roethy W, Rajek A, Nojiri C, Wolner E, Wieselthaler GM. The DuraHeart VAD, a Magnetically Levitated Centrifugal Pump The University of Vienna Bridge-to-Transplant Experience. Circ J 2006; 70:1421-5. [PMID: 17062964 DOI: 10.1253/circj.70.1421] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The clinical application of the DuraHeart (Terumo Heart Inc, USA) has begun in Europe as a clinical trial of a third-generation implantable centrifugal blood pump. Four successful clinical implants are presented. METHODS AND RESULTS Four male patients had end-stage left heart failure and received a DuraHeart VAD as a left ventricular assist device for bridge-to-transplantation. The pump showed good performance with flow rates of 4.9+/-0.5 L/min after gradual weaning of extracorporeal circulation. The pump flow was then maintained at 6.1+/-0.5, 5.5+/-0.3, 5.5+/-0.1, 5.7+/-0.1, 5.5, 6.4 and 6.5 L/min at the 1st, 4th, 8th, 12th, 16th, 20th and 24th postoperative week, respectively. No significant elevation of mean plasma-free hemoglobin was detected. The patients were discharged on the 18th, 42nd, 41st and 31st postoperative day, respectively, and all were successfully transplanted on the 202nd, 84th, 128th and 96th postoperative day, respectively. At the time of transplant surfaces of the removed pumps were free from thrombus formation, although intraventricular pannus growth was observed around the inflow cannulae in all patients. CONCLUSION The DuraHeart VAD showed stable and sufficient circulatory support for the bridge-to-transplant procedure in this cohort of 4 patients.
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Affiliation(s)
- Tomohiro Nishinaka
- Department of Cardiothoracic Surgery, Medical University of Vienna, A-1090 Vienna, Austria
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