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Lyu L, Yao J, Gao G, Long C, Hei F, Ji B, Liu J, Yu K, Hu Q, Hu J. Incidence, Risk Factors, and Outcomes of Hyperbilirubinemia in Adult Cardiac Patients Supported by Veno-Arterial ECMO. Artif Organs 2017; 42:148-154. [PMID: 28877352 DOI: 10.1111/aor.12979] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/10/2017] [Revised: 03/26/2017] [Accepted: 04/26/2017] [Indexed: 12/12/2022]
Abstract
The aims of this study were to evaluate the incidence, risk factors, and outcomes of hyperbilirubinemia in cardiac patients with veno-arterial (VA) ECMO. Data on 89 adult patients with cardiac diseases who received VA ECMO implantation in our hospital were retrospectively reviewed. All patients were divided into the following three groups: 24 in normal group (N, total bilirubin [TBIL] ≤3 mg/dL), 30 in high bilirubin group (HB, 6 mg/dL ≥ TBIL > 3 mg/dL), and 35 in severe high bilirubin group (SHB, TBIL > 6 mg/dL). lg(variables + 1) was performed for nonnormally distributed variables. The incidence of hyperbilirubinemia (>3 mg/dL) was 73%. In a multiple linear regression analysis, lg(peak TBIL + 1) was significantly associated with lg(peak AST + 1) (b-coefficient 0.188, P = 0.001), lg(peak pFHb + 1) (b-coefficient 0.201, P = 0.003), and basic TBIL (b-coefficient 0.006, P = 0.009). Repeated measurement analysis of variance revealed that the main effect for three groups in pFHb and lg(AST + 1) was significant at first 3 days during ECMO. The patients in SHB had low platelets during ECMO and low in-hospital survival rate. Hyperbilirubinemia remains common in patients with VA ECMO and is associated with low platelets and high in-hospital mortality. Hemolysis and liver dysfunction during ECMO and basic high bilirubin levels are risk factors of hyperbilirubinemia.
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Affiliation(s)
- Lin Lyu
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jingxin Yao
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Guodong Gao
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Cun Long
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Feilong Hei
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bingyang Ji
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jinping Liu
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Kun Yu
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qiang Hu
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jinxiao Hu
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Goda M, Yabu N, Tominaga N, Machida D, Isomatsu Y, Suzuki S, Nitta M, Komura N, Nakayama N, Kiyokuni M, Sugano T, Masuda M. The AB Portable Driver Generates Higher Drive-Line Pressures Possibly Leading to Accelerated Hemolysis. Artif Organs 2017; 42:235-239. [PMID: 28853178 DOI: 10.1111/aor.12990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/15/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 12/30/2022]
Abstract
The AB5000 Circulatory Support System is paracorporeal pulsatile ventricular assist device. The AB Portable Driver is a portable console for this system. We experienced two cases with accelerated hemolysis while receiving support by the AB Portable Driver. The purpose of this study was to clarify the mechanical differences associated with the hemolysis between the AB5000 console and the AB Portable Driver. The mock circulatory system modeled by an AB5000 ventricle and a blood sampling bag of vinyl chloride was run with an AB5000 console or AB Portable Driver. The peak drive-line pressure, the mean arterial cannula pressure and the pumping rate of the VAD were recorded. The AB5000 console generated a peak drive-line pressure of 280-300 mm Hg in LVAD mode and 210-220 mm Hg in RVAD mode, approximately 100 mm Hg lower than officially documented. In contrast, the AB Portable Driver generated pressures of 310-330 mm Hg in LVAD mode and 230-250 mm Hg in RVAD mode, 65-95 mm Hg higher than officially documented. The AB Portable Driver console generates higher drive-line pressures than the AB5000 console, possibly explaining the accelerated hemolysis.
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Affiliation(s)
- Motohiko Goda
- Department of Cardiovascular Surgery, Yokohama City University, Yokohama, Japan
| | - Naoto Yabu
- Department of Cardiovascular Surgery, Yokohama City University, Yokohama, Japan
| | - Norihisa Tominaga
- Department of Cardiovascular Surgery, Yokohama City University, Yokohama, Japan
| | - Daisuke Machida
- Department of Cardiovascular Surgery, Yokohama City University, Yokohama, Japan
| | - Yukihisa Isomatsu
- Department of Cardiovascular Surgery, Yokohama City University, Yokohama, Japan
| | - Shinichi Suzuki
- Department of Cardiovascular Surgery, Yokohama City University, Yokohama, Japan
| | - Manabu Nitta
- Department of Cardiology, Yokohama City University, Yokohama, Japan
| | - Naohiro Komura
- Department of Cardiology, Yokohama City University, Yokohama, Japan
| | - Naoki Nakayama
- Department of Cardiology, Yokohama City University, Yokohama, Japan
| | | | - Teruyasu Sugano
- Department of Cardiology, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Cardiovascular Surgery, Yokohama City University, Yokohama, Japan
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3
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Stephens AF, Stevens MC, Gregory SD, Kleinheyer M, Salamonsen RF. In Vitro Evaluation of an Immediate Response Starling-Like Controller for Dual Rotary Blood Pumps. Artif Organs 2017; 41:911-922. [PMID: 28741664 DOI: 10.1111/aor.12962] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/05/2016] [Revised: 03/26/2017] [Accepted: 04/12/2017] [Indexed: 11/30/2022]
Abstract
Rotary ventricular assist devices (VADs) are used to provide mechanical circulatory support. However, their lack of preload sensitivity in constant speed control mode (CSC) may result in ventricular suction or venous congestion. This is particularly true of biventricular support, where the native flow-balancing Starling response of both ventricles is diminished. It is possible to model the Starling response of the ventricles using cardiac output and venous return curves. With this model, we can create a Starling-like physiological controller (SLC) for VADs which can automatically balance cardiac output in the presence of perturbations to the circulation. The comparison between CSC and SLC of dual HeartWare HVADs using a mock circulation loop to simulate biventricular heart failure has been reported. Four changes in cardiovascular state were simulated to test the controller, including a 700 mL reduction in circulating fluid volume, a total loss of left and right ventricular contractility, reduction in systemic vascular resistance ( SVR) from 1300 to 600 dyne s/cm5, and an elevation in pulmonary vascular resistance ( PVR) from 100 to 300 dyne s/cm5. SLC maintained the left and right ventricular volumes between 69-214 mL and 29-182 mL, respectively, for all tests, preventing ventricular suction (ventricular volume = 0 mL) and venous congestion (atrial pressures > 20 mm Hg). Cardiac output was maintained at sufficient levels by the SLC, with systemic and pulmonary flow rates maintained above 3.14 L/min for all tests. With the CSC, left ventricular suction occurred during reductions in SVR, elevations in PVR, and reduction in circulating fluid simulations. These results demonstrate a need for a physiological control system and provide adequate in vitro validation of the immediate response of a SLC for biventricular support.
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Affiliation(s)
- Andrew F Stephens
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Engineering, Griffith University, QLD, Australia
| | - Michael C Stevens
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Graduate School of Biomedical Engineering, University of New South Wales, NSW, Australia.,Sydney Medical School, University of Sydney, NSW, Australia
| | - Shaun D Gregory
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Engineering, Griffith University, QLD, Australia.,School of Medicine, University of Queensland, QLD, Australia
| | - Matthias Kleinheyer
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Engineering, Griffith University, QLD, Australia
| | - Robert F Salamonsen
- Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia.,Intensive Care Unit, Alfred Hospital, Prahran, VIC, Australia
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Campos Arias D, Londono F, Rodríguez Moliner T, Georgakopoulos D, Stergiopulos N, Segers P. Hemodynamic Impact of the C-Pulse Cardiac Support Device: A One-Dimensional Arterial Model Study. Artif Organs 2017; 41:E141-E154. [PMID: 28548693 DOI: 10.1111/aor.12922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 05/30/2016] [Revised: 11/22/2016] [Accepted: 01/04/2017] [Indexed: 01/09/2023]
Abstract
The C-Pulse is a novel extra-aortic counter-pulsation device to unload the heart in patients with heart failure. Its impact on overall hemodynamics, however, is not fully understood. In this study, the function of the C-Pulse heart assist system is implemented in a one-dimensional (1-D) model of the arterial tree, and central and peripheral pressure and flow waveforms with the C-Pulse turned on and off were simulated. The results were studied using wave intensity analysis and compared with in vivo data measured non-invasively in three patients with heart failure and with invasive data measured in a large animal (pig). In all cases the activation of the C-Pulse was discernible by the presence of a diastolic augmentation in the pressure and flow waveforms. Activation of the device initiates a forward traveling compression wave, whereas a forward traveling expansion wave is associated to the device relaxation, with waves exerting an action in the coronary and the carotid vascular beds. We also found that the stiffness of the arterial tree is an important determinant of action of the device. In settings with reduced arterial compliance, the same level of aortic compression demands higher values of external pressure, leading to stronger hemodynamic effects and enhanced perfusion. We conclude that the 1-D model may be used as an efficient tool for predicting the hemodynamic impact of the C-Pulse system in the entire arterial tree, complementing in vivo observations.
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Affiliation(s)
- Daimé Campos Arias
- IBiTech-bioMMeda, Ghent University, Ghent, Belgium.,Universidad Tecnológica de La Habana José Antonio Echeverría (Cujae), Biomechanics and Biomaterials Research Group, Havana, Cuba
| | | | - Tania Rodríguez Moliner
- Universidad Tecnológica de La Habana José Antonio Echeverría (Cujae), Biomechanics and Biomaterials Research Group, Havana, Cuba
| | | | - Nikos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology (LHTC), Ecole Polytechnique Fédérale de Lausanne, Lausanne Switzerland
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Crosby JR, DeCook KJ, Tran PL, Betterton E, Smith RG, Larson DF, Khalpey ZI, Burkhoff D, Slepian MJ. A Physical Heart Failure Simulation System Utilizing the Total Artificial Heart and Modified Donovan Mock Circulation. Artif Organs 2016; 41:E52-E65. [PMID: 27935084 DOI: 10.1111/aor.12808] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 05/02/2016] [Revised: 06/21/2016] [Accepted: 06/30/2016] [Indexed: 01/11/2023]
Abstract
With the growth and diversity of mechanical circulatory support (MCS) systems entering clinical use, a need exists for a robust mock circulation system capable of reliably emulating and reproducing physiologic as well as pathophysiologic states for use in MCS training and inter-device comparison. We report on the development of such a platform utilizing the SynCardia Total Artificial Heart and a modified Donovan Mock Circulation System, capable of being driven at normal and reduced output. With this platform, clinically relevant heart failure hemodynamics could be reliably reproduced as evidenced by elevated left atrial pressure (+112%), reduced aortic flow (-12.6%), blunted Starling-like behavior, and increased afterload sensitivity when compared with normal function. Similarly, pressure-volume relationships demonstrated enhanced sensitivity to afterload and decreased Starling-like behavior in the heart failure model. Lastly, the platform was configured to allow the easy addition of a left ventricular assist device (HeartMate II at 9600 RPM), which upon insertion resulted in improvement of hemodynamics. The present configuration has the potential to serve as a viable system for training and research, aimed at fostering safe and effective MCS device use.
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Affiliation(s)
| | | | - Phat L Tran
- Biomedical Engineering GIDP, University of Arizona, Tucson, AZ.,Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ.,Artificial Heart Department, Banner University Medical Center, University of Arizona, Tucson, AZ
| | - Edward Betterton
- Artificial Heart Department, Banner University Medical Center, University of Arizona, Tucson, AZ
| | - Richard G Smith
- Biomedical Engineering GIDP, University of Arizona, Tucson, AZ.,Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ.,Artificial Heart Department, Banner University Medical Center, University of Arizona, Tucson, AZ
| | | | - Zain I Khalpey
- Department of Surgery, University of Arizona, Tucson, AZ
| | | | - Marvin J Slepian
- Biomedical Engineering GIDP, University of Arizona, Tucson, AZ.,Department of Biomedical Engineering, University of Arizona, Tucson, AZ.,Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ
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