Artificial organs
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This is a retrospective cohort study to determine if routine intra-aortic balloon pump (IABP) placement prior to aortic valve replacement in elderly patients with severe aortic stenosis without significant coronary artery stenosis reduces cardiac complications. Participants were patients aged ≥70 years without significant coronary stenosis, who had severe aortic stenosis, and were undergoing isolated aortic valve replacement. Our primary endpoint was postoperative cardiac morbidity rate as a composite of the adverse cardiac events: elevated creatine kinase with muscle and brain subunits (CK-MB)/CK (>5%), fatal ventricular arrhythmias requiring therapy, or catecholamine index of >10. ⋯ According to multivariate analysis using a logistic European system for cardiac operative risk evaluation value of >10% to define increased morbidity, elective IABP use significantly reduced cardiac morbidity (odds ratio, 0.11; 95% confidence interval, 0.02-0.67; P = 0.016). Additionally, the elective IABP group was more likely to show low CK-MB/CK than the non-IABP group (4.1 ± 1.9% vs. 6.1 ± 3.1%, respectively, P = 0.026). We concluded that among elderly aortic valve replacement patients without significant coronary artery stenosis, elective IABP use may reduce the incidence of major adverse cardiac events.
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The new generation of left ventricular assist devices (LVADs) has enabled minimally invasive surgical procedures for implantation. Herein we present two alternative approaches for minimally invasive LVAD explantation following cardiac recovery, avoiding a sternotomy and improving patient safety.
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Long-term mechanical circulatory assistance opened new problems in ventricular assist device-patient interaction, especially in relation to autonomic controls. Modeling studies, based on adequate models, could be a feasible approach of investigation. The aim of this work is the exploitation of a hybrid (hydronumerical) cardiovascular simulator to reproduce and analyze in vivo experimental data acquired during a continuous flow left ventricular assistance. ⋯ Results show that the simulator is able to reproduce animal-specific hemodynamic status both in physiological and pathological conditions, to reproduce cardiovascular left ventricular assist device (LVAD) interaction and the progressive unloading of the left ventricle for different pump speeds, and to investigate the effects of the LVAD on baroreflex activity. Results in chronic heart failure conditions show that an increment of LVAD speed from 20 000 to 22 000 rpm provokes a decrement of left ventricular flow of 35% (from 2 to 1.3 L/min). Thanks to its flexibility and modular structure, the simulator is a platform potentially useful to test different assist devices, thus providing clinicians additional information about LVAD therapy strategy.
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Letter Case Reports
HVAD implantation in right atrium-to-right pulmonary artery configuration.