Artificial organs
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Comparative Study
Pulsatile venoarterial perfusion using a novel synchronized cardiac assist device augments coronary artery blood flow during ventricular fibrillation.
Patients with cardiogenic shock have a very high mortality. Here we report the first use of a percutaneous pulsatile cardiac assist device, based on a diagonal pump synchronized with the heart cycle by means of an electrocardiographic signal in adult pigs. Eight domestic pigs underwent mandatory ventilation. ⋯ Percutaneous cardiac support using a venoarterial cardiac assist device equipped with a novel diagonal pump is able to restore and increase systemic and coronary circulation during ventricular fibrillation. Electrocardiographically triggered synchronized cardiac assist provides an additional increase of coronary artery flow. These promising results are to be confirmed in humans.
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Comparative Study
Evaluation of conventional nonpulsatile and novel pulsatile extracorporeal life support systems in a simulated pediatric extracorporeal life support model.
The objective of this study is to evaluate two extracorporeal life support (ECLS) circuits and determine the effect of pulsatile flow on pressure drop, flow/pressure waveforms, and hemodynamic energy levels in a pediatric pseudopatient. One ECLS circuit consisted of a Medos Deltastream DP3 diagonal pump and Hilite 2400 LT oxygenator with arterial/venous tubing. The second circuit consisted of a Maquet RotaFlow centrifugal pump and Quadrox-iD Pediatric oxygenator with arterial/venous tubing. ⋯ The Deltastream DP3 pump also demonstrated consistently higher total hemodynamic energy at the pre-oxygenator site in pulsatile mode and a lesser pressure drop across the oxygenator. The Deltastream DP3 pump generated physiological pulsatility without backflow and provided increased hemodynamic energy. This novel ECLS circuit demonstrates suitable in vitro performance and adaptability to a wide range of pediatric patients.
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The objective of this clinical study is to determine whether correlation exists among cerebral and renal near-infrared spectroscopy (NIRS) measurements, renal Doppler ultrasonography parameters (resistive index, peak systolic velocity), and early postoperative clinical outcomes following cardiac surgery in neonates and infants. Thirty-seven patients undergoing surgery for congenital heart defects with an age of less than 3 months, all of whom were in the high-risk group according to Aristotle Basic Complexity risk stratification score, were enrolled in our study. Cerebral, renal NIRS values and renal Doppler ultrasonography measurements were recorded for each patient at the 4th postoperative hour. ⋯ The lactate levels were significantly higher in Group I (P = 0.049), as well. The postoperative intensive care unit and hospital stay of Group I was significantly higher than Group II (P = 0.048). Both cerebral and renal NIRS values and the assessment of renal RI as well as peak systolic values can be used in order to predict the early clinical outcome in cardiac surgery patients in early infantile and neonatal period.
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Comparative Study
In vitro hemodynamic evaluation of a novel pulsatile extracorporeal life support system: impact of perfusion modes and circuit components on energy loss.
The objective of this study is to investigate the impact of every component of extracorporeal life support (ECLS) circuit on hemodynamic energy transmission in terms of energy equivalent pressure (EEP), total hemodynamic energy (THE), and surplus hemodynamic energy (SHE) under nonpulsatile and pulsatile modes in a novel ECLS system. The ECLS circuit consisted of i-cor diagonal pump and console (Xenios AG, Heilbronn, Germany), an iLA membrane ventilator (Xenios AG), an 18 Fr femoral arterial cannula, a 23/25 Fr femoral venous cannula, and 3/8-in ID arterial and venous tubing. The circuit was primed with lactated Ringer's solution and human whole blood (hematocrit 33%). ⋯ The iLA membrane ventilator is a low-resistance oxygenator, and allows more hemodynamic energy to be delivered to the patient under pulsatile mode. The 18 Fr femoral arterial cannula has acceptable pressure drops under nonpulsatile and pulsatile modes. Further in vivo studies are warranted to confirm these results.
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Comparative Study
Evaluation of different diameter arterial tubing and arterial cannulae in simulated neonatal/pediatric cardiopulmonary bypass circuits.
The objective of this study is to evaluate three different diameters of arterial tubing and three diameters of arterial cannulae in terms of pressure drop, and hemodynamic energy delivery in simulated neonatal/pediatric cardiopulmonary bypass (CPB) circuits. The CPB circuit consisted of a Terumo Capiox Baby FX05 oxygenator (Terumo Corporation, Tokyo, Japan), arterial tubing (1/4 in, 3/16 in, or 1/8 in × 150 cm), and a Medtronic Bio-Medicus arterial cannula (8, 10, or 12 Fr; Medtronic, Inc., Minneapolis, MN, USA). The pseudo patient's pressure was maintained at 50 mm Hg. ⋯ High flow rate, hypothermia, small diameter arterial tubing. and arterial cannula created more hemodynamic energy at the preoxygenator site, but energy loss across CPB circuit also increased. Although small diameter (<1/4 in ID) arterial tubing may decrease total CPB priming volume, it also led to significantly higher circuit pressure, higher pressure drop, and more hemodynamic energy loss across CPB circuit. Larger diameter arterial cannula had less pressure drop and allowed more hemodynamic energy delivery to the patient.