Extracellular vesicles for treatment of solid organ ischemia-reperfusion injury.

As the incidence of ischemia-reperfusion (I-R) injury has substantially increased, there is a pressing need to develop effective strategies to treat this global health issue. I-R injury can affect all organs and is associated with high morbidity and mortality rates. Pathological settings such as myocardial infarction, stroke, hemorrhagic shock, and solid organ transplant are particularly prone to cause I-R injury. Ischemia (hypoxia) and/or reperfusion (reoxygenation) induces various forms of cellular and structural damage. A major cause of damage is local inflammatory responses, which may spread to produce more advanced systemic inflammation. Management of I-R injury relies primarily on supportive measures, as specific treatment strategies are lacking. Extracellular vesicles (EVs) are cell-secreted nano-scale structures containing various biomolecules involved in cell communication and multiple physiological processes. EVs derived from certain cell types have been shown to exhibit anti-inflammatory, antioxidant, and angiogenic properties. This review provides an overview of EV-based therapeutics for I-R injury in kidneys, liver, heart, lungs, and brain. Additionally, the mechanisms by which EVs protect against I-R injury are discussed. Promising preclinical findings highlight the potential clinical use of EVs for I-R injury.

Absorbable antibiotic beads as an adjuvant therapy in treating ventricular assist devices driveline infection: A case report.

BACKGROUND: Ventricular assist devices driveline infections are common, recalcitrant, and carry high morbidity and mortality. Herein, we reported a patient with driveline infection that was successfully treated with a combination of systemic antibiotics, surgical debridement, and instillation of absorbable antibiotic beads to the wound bed. METHODS AND RESULTS: A 39-year-old man with nonischemic cardiomyopathy underwent insertion of a continuous flow left ventricular assist device. Four years postoperatively, the patient presented with clinical, laboratory, and radiologic signs of driveline tract infection. He underwent extensive surgical debridement, installation of absorbable antibiotic beads that consisted of calcium sulfate, vancomycin, and tobramycin, into the wound bed, and systemic antibiotics. The patient was free of infection 9 month postoperatively. CONCLUSION: Absorbable calcium sulfate antibiotic beads may serve as a beneficial adjunct to surgical debridement and systemic antibiotics for the treatment of ventricular assist device driveline infection, and merit further investigation.

Three-dimensional printing facilitates surgical planning for resection of an atypical cardiac myxoma.

BACKGROUND: Cardiac myxomas are common and account for 50% of primary intracardiac tumors. Atypical locations of cardiac myxoma increase the risk of intraoperative iatrogenic injuries. Herein, we report a case of using three-dimensional printing (3D) to facilitate the removal of an atypical cardiac myxoma in a 63-year-old woman. METHODS AND RESULTS: Mass in the high posterior atrial septum was confirmed through imaging. Due to the potential involvement of the mass to surrounding vital structures, 3D printing of the cardiac mass was performed. The tumor was completely resected via median sternotomy and the resulting defect was repaired with the bovine pericardium. The patient had an uncomplicated postoperative course except for the development of sick sinus syndrome. One-year follow-up showed no tumor recurrent. CONCLUSION: 3D printing technology in patients with atypical cardiac tumors enhances our understanding of the extent of the tumor invasion and facilitates planning the operation to avoid intraoperative complications.

Autologous Blood Patching to Mitigate Persistent Air Leaks Following Pulmonary Resection: A Novel Approach.

Background Autologous blood patch (ABP) utilized as a visceral pleural sealant for air leak post lung resection has been well documented in medical literature. Purpose To present our experience of a novel approach, we employed to instill autologous blood into the pleural space to mitigate persistent air leaks following pulmonary resection. Methods From January 2007 to September 2011, 19 patients were submitted to autologous blood patching for persistent air leaks following surgery. Demographic and surgical characteristics were collected at baseline. Blood patching measures were recorded at the time of the event. Continuous variables were summarized with median and range while categorical measures were summarized with frequency and percent. Due to the small sample size and descriptive nature of this study, no hypothesis tests were performed. All analyses were conducted using R Statistical Software.  Results The median age of patients who required a blood patch for a persistent air leak was 67.9 (Range: 50.3-78.7) years and 11 (57.9%) were males and 8 (42.1%) were females. The majority (78.9%) of the patients' first surgery was mass resection and 4 (21.1%) had a lung volume reduction. Seven (36.7%) required a re-do surgery, and almost all (89.5%) had 28 mm chest tubes used during surgery. The majority or 63.2% (N=12) of the patient's air leaks were classified as moderate, 21.1% (N=4) as severe, 15.8% as mild (N=3); twelve (63.2%) required one attempt for a successful blood patch, 6 (31.6%) required two attempts, and one (5.3%) required three which were all unsuccessful. The median number of days from detecting air leaks to blood patch for the air leak that required two attempts was 9 (Range: 8, 23) days for lung volume reduction patients and 16 (Range: 6, 26 ) days for mass resection patients. Conclusion Blood patching remains an effective bedside strategy that can be carried out with minimal risk. We believe opportunities exist to further advance the method of delivering blood as an autologous sealant to mitigate persistent air leaks (PAL).

Use of Omental Flap for Treating Cardiocutaneous Fistula After Ventricular Aneurysm Repair.

Infection of an endoventricular patch used for left ventricular aneurysm repair with formation of cardiocutaneous fistula is a rare but potentially serious complication. We report an adult patient who developed a cardiocutaneous fistula 1 year after repair of a third left ventricular aneurysm. The patient was successfully treated with a redo operation using a bovine pericardial patch with omental flap coverage. He is alive and well 10 years later.

Refractory chylous effusions in lymphangioleiomyomatosis patient post lung transplant.

Lymphangioleiomyomatosis is a rare systemic disorder of unknown etiology that affects young women almost exclusively. Chylous effusions are known to be associated with lymphangioleiomyomatosis and may be difficult to treat. We present the case of a 37-year-old female who received bilateral lung transplantation for lymphangioleiomyomatosis complicated by refractory chylothorax and chylous ascites, ultimately controlled through repeated, open surgical procedures and percutaneous lymphatic embolization interventions. The combined surgical and interventional radiological approach, while not novel in their own right, suggests that a multi-modal interventional approach may be required in refractory cases.