Pulsatile ventricular assist device as a bridge to transplant for the early high-risk single-ventricle physiology.

BACKGROUND: The use of ventricular assist devices (VADs) as a bridge-to-transplant in patients with single-ventricle physiology post-stage one palliation has been associated with poor outcomes. We describe our center's successful experience in the use of paracorporeal pulsatile VADs in the palliation of high-risk single ventricle physiology before or after the first stage of palliation with an impetus on pre-palliation implant. METHODS: This is a single-center retrospective review of univentricular patients implanted with the Berlin Heart EXCOR VAD. Our center's approach includes early implantation of the Berlin Heart EXCOR with common atrial cannulation, a cardiac index between 3.5 and 5 L/min/m2, and a bivalirudin-based anticoagulation regimen. Patient-related data were collected postimplant at week 1 and months 1, 2, and 3. Post-transplant data, including neurological outcomes, were collected. RESULTS: Nine patients were supported. Survival to discharge post-transplant was 83% (5/6) in patients bridged-to-transplant and 33% (1/3) in patients bridged-to-decision. Six patients had no previous palliation. Median hospital stay before implantation was 111 days for nonsurvivors versus 20 days for survivors. The need for extracorporeal membrane oxygenation and cardiopulmonary resuscitation in nonsurvivors versus survivors was 1 in 3 versus 1 in 6 and 2 in 3 versus 1 in 6, respectively. There were no major central nervous system complications except for 1 significant hemorrhagic event. The pediatric overall performance category score on follow-up was normal to mild disability in 83% of survivors. Limitations include hemolysis and intermittent periods of infection and/or inflammation. CONCLUSIONS: The use of pulsatile paracorporeal VADs is a feasible option as a bridge-to-transplant in the peri-stage one high-risk single ventricle.

Using live cells to generate aptamers for cancer study.

Aptamers are ssDNA, RNA, or modified nucleic acids, usually consisting of short strands of oligonucleotides. Aptamers have the ability to bind specifically to a range of targets, from small organic molecules to proteins. However, by using cell-based aptamer selection, we have developed a strategy to identify the molecular signatures on the surface of targeted cells by exploiting the differences at the molecular level between any two given cell types. By applying this method, we have generated a panel of aptamers for the specific recognition of leukemia cells, and we report the results in this study. The selected aptamers were found to bind to target cells with an equilibrium dissociation constant (K (d)) in the nanomolar-to-picomolar range. Overall, the cell-based selection process is simple, fast, straightforward, and reproducible. Most importantly, since this strategy can be implemented without prior knowledge of a target's specific molecular signature, cell-based aptamer selection holds great promise for the development of specific molecular probes for cancer diagnosis and cancer biomarker discovery.