Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.721
Filtrar
1.
PLoS One ; 15(10): e0239604, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33044976

RESUMO

Demand for heart transplants far exceeds supply of donated organs. This is attributed to the high percentage of donor hearts that are discarded and to the narrow six-hour time window currently available for transplantation. Ex-vivo heart perfusion (EVHP) provides the opportunity for resuscitation of damaged organs and extended transplantation time window by enabling functional assessment of the hearts in a near-physiologic state. Present work investigates the fluid mechanics of the ex-vivo flow loop and corresponding impact on cardiac performance. A mechanical flow loop is developed that is analogous to the region of the EVHP system that mimics in-vivo systemic circulation, including the body's largest and most compliant artery, the aorta. This investigation is focused on determining the effect of mock aortic tubing compliance on pump performance. A custom-made silicone mock aorta was developed to simulate a range of in-vivo conditions and a physiological flow was generated using a commercial ventricular assist device (VAD). Monitored parameters, including pressure, tube distension and downstream velocity, acquired using time-resolved particle imaging velocimetry (PIV), were applied to an unsteady Bernoulli analysis of the flow in a novel way to evaluate pump performance as a proxy for cardiac workload. When compared to the rigid case, the compliant mock aorta case demonstrated healthier physiologic pressure waveforms, steadier downstream flow and reduced energetic demands on the pump. These results provide experimental verification of Windkessel theory and support the need for a compliant mock aorta in the EVHP system.


Assuntos
Aorta/fisiologia , Transplante de Coração/métodos , Modelos Cardiovasculares , Complacência (Medida de Distensibilidade) , Circulação Extracorpórea , Coração Auxiliar , Hemodinâmica , Humanos , Técnicas In Vitro , Preservação de Órgãos/instrumentação , Preservação de Órgãos/métodos , Perfusão/instrumentação , Perfusão/métodos , Doadores de Tecidos , Obtenção de Tecidos e Órgãos
2.
Internist (Berl) ; 61(10): 1010-1016, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32897403

RESUMO

BACKGROUND: Despite ongoing development, mortality in sepsis remains considerable. Various techniques for extracorporeal cytokine removal have been described, but evidence remains conflicting. OBJECTIVES: The aim of this article is to summarize currently used extracorporeal blood purification techniques and their evidence. METHODS: Non-systematic literature review RESULTS: There are currently various blood purification techniques used with different levels of evidence regarding cytokine removal, vasopressor sparing effects and reduction of mortality, including high-volume dialysis with and without high cut-off filters, special adsorption filters (including CytoSorb®, CytoSorbents Europe, Berlin, Germany, and polymyxin­B filters). There is development regarding therapeutic plasma exchange. For some blood purification techniques such as combined plasma filtration and adsorption, multicentric randomized studies found a negative effect on survival. CONCLUSIONS: Despite a theoretical rationale, the use of blood purification methods cannot be recommended for sepsis patients due to the lack of evidence of their efficacy. Heterogeneous inflammatory responses in sepsis render conduction of larger trials difficult. Thus, future studies should cautiously identify appropriate sepsis subtypes to be included. Available techniques should be chosen as individualized complementary treatments and not as competing systems.


Assuntos
Circulação Extracorpórea/métodos , Hemofiltração , Sepse/terapia , Humanos
3.
BMC Nephrol ; 21(1): 356, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32819292

RESUMO

BACKGROUND: Extracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because of its beneficial impact on elimination of inflammatory cytokines. METHODS: This controlled trial has been conducted on critically ill COVID-19 patients admitted in the state hospital affiliated to Babol University of Medical Sciences, Iran who received different antiviral and antibacterial drugs, and different modalities of respiratory treatments and did not have positive clinical improvement. No randomization and blindness was considered. All of the participants underwent three sessions of resin-directed hemoperfusion using continuous renal replacement therapy with a mode of continuous venovenous hemofiltration (CVVH). RESULTS: Five men and five women with a mean age of 57.30 ± 18.07 years have been enrolled in the study; and six of them have improved after the intervention. Peripheral capillary oxygen saturation (SpO2) changed after each session. Mean SpO2 before the three sessions of hemoperfusion was 89.60% ± 3.94% and increased to 92.13% ± 3.28% after them (p < 0.001). Serum IL-6 showed a reduction from 139.70 ± 105.62 to 72.06 ± 65.87 pg/mL (p = 0.073); and c-reactive protein decreased from 136.25 ± 84.39 to 78.25 ± 38.67 mg/L (P = 0.016). CONCLUSIONS: Extracorporeal hemoadsorption could improve the general condition in most of recruited patients with severe coronavirus disease; however, large prospective multicenter trials in carefully selected patients are needed to definitely evaluate the efficacy of hemoperfusion in COVID-19 patients. TRIAL REGISTRATION: The research protocol has been registered in the website of Iranian Registry of Clinical Trials with the reference number IRCT20150704023055N2 .


Assuntos
Betacoronavirus , Infecções por Coronavirus/sangue , Infecções por Coronavirus/terapia , Circulação Extracorpórea/métodos , Hemofiltração/métodos , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Terapia de Substituição Renal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Resultado do Tratamento
4.
Crit Care ; 24(1): 490, 2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32768001

RESUMO

BACKGROUND: With recent advances in technology, patients with acute respiratory distress syndrome (ARDS) and severe acute exacerbations of chronic obstructive pulmonary disease (ae-COPD) could benefit from extracorporeal CO2 removal (ECCO2R). However, current evidence in these indications is limited. A European ECCO2R Expert Round Table Meeting was convened to further explore the potential for this treatment approach. METHODS: A modified Delphi-based method was used to collate European experts' views to better understand how ECCO2R therapy is applied, identify how patients are selected and how treatment decisions are made, as well as to identify any points of consensus. RESULTS: Fourteen participants were selected based on known clinical expertise in critical care and in providing respiratory support with ECCO2R or extracorporeal membrane oxygenation. ARDS was considered the primary indication for ECCO2R therapy (n = 7), while 3 participants considered ae-COPD the primary indication. The group agreed that the primary treatment goal of ECCO2R therapy in patients with ARDS was to apply ultra-protective lung ventilation via managing CO2 levels. Driving pressure (≥ 14 cmH2O) followed by plateau pressure (Pplat; ≥ 25 cmH2O) was considered the most important criteria for ECCO2R initiation. Key treatment targets for patients with ARDS undergoing ECCO2R included pH (> 7.30), respiratory rate (< 25 or < 20 breaths/min), driving pressure (< 14 cmH2O) and Pplat (< 25 cmH2O). In ae-COPD, there was consensus that, in patients at risk of non-invasive ventilation (NIV) failure, no decrease in PaCO2 and no decrease in respiratory rate were key criteria for initiating ECCO2R therapy. Key treatment targets in ae-COPD were patient comfort, pH (> 7.30-7.35), respiratory rate (< 20-25 breaths/min), decrease of PaCO2 (by 10-20%), weaning from NIV, decrease in HCO3- and maintaining haemodynamic stability. Consensus was reached on weaning protocols for both indications. Anticoagulation with intravenous unfractionated heparin was the strategy preferred by the group. CONCLUSIONS: Insights from this group of experienced physicians suggest that ECCO2R therapy may be an effective supportive treatment for adults with ARDS or ae-COPD. Further evidence from randomised clinical trials and/or high-quality prospective studies is needed to better guide decision making.


Assuntos
Dióxido de Carbono/sangue , Circulação Extracorpórea/métodos , Unidades de Terapia Intensiva , Doença Pulmonar Obstrutiva Crônica/terapia , /terapia , Consenso , Técnica Delfos , Europa (Continente) , Humanos
5.
Nat Med ; 26(7): 1102-1113, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32661401

RESUMO

Patients awaiting lung transplantation face high wait-list mortality, as injury precludes the use of most donor lungs. Although ex vivo lung perfusion (EVLP) is able to recover marginal quality donor lungs, extension of normothermic support beyond 6 h has been challenging. Here we demonstrate that acutely injured human lungs declined for transplantation, including a lung that failed to recover on EVLP, can be recovered by cross-circulation of whole blood between explanted human lungs and a Yorkshire swine. This xenogeneic platform provided explanted human lungs a supportive, physiologic milieu and systemic regulation that resulted in functional and histological recovery after 24 h of normothermic support. Our findings suggest that cross-circulation can serve as a complementary approach to clinical EVLP to recover injured donor lungs that could not otherwise be utilized for transplantation, as well as a translational research platform for immunomodulation and advanced organ bioengineering.


Assuntos
Lesão Pulmonar Aguda/terapia , Transplante de Pulmão/métodos , Pulmão/irrigação sanguínea , Preservação de Órgãos/métodos , Lesão Pulmonar Aguda/sangue , Lesão Pulmonar Aguda/fisiopatologia , Animais , Circulação Extracorpórea/métodos , Humanos , Pulmão/fisiopatologia , Perfusão/métodos , Suínos , Doadores de Tecidos
6.
J Biomed Mater Res A ; 108(10): 1974-1990, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32662571

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has revealed major shortcomings in our ability to mitigate transmission of infectious viral disease and provide treatment to patients, resulting in a public health crisis. Within months of the first reported case in China, the virus has spread worldwide at an unprecedented rate. COVID-19 illustrates that the biomaterials community was engaged in significant research efforts against bacteria and fungi with relatively little effort devoted to viruses. Accordingly, biomaterials scientists and engineers will have to participate in multidisciplinary antiviral research over the coming years. Although tissue engineering and regenerative medicine have historically dominated the field of biomaterials, current research holds promise for providing transformative solutions to viral outbreaks. To facilitate collaboration, it is imperative to establish a mutual language and adequate understanding between clinicians, industry partners, and research scientists. In this article, clinical perspectives are shared to clearly define emerging healthcare needs that can be met by biomaterials solutions. Strategies and opportunities for novel biomaterials intervention spanning diagnostics, treatment strategies, vaccines, and virus-deactivating surface coatings are discussed. Ultimately this review serves as a call for the biomaterials community to become a leading contributor to the prevention and management of the current and future viral outbreaks.


Assuntos
Betacoronavirus , Materiais Biocompatíveis , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Técnicas Biossensoriais , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Desinfecção/métodos , Sistemas de Liberação de Medicamentos , Circulação Extracorpórea , Filtração , Humanos , Testes Imunológicos/instrumentação , Testes Imunológicos/métodos , Metais , Nanoestruturas , Técnicas de Amplificação de Ácido Nucleico/instrumentação , Técnicas de Amplificação de Ácido Nucleico/métodos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Equipamentos de Proteção , RNA Viral/análise , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/transmissão , Tensoativos , Engenharia Tecidual , Vacinas Virais
7.
Medicine (Baltimore) ; 99(28): e20934, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664090

RESUMO

This study aimed to investigate the myocardial protective effect of liquid sodium phosphocreatine cardiac arrest in extracorporeal circulation surgery treating infants with atrial septal defects.Eighty-four infants with atrial septal defects who required extracorporeal circulation surgery treatment at our hospital from January 2016 to June 2018 were divided into an observation group and a control group through a digitally randomized method, with 42 cases in each group. The control group adopted the conventional modified St Thomas II high potassium cold liquid crystal cardiac arrest, while the observation group adopted the liquid sodium phosphocreatine cardiac arrest.The myocardial enzyme indexes of the 2 groups 3, 6, 12, and 24 hours postoperatively were higher than before establishing the cardiopulmonary bypass and the enzyme indexes of the control group at the same time were higher than that of the observation group; adenosine triphosphate, adenosine diphosphate, and other energy levels and the postoperative recovery rate energy levels of the observation group were higher than those in the control group, the difference was statistically significant (P < .05).Liquid sodium phosphocreatine cardiac arrest used in extracorporeal circulation surgery treating infants with atrial septal defects can reduce myocardial ischemia-reperfusion injury, maintain energy supply during ischemia, strengthen the St Thomas II effect, and aid postoperative cardiac function recovery of high potassium cold liquid crystal cardiac arrest used in infants with atrial septal defects and treated with extracorporeal circulation surgery.


Assuntos
Ponte Cardiopulmonar/métodos , Cardiotônicos/farmacologia , Parada Cardíaca Induzida/métodos , Comunicação Interatrial/cirurgia , Fosfocreatina/farmacologia , Difosfato de Adenosina/metabolismo , Trifosfato de Adenosina/metabolismo , Cardiotônicos/administração & dosagem , Estudos de Casos e Controles , Pré-Escolar , Circulação Extracorpórea/métodos , Feminino , Parada Cardíaca/induzido quimicamente , Comunicação Interatrial/diagnóstico , Comunicação Interatrial/tratamento farmacológico , Humanos , Lactente , Masculino , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Miocárdio/química , Miocárdio/enzimologia , Preservação de Órgãos/métodos , Fosfocreatina/administração & dosagem , Período Pós-Operatório , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/farmacologia , Substâncias Protetoras/administração & dosagem , Recuperação de Função Fisiológica/efeitos dos fármacos
8.
Transfus Apher Sci ; 59(4): 102855, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32636114

RESUMO

The activation of the innate and adaptive immune systems by SARS-CoV-2 causes the release of several inflammatory cytokines, including IL-6. The inflammatory hypercytokinemia causes immunopathological changes in the lungs including vascular leakage, and alveolar edema. As a result of these changes in the lungs, hypoxia and acute respiratory distress syndrome occur in patients with COVID-19. Even though there are clinical trials on the development of therapeutics and vaccines, there are currently no licensed vaccines or therapeutics for COVID-19. Pharmacological approaches have shown poor results in sepsis-like syndromes caused by the hypercytokinemia. Suppressing the cytokine storm is an important way to prevent the organ damage in patients with COVID-19. Extracorporeal blood purification could be proposed as an adjunctive therapy for sepsis, aiming to control the associated dysregulation of the immune system, which is known to protect organ functions. Several extracorporeal blood purification therapies are now available, and most of them target endotoxins and/or the cytokines and aim improving the immune response. For this purpose, plasmapheresis and immunoadsorption may be an important adjunctive treatment option to manage the complications caused by cytokine storm in critically ill patients with COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Circulação Extracorpórea , Pandemias , Plasmaferese , Pneumonia Viral/terapia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Síndrome da Liberação de Citocina/sangue , Síndrome da Liberação de Citocina/etiologia , Síndrome da Liberação de Citocina/prevenção & controle , Citocinas/sangue , Humanos , Troca Plasmática , Plasmaferese/métodos , Pneumonia Viral/sangue , Pneumonia Viral/complicações , /etiologia
10.
J Extra Corpor Technol ; 52(2): 90-95, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32669734

RESUMO

We present our multidisciplinary and multistep strategy in patients undergoing minimally invasive aortic valve replacement (mAVR) on minimally invasive extracorporeal circulation (MiECC) compared with control groups of a single strategy and conventional techniques. This cohort study included high-risk patients (Society of Thoracic Surgeons [STS] risk score >8%) undergoing aortic valve surgery under different strategies during the period from January 2017 until March 2019. Patients were matched for age, gender, body mass index, and STS score: group 1 (MiAVR) based on a minimally invasive technique with J-mini-sternotomy, rapid deployment valve (RDV), and type IV customized MiECC; group 2 (control-mAVR) consisted of minimally invasive technique with only J mini-sternotomy and RDV on a conventional extracorporeal system; group 3 (control-MiECC): full sternotomy and type IV customized MiECC; and group 4 (control): full sternotomy on a conventional extracorporeal system. The MiAVR group had significantly less duration of x-clamp time (35.4 ± 11 minutes), postoperative respiratory support (4.1 ± 1 hour), postoperative hemorrhage (250 ± 50 mL), and intensive care unit stay (1 ± .5 days) than the control-conventional (group 4) group. Seventy-six percent of patients did not receive any blood products in MiAVR (p = .025 vs. group 4). Incidence of atrial fibrillation (8%) and low cardiac output (14%) in MiAVR were significantly better than control. Critics of minimally invasive techniques sustain that potential advantages are offset by a longer cross-clamp and cardiopulmonary bypass duration, which may translate into inferior clinical outcomes. We advocate that our multidisciplinary approach supported by multiple technologies may be associated with faster recovery and superior outcomes than conventional minimally/conventional techniques.


Assuntos
Valva Aórtica , Implante de Prótese de Valva Cardíaca , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estética , Circulação Extracorpórea , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Resultado do Tratamento
11.
Enferm. foco (Brasília) ; 11(2): 154-159, jul. 2020. graf, tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1104412

RESUMO

Objetivo: traçar o perfil dos enfermeiros perfusionistas brasileiros atuantes no mercado de trabalho. Métodos: trata-se de um estudo observacional com delineamento transversal. Foram obtidos dados de perfil sócio demográfico e profissional dos perfusionistas em situação ativa no Brasil através do preenchimento de um questionário eletrônico. A amostra contemplou 70 enfermeiros perfusionistas. Resultados: a maioria dos profissionais é do sexo feminino (44%), possui 38,3±8,62 anos. A formação complementar demonstra um período de transição e aperfeiçoamento nesta especialidade: 84,2% destes possuem pós-graduação. Conclusão: o perfil profissional dos enfermeiros perfusionistas está em franca evolução em termos de qualificação e, nesse enfoque, torna-se necessário o conhecimento da especialidade para o delineamento de novas ações e inserção profissional em diferentes cenários da tecnologia extracorpórea. (AU)


Objective: to profile the Brazilian perfusionist nurses working in the labor market. Methods: This is an observational study with cross-sectional design. Data on socio-demographic and professional profile of perfusionists in active situation in Brazil were obtained by completing an electronic questionnaire. The sample included 70 perfusionist nurses. Results: most professionals are female (44%), 38.3 ± 8.62 years old. Complementary education demonstrates a period of transition and improvement in this specialty: 84.2% of these have postgraduate degrees. Conclusion: the professional profile of perfusionist nurses is clearly evolving in terms of qualification and, in this approach, it is necessary to know the specialty to delineate new actions and professional insertion in different scenarios of extracorporeal technology. (AU)


Objetivo: perfilar las enfermeras perfusionistas brasileñas que trabajan en el mercado laboral. Métodos: Este es un estudio observacional con diseño transversal. Los datos sobre el perfil sociodemográfico y profesional de perfusionistas en situación activa en Brasil se obtuvieron completando un cuestionario electrónico. La muestra incluyó 70 enfermeras perfusionistas. Resultados: la mayoría de los profesionales son mujeres (44%), 38.3 ± 8.62 años. La educación complementaria demuestra un período de transición y mejora en esta especialidad: 84,2% de ellos tienen títulos de posgrado. Conclusión: el perfil profesional de las enfermeras perfusionistas está evolucionando claramente en términos de calificación y, en este enfoque, es necesario conocer la especialidad para delinear nuevas acciones e inserción profesional en diferentes escenarios de tecnología extracorpórea. (AU)


Assuntos
Circulação Extracorpórea , Procedimentos Cirúrgicos Cardiovasculares , Enfermagem , Enfermeiras e Enfermeiros
13.
Angiol Sosud Khir ; 26(2): 52-59, 2020.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-32597885

RESUMO

AIM: The purpose of the study was to perform intraoperative assessment of blood flow in coronary bypass grafts of the 'first' and 'third' order according to Calafiore A.M. with the help of the TTFM technique and to compare the obtained results. PATIENTS AND METHODS: This retrospective, single-centre study enrolled a total of 222 patients subjected to coronary artery bypass grafting (CABG) from January to November 2017. Depending on the type of bypass grafting of the posterior interventricular artery (PIVA), the patients were divided into 2 groups. Group One consisted of 108 patients undergoing bypass grafting of the PIVA with the help of combined Y-grafts from the right internal thoracic artery (RTIA). Group Two was composed of 114 patients subjected to autovenous coronary artery bypass grafting of the PIVA. Blood flow was assessed with the help of the VeriQ MediStim® flowmeter after termination of extracorporeal circulation (ECC), at systolic pressure of 100-110 mm Hg. The parameters of blood flow were assessed using the 1.5- and 2-mm probes. In a specially designed protocol we registered the type of the shunt, the bypassed artery, and values of flowmetry parameters. We also evaluated the pattern of the flowmetric curve according to Takemi Handa et al. RESULTS: The obtained findings revealed a statistically significant difference in the values of Qmean (p=0.001), with the PI values in the groups not statistically differing (p=0.14). Thus, in patients with similar parameters influencing the volumetric velocity of blood flow (the degree of proximal stenosis, diameter of the bypassed artery, mean systolic AP and HR) the value of Qmean was higher in the group with coronary artery bypass grafting (CABG), i. e., in the group of the 'first-order' conduits. Therefore, an autovein directly anastomosed to the aorta experiences grater haemodynamic overload, which completely confirms the theory of Calafiore A.M. CONCLUSION: First-order conduits (CABG) appear to experience greater wall strain because of greater haemodynamic overload as compared with third-order conduits (Y-grafts). A composite Y-graft may be an alternative technique of bypass grafting of the basin of the right coronary artery (RCA). A composite Y-graft has greater resistance to wall shear stress than an autovein anastomosed to the aorta.


Assuntos
Ponte de Artéria Coronária , Artéria Torácica Interna , Angiografia Coronária , Circulação Coronária , Vasos Coronários/cirurgia , Circulação Extracorpórea , Humanos , Estudos Retrospectivos , Grau de Desobstrução Vascular
14.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(3): 393-396, 2020 May.
Artigo em Chinês | MEDLINE | ID: mdl-32543149

RESUMO

Objective: To investigate the establishment of atrial septal defect model with high success rate in pigs with extracorporeal circulation and the method of followed patch repair. Methods: Twenty Chinese miniature pigs weighing 45.3-55.7 kg were used, four of which were used for blood donationand the remaining for models. General anesthesia was conducted with intubation. Thoracotomy was performed through the right fourth intercostal space, and the ascending aorta cannulation with a wire-guide technique was carried out. The extra-pericardial method was used for the superior and inferior vena cava cannulation. The ascending aorta was not cross-clamped. After snaring the superior and inferior vena cava, the right atrium was opened on pump. Sutures were preset and a clamp was used to create and expand an interatrial septal hole followed by the implantation of the experimental patch. Results: One animal died due to the aortic root torn and hemorrhage while exposing the right atrial appendage. The remaining 15 pigs successfully completed the operation. Among these 15 experimental animals, one had postoperative hypotension. The average pressure was decreased to 38 mmHg (1 mmHg=0.133 kPa), which was corrected by vasoactive agents and fluid resuscitation. One animal had intraoperative cardiac arrest and was resuscitated by heart massage. Fifteen experimental animals were raised for 6 months and all survived. Conclusion: The selection of suitable experimental animals like swine and well-established surgical methods could ensure the success establishment of experimental models and patch repairment.


Assuntos
Ponte Cardiopulmonar , Circulação Extracorpórea , Comunicação Interatrial , Animais , Comunicação Interatrial/cirurgia , Suínos , Toracotomia , Veia Cava Inferior
15.
Transplant Proc ; 52(5): 1528-1535, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32327262

RESUMO

The shortage of available organ donors is a significant problem worldwide, and various efforts have been carried out to avoid the loss of potential organ donors. Among them, organ donation from cardiocirculatory deceased donors (DCD), in which withdrawal of life-sustaining therapies is ongoing (Maastricht type III donors), is one emerging strategy. Thanks to the latest advances in transplantation and organ preservation, such as normothermic regional perfusion (NRP), ex vivo perfusion techniques, and good organization and communication among prehospital care providers, emergency departments, intensive care units, and transplantation units, DCD is rapidly increasing; it's estimated that it will increase the number of donations of lungs and splanchnic organs by more than 40%. Although Maastricht type II DCD requires a 24/7 available experienced extra corporeal membrane oxygenation (ECMO) team in the institution, Maastricht DCD type III could be organized in secondary care and spoke hospitals without in loco ECMO facilities for NRP. This article analyses a potential mobile team organization based on the hub-and-spoke model, which already exists and functions in Italy, by estimating the dimension of the controlled DCD phenomenon in Italy, coordination requirements, costs, personnel training, and education, and reporting a single center experience in Milan, Italy.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Unidades Móveis de Saúde , Preservação de Órgãos/métodos , Coleta de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos , Sistema Cardiovascular , Morte , Serviço Hospitalar de Emergência , Circulação Extracorpórea/métodos , Humanos , Unidades de Terapia Intensiva , Itália , Transplante de Órgãos , Perfusão/métodos , Doadores de Tecidos/provisão & distribução
16.
Curr Opin Organ Transplant ; 25(3): 237-240, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32304422

RESUMO

PURPOSE OF REVIEW: Ex-vivo perfusion has emerged in recent years as an alternative to cold static preservation of organs harvested for transplant. Normothermic ex-vivo perfusion, the subject of this review, maintains the donor heart in a near physiologic state, and allows the transplant team to monitor and control perfusion to the organ prior to implantation. A growing body of evidence has established the safety and viability of this technique, which may improve on current standards of donor management. RECENT FINDINGS: Following initial single-arm studies over a decade ago, ex-vivo perfusion has been studied in a prospective, randomized fashion in standard donor hearts (PROCEED II trial). The short and intermediate-term results demonstrated similar outcomes compared with cold storage with significantly shorter cold ischemic time. Since then, ex-vivo perfusion has been studied in extended-criteria donor hearts, first in observational studies, and currently in randomized, prospective fashion in the recently completed EXPAND-Heart trial, which is anticipated to be reported in 2020. SUMMARY: Normothermic ex-vivo perfusion has an established literature base and holds promise for changing current practices of heart preservation. Results of forthcoming pivotal studies will help determine its role in more widespread clinical adoption.


Assuntos
Aloenxertos/transplante , Circulação Extracorpórea/métodos , Transplante de Coração/métodos , Coração/fisiopatologia , Perfusão/métodos , Humanos , Estudos Prospectivos
17.
Curr Opin Organ Transplant ; 25(3): 285-292, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32304426

RESUMO

PURPOSE OF REVIEW: Lung transplantation offers the only realistic therapeutic option for patients with end-stage lung disease. However, this is impacted by a shortfall in availability of suitable donor-lungs. Normothermic machine perfusion of donor-lungs outside the donor body also known as ex-vivo lung perfusion (EVLP) offers a potential solution through objective assessment, reconditioning and treatment of donor-lungs initially deemed unsuitable for use. This review discusses key advances and challenges in the wider clinical adoption of this technology. RECENT FINDINGS: This review will summarize key research within the following areas: recent clinical trials utilizing EVLP, logistical challenges, EVLP protocol innovations, novel assessment methods and current research into therapeutic modulation of lung function during EVLP. SUMMARY: Normothermic machine perfusion of donor-lungs ex-vivo offers a promising platform to assess and modulate donor-lung quality prior to transplantation. Consensus on how and when to best utilize EVLP is yet to be reached, meaning that widespread clinical adoption of the technology has not yet become a reality. Further work is needed on agreed indications, perfusion protocols and organization of services before becoming a regularly used procedure prior to lung transplantation.


Assuntos
Circulação Extracorpórea/métodos , Transplante de Pulmão/métodos , Perfusão/métodos , Doadores de Tecidos/estatística & dados numéricos , Humanos
19.
Rev. chil. cardiol ; 39(1): 16-23, abr. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1115445

RESUMO

ANTECEDENTES: El reemplazo protésico de la válvula tricúspide es un procedimiento infrecuente, con elevada mortalidad y morbilidad operatoria, independientemente de la etiología de la insuficiencia tricuspídea. Persiste aún una discusión respecto al tipo de prótesis a utilizar, mecánica o biológica. OBJETIVO: Analizar nuestros resultados perioperatorios y alejados en el reemplazo valvular tricuspídeo, comparando ambos tipos de prótesis. MÉTODO: Revisión de la Base de Datos de nuestro Servicio de Cirugía Cardiovascular para el periodo enero 1991 - diciembre 2017. Identificados los pacientes con reemplazo valvular tricuspídeo (RVT); se revisaron los protocolos operatorios y los ecocardiogramas. La supervivencia se certificó a través del Registro Civil e Identificación de Chile. RESULTADOS: Se identificaron 83 pacientes con RVT (76% mujeres), los que representaron el 0,7% del total de las cirugías con circulación extracorpórea y el 2,1% de las cirugías valvulares para el periodo en estudio. La edad promedio fue 49±16,5 años. Cuarenta y nueve casos (59%) correspondieron a reoperaciones y otros 49 tuvieron un procedimiento asociado. En 40 pacientes (48%) se utilizó una prótesis mecánica y en 43 (52%) una biológica. La mortalidad operatoria global fue 9,6% (8 pacientes, 4 con una prótesis mecánica y 4 con una biológica). El seguimiento se completó en el 100%, con un promedio de 7,1 años. Veintiocho pacientes fallecieron durante el seguimiento; la principal causa fue insuficiencia cardiaca. Así, la supervivencia a 5 años fue 70,3 ± 5,3% y a 10 años 58 ± 6,3%, sin diferencia significativa entre ambos tipos de prótesis. Siete pacientes se reoperaron durante el seguimiento (5 casos con prótesis biológica y 2 mecánica). CONCLUSIÓN: El RVT continúa siendo un procedimiento infrecuente, con mayor incidencia en mujeres, en la quinta década de la vida. La mayoría de los pacientes presentaba comorbilidad y había tenido cirugía cardiovascular previa. La mitad de estos recibió una prótesis mecánica y la otra, biológica. No hubo diferencias significativas entre ambos tipos de prótesis en cuanto a mortalidad operatoria, supervivencia alejada o reoperación.


BACKGROUND: Tricuspid valve replacement (TVR) is an uncommon surgical procedure, associated with high mortality and morbidity. The use of biological or mechanical prostheses in TVR has advantages and disadvantages and, therefore, there persists a debate regarding the choice of one or other type of prostheses. AIM: To analyze our operative and long-term surgical results, comparing both types of prosthetic valves. METHODS: The Data Base of the Cardiovascular Surgery Service was reviewed for the period between January 1991 and December 2017. 83 patients with TVR were identified, the operative notes and echocardiogram reports were analyzed. Survival was obtained from the Chilean Civil Identification Service. RESULTS: 83 patients (76% women) had TVR. They represented 0.7% of the total cases operated on with extracorporeal circulation and 2.1% of all valve disease cases, for the study period. Mean age was 49±16.5 years. 49 cases (59%) were reoperations and another 49 had an associated procedure. In 40 patients (48%) a mechanical prosthesis was used and in 43 (52%) a biological one was implanted. Operative mortality rate was 9.6% (8 patients, had a mechanical valve and the other 8, a biological one). Follow-up was 100% completed, with an average of 7.1 years. 28 patients died during follow-up; the main cause of death was heart failure. Five-year survival rate was 70.3 ± 5.3% and at 10 years it was 58 ± 6.3%, without significant difference the type of prostheses. Seven patients were re-operated during follow-up (5 cases corresponded to a biological prostheses and 2 to a mechanical one). CONCLUSION: TVR is still an infrequent surgical procedure, more commonly performed in women, on the fifth decade of life. Most patients presented comorbidities and had a previous cardiovascular surgical operation. Half of them received a mechanical prosthesis and half a biological one. There was no significant difference between both types of prostheses related to surgical mortality, long-term survival or reoperation.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/métodos , Circulação Extracorpórea , Reoperação , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/mortalidade , Bioprótese , Comorbidade , Análise de Sobrevida , Seguimentos , Resultado do Tratamento , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos
20.
Transplant Proc ; 52(3): 905-909, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32113694

RESUMO

Venovenous bypass (VVB) is a technique that was developed in the 1980s to mitigate untoward hemodynamic effects of complete cross-clamping of the inferior vena cava during liver transplantation (LT). Since the introduction of nonclassic surgical techniques, the interest in using VVB has decreased. Despite this, VVB is still commonly practiced today. In the last 2 decades, significant changes have been made in many aspects of LT. New developments in VVB have been also reported. A percutaneous technique appears safer and easier to perform compared with the surgical cut-down method. Recent data suggest that patients with high acuity may benefit more from VVB. Advances in extracorporeal technologies offer new opportunities for VVB in managing critically ill patients in LT. Here, we review these new developments in VVB.


Assuntos
Circulação Extracorpórea/métodos , Transplante de Fígado/métodos , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Veia Cava Inferior/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA