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2.
J Cardiothorac Vasc Anesth ; 31(5): 1595-1602, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28648774

RESUMO

OBJECTIVES: To determine hemostasis perturbations, including von Willebrand factor (VWF) multimers, after implantation of a new bioprosthetic and pulsatile total artificial heart (TAH). DESIGN: Preclinical study SETTING: Single-center biosurgical research laboratory. PARTICIPANTS: Female Charolais calves, 2-to-6 months old, weighing 102-to-122 kg. INTERVENTIONS: Surgical implantation of TAH through a mid-sternotomy approach. MEASUREMENTS AND MAIN RESULTS: Four of 12 calves had a support duration of several days (4, 4, 8, and 10 days), allowing for the exploration of early steps of hemostasis parameters, including prothrombin time; coagulation factor levels (II, V, VII+X, and fibrinogen); and platelet count. Multimeric analysis of VWF was performed to detect a potential loss of high-molecular weight (HMW) multimers, as previously described for continuous flow rotary blood pumps. Despite the absence of anticoagulant treatment administered in the postoperative phase, no signs of coagulation activation were detected. Indeed, after an immediate postsurgery decrease of prothrombin time, platelet count, and coagulation factor levels, most parameters returned to baseline values. HMW multimers of VWF remained stable either after initiation or during days of support. CONCLUSIONS: Coagulation parameters and platelet count recovery in the postoperative phase of the Carmat TAH (Camat SA, Velizy Villacoublay Cedex, France) implantation in calves, in the absence of anticoagulant treatment and associated with the absence of decrease in HMW multimers of VWF, is in line with early hemocompatibility that is currently being validated in human clinical studies.


Assuntos
Bioprótese/tendências , Transplante de Coração/tendências , Coração Artificial/tendências , Hemostasia/fisiologia , Doenças de von Willebrand , Fator de von Willebrand/metabolismo , Animais , Bioprótese/efeitos adversos , Bovinos , Feminino , Transplante de Coração/efeitos adversos , Transplante de Coração/instrumentação , Coração Artificial/efeitos adversos , Recuperação de Função Fisiológica/fisiologia , Doenças de von Willebrand/sangue , Doenças de von Willebrand/diagnóstico
3.
J Artif Organs ; 20(3): 187-193, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28620709

RESUMO

This review was created based on a translation of the Japanese review written in the Japanese Journal of Artificial Organs in 2015 (Vol.44, No. 3, pp.130-135), with some modifications regarding several references published in 2015 or later.


Assuntos
Cardiologia , Coração Artificial/tendências , Publicações Periódicas como Assunto , Sistema de Registros , Humanos , Japão
4.
Anesth Analg ; 124(4): 1071-1086, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27984228

RESUMO

The past decade has seen an exponential increase in the application and development of durable long-term as well as nondurable short-term mechanical circulatory support for cardiogenic shock and acute or chronic heart failure. Support has evolved from bridge-to-transplant to destination therapy, bridge to rescue, bridge to decision making, and bridge to a bridge. Notable trends include device miniaturization, minimally invasive and/or percutaneous insertion, and efforts to superimpose pulsatility on continuous flow. We can certainly anticipate that innovation will accelerate in the months and years to come. However, despite-or perhaps because of-the enhanced equipment now available, mechanical circulatory support is an expensive, complex, resource-intensive modality. It requires considerable expertise that should preferably be centralized to highly specialized centers. Formidable challenges remain: systemic inflammatory response syndromes and vasoplegia after device insertion; postoperative sepsis; optimal anticoagulation regimens to prevent device-induced thrombosis and cerebral thromboembolism; wound site, intracranial, and gastrointestinal bleeding; multisystem injury and failure; patient dissatisfaction (even when providers consider the procedure a "success"); and ethical decision making in conditions of futility.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/tendências , Coração Artificial/tendências , Coração Auxiliar/tendências , Invenções/tendências , Oxigenação por Membrana Extracorpórea/instrumentação , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/cirurgia , Humanos , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/cirurgia
7.
J Card Surg ; 30(11): 856-64, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26404743

RESUMO

We present a review of the evolution of total artificial hearts (TAHs) and new directions in development, including the coupling of VADs as biventricular TAH support.


Assuntos
Insuficiência Cardíaca/terapia , Coração Artificial/tendências , Coração Auxiliar/tendências , Humanos
8.
Med Sci Monit Basic Res ; 21: 183-90, 2015 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-26343363

RESUMO

The totally artificial heart (TAH) is among the most prominent medical innovations of the 21st century, especially due to the increasing population with end-stage heart failure. The progressive course of the disease, its resistance to conventional therapy, and the scarcity of hearts available for transplantation were the prime impetus for developing a TAH, especially when other options of mechanical circulatory assist devices are exhausted. In this review, we narrate the history of TAH, give an overview of its technology, and address the pros and cons of the currently available TAH models in light of published clinical experience.


Assuntos
Cardiopatias/terapia , Transplante de Coração/métodos , Transplante de Coração/tendências , Coração Artificial/tendências , Cardiopatias/cirurgia , Humanos , Desenho de Prótese
9.
Curr Opin Pediatr ; 27(5): 597-603, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26281035

RESUMO

PURPOSE OF REVIEW: Mechanical circulatory support (MCS) has rapidly evolved toward continuous flow technology in adults. In the pediatric population, the Berlin EXCOR, a paracorporeal pulsatile pump, is the only MCS device specifically approved for pediatric use. The current era of pediatric MCS includes an increasing application of adult continuous flow pumps to pediatric patients. RECENT FINDINGS: The Berlin EXCOR pulsatile pump has been studied in over 200 patients. The major limitations of this device are neurologic dysfunction (which occurs in about 30% of supported patients) and the requirement for in-hospital care until transplant. Two continuous flow pumps (HVAD and HeartMate II) have been successfully applied in children and adolescents, and the SynCardia total artificial heart has been used in adolescents. The National Heart, Lung, and Blood Institute - sponsored Pediatric Mechanically Assisted Circulatory Support registry has collected pediatric MCS data since 2012 and will provide valuable outcomes data to help refine this field. Survival with these durable devices has been generally good (except for small infants and patients with complex congenital heart disease), with nearly 50% receiving a heart transplant within 6 months. Patients with single ventricle physiology continue to pose major challenges. Two clinical trials for miniaturized adult continuous flow devices and one trial for a new pediatric pump will begin within the next year. SUMMARY: New continuous flow devices are entering or poised to enter clinical trials. If approved, these devices will enhance the safety and variety of options for longer-term pediatric support.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Cardiopatias Congênitas/cirurgia , Coração Artificial , Coração Auxiliar , Pediatria , Adolescente , Criança , Pré-Escolar , Oxigenação por Membrana Extracorpórea/tendências , Cardiopatias Congênitas/fisiopatologia , Coração Artificial/tendências , Coração Auxiliar/tendências , Humanos , Pediatria/tendências , Estudos Prospectivos , Resultado do Tratamento , Função Ventricular
10.
Artif Organs ; 39(3): 260-87, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25788211

RESUMO

In this Editor's Review, articles published in 2014 are organized by category and briefly summarized. We aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. As the official journal of the International Federation for Artificial Organs, the International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, the International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers, the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons, for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.


Assuntos
Órgãos Artificiais/tendências , Materiais Biocompatíveis , Circulação Extracorpórea/tendências , Publicações Periódicas como Assunto , Órgãos Artificiais/normas , Desenho de Equipamento , Segurança de Equipamentos , Circulação Extracorpórea/métodos , Feminino , Previsões , Coração Artificial/normas , Coração Artificial/tendências , Humanos , Rins Artificiais/normas , Rins Artificiais/tendências , Masculino , Próteses e Implantes/normas , Próteses e Implantes/tendências , Estados Unidos
11.
ASAIO J ; 61(1): 8-14, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25248044

RESUMO

Advances in medical therapies have yielded improvement in morbidity and a decrease in mortality for patients with congenital heart disease, both surgically palliated and uncorrected. An unintended consequence is a cohort of adolescent and adult patients with heart failure who require alternative therapies. One intriguing option is placement of a total artificial heart (TAH) either as a bridge to transplant or as a destination therapy. Of the 1091 Jarvik-7 type TAH (Symbion, CardioWest and SynCardia) placed between 1985 and 2012, only 24 have been performed in patients with congenital heart disease, and a total of 51 were placed in patients younger than 21. At our institution, the SynCardia TAH was implanted in a 19-year-old patient with cardiac allograft failure because of chronic rejection and related multisystem organ failure including need for hemodialysis. Over the next year, she was nutritionally and physically rehabilitated, as were her end organs, allowing her to come off dialysis, achieve normal renal function and eventually be successfully transplanted. Given the continued growth of adolescent and adult congenital heart disease populations with end-stage heart failure, the TAH may offer therapeutic options where previously there were few. In addition, smaller devices such as the SynCardia 50/50 will open the door for applications in smaller children. The Freedom Driver offers the chance for patients to leave the hospital with a TAH, as does the AbioCor, which is a fully implantable TAH option. In this report, we review the history of the TAH and potential applications in adolescent patients and congenital heart disease.


Assuntos
Cardiopatias/congênito , Cardiopatias/cirurgia , Insuficiência Cardíaca/cirurgia , Coração Artificial , Adolescente , Adulto , Arritmias Cardíacas/cirurgia , Cardiomiopatias/cirurgia , Feminino , Técnica de Fontan/efeitos adversos , Neoplasias Cardíacas/cirurgia , Transplante de Coração/efeitos adversos , Coração Artificial/tendências , Coração Auxiliar/tendências , Humanos , Masculino , Miocardite/cirurgia , Adulto Jovem
16.
Best Pract Res Clin Anaesthesiol ; 26(2): 147-65, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22910087

RESUMO

End-stage heart failure represents a highly morbid condition for the patient with limited treatment options. From a surgical perspective, the treatment options for effective long-term survival are usually limited to heart transplantation, heart-lung transplantation or implantation of a destination mechanical circulatory support device. Assuming an advanced heart-failure patient is indeed deemed a candidate for transplantation, the patient is subject to shortages in donor organ availability and thus possible further decompensation and potential death while awaiting transplantation. Various extracorporeal and implantable ventricular-assist devices (VADs) may be able to provide temporary or long-term circulatory support for many end-stage heart-failure patients but mechanical circulatory support options for patients requiring long-term biventricular support remain limited. Implantation of a total artificial heart (TAH) currently represents one, if not the best, long-term surgical treatment option for patients requiring biventricular mechanical circulatory support as a bridge to transplant. The clinical applicability of available versions of positive displacement pumps is limited by their size and complications. Application of continuous-flow technology can help in solving some of these issues and is currently being applied in the research towards a new generation of smaller and more effective TAHs. In this review, we discuss the history of the TAH, its development and clinical application, implications for anaesthetic management, published outcomes and the future outlook for TAHs.


Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração/métodos , Coração Artificial , Anestesia/métodos , Animais , Desenho de Equipamento , Insuficiência Cardíaca/fisiopatologia , Coração Artificial/tendências , Humanos , Sobrevida , Fatores de Tempo , Doadores de Tecidos/provisão & distribução
17.
IEEE Pulse ; 3(3): 14-20, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22678834

RESUMO

Artificial organs have already become an important part of medical care, and with the advent of new devices, materials, and approaches, either in development or already on the market, they will become even more commonplace in the future.


Assuntos
Órgãos Artificiais/tendências , Diabetes Mellitus Tipo 1/terapia , Coração Artificial/tendências , Humanos , Rins Artificiais/tendências , Nanofibras , Polímeros , Próteses e Implantes , Diálise Renal/tendências
18.
Cardiol Clin ; 29(4): 559-82, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22062206

RESUMO

The recent, widespread success of mechanical circulatory support has prompted the development of numerous implantable devices to treat advanced heart failure. It is important to raise awareness of novel device systems, the mechanisms by which they function, and implications for patient management. This article discusses devices that are being developed or are in clinical trials. Devices are categorized as standard full support, less-invasive full support, partial support: rotary pumps, partial support: counterpulsation devices, right ventricular assist device, and total artificial heart. Implantation strategy, mechanism of action, durability, efficacy, hemocompatibility, and human factors are considered. The feasibility of novel strategies for unloading the failing heart is examined.


Assuntos
Insuficiência Cardíaca/terapia , Coração Auxiliar/tendências , Desenho de Prótese/tendências , Adulto , Contrapulsação/instrumentação , Contrapulsação/tendências , Previsões , Coração Artificial/tendências , Humanos , Implantação de Prótese/métodos
19.
Artif Organs ; 35(7): E161-3, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21615430

RESUMO

Although current continuous-flow total artificial hearts (CFTAHs) are much smaller than previous models, venous kinking may still occur after device implantation, especially in smaller animals. By inserting a self-expanding stent at the site of venous narrowing in a sheep model implanted with a CFTAH, we were able to restore the normal venous geometry and dramatically increase the CFTAH output. Because this percutaneous approach avoids the challenges associated with reoperation in these cases, it may be useful to other CFTAH investigators.


Assuntos
Coração Artificial , Stents , Veia Cava Inferior/cirurgia , Animais , Constrição Patológica/patologia , Constrição Patológica/cirurgia , Coração Artificial/efeitos adversos , Coração Artificial/tendências , Ovinos , Veia Cava Inferior/patologia
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