inguinal-cannulation-for-establishing-extracorporeal-circulation

Inguinal Cannulation for Establishing Extracorporeal Circulation in Adult Porcine Model

Due to the similar size ratios, adult porcine models are suitable for cardiovascular and circulatory physiology studies on extracorporeal circulation. As ...

University Hospital of Heidelberg

[Stent implantation or surgical treatment for chronic and acute aortic dissection - For surgical treatment].

Increased use of continuous-flow left ventricular assist devices for long-term mechanical support necessitates a better understanding of hemodynamic changes in the native heart and the ascending aorta. By using patient-specific computational models, correlations of potentially adverse hemodynamic conditions with the orientation of the left ventricular assist device outflow graft and their relationship with aortic insufficiency and ischemic events were investigated.

Computational fluid dynamics in patients with continuous-flow left ventricular assist device support show hemodynamic alterations in the ascending aorta.

Infective endocarditis is a life threatening complication of intravenous drug abuse, which continues to be a major burden with inadequately characterised long-term outcomes. We reviewed our institutional experience of surgical treatment of infective endocarditis in active intravenous drug abusers with the aim of identifying the determinants long-term outcome of this distinct subgroup of infective endocarditis patients.

Surgical treatment of infective endocarditis in active intravenous drug users: a justified procedure?

Research into the development of artificial heart muscle has been limited to assembly of stem cell-derived cardiomyocytes seeded around a matrix, while nonbiological approaches to tissue engineering have rarely been explored. The aim of the study was to apply electrically contractile polymer-based actuators as cardiomyoplasty for positive inotropic support of the right ventricle. Complex trilayer polypyrrole (PPy) bending polymers for high-speed applications were generated. Bending motion occurred directly as a result of electrochemically driven charging and discharging of the PPy layers. In a rat model (n = 5), strips of polymers (3 × 20 mm) were attached and wrapped around the right ventricle (RV). RV pressure was continuously monitored invasively by direct RV cannulation. Electrical activation occurred simultaneously with either diastole (in order to evaluate the polymer's stand-alone contraction capacity; group 1) or systole (group 2). In group 1, the pressure generation capacity of the polymers was measured by determining the area under the pressure curve (area under curve, AUC). In group 2, the RV pressure AUC was measured in complexes directly preceding those with polymer contraction and compared to RV pressure complexes with simultaneous polymer contraction. In group 1, the AUC generated by polymer contraction was 2768 ± 875 U. In group 2, concomitant polymer contraction significantly increased AUC compared with complexes without polymer support (5987 ± 1334 U vs. 4318 ± 691 U, P ≤ 0.01). Electrically contractile polymers are able to significantly augment right ventricular contraction. This approach may open new perspectives for myocardial tissue engineering, possibly in combination with fetal or embryonic stem cell-derived cardiomyocytes.

Electrically contractile polymers augment right ventricular output in the heart.

Many end-stage heart failure patients are not eligible to undergo heart transplantation due to organ shortage, and even those under consideration for transplantation might suffer long waiting periods. A better understanding of the hemodynamic impact of left ventricular assist devices (LVAD) on the cardiovascular system is therefore of great interest. Computational fluid dynamics (CFD) simulations give the opportunity to study the hemodynamics in this patient population using clinical imaging data such as computed tomographic angiography. This article reviews a recent study series involving patients with pulsatile and constant-flow LVAD devices in which CFD simulations were used to qualitatively and quantitatively assess blood flow dynamics in the thoracic aorta, demonstrating its potential to enhance the information available from medical imaging.

Review of recent results using computational fluid dynamics simulations in patients receiving mechanical assist devices for end-stage heart failure.

On the basis of Custodiol preservation and cardioplegic solution a novel cardioplegic solution was developed to improve the postischemic cardiac and endothelial function. In this study, we investigated whether its reduced cytotoxicity and its ability to reduce reactive oxygen species generation during hypoxic condition have beneficial effects in a clinically relevant canine model of CPB.

Custodiol-N, the novel cardioplegic solution reduces ischemia/reperfusion injury after cardiopulmonary bypass.

Only few reports exist on malignant thoracic neoplasms that require cardiopulmonary bypass during resection. We aimed to investigate the early and late clinical outcome of these patients.

Resection of thoracic malignancies infiltrating cardiac structures with use of cardiopulmonary bypass.

Myocardial infarction (MI) is a common cause of mortality in patients with diabetes mellitus (DM) and vascular dysfunction is a major component of diabetic cardiomyopathy. We investigated the systemic influence of acute MI on the diabetes-induced pathogenic changes in the rat aorta.

Mild type 2 diabetes mellitus improves remote endothelial dysfunction after acute myocardial infarction.

End-stage heart failure (HF) is associated with renal failure (RF). This study aimed to determine the prognostic influence of RF and post-operative hemodialysis on short-term survival following left ventricular assist device (LVAD) implantation. This retrospective study includes 68 patients undergoing LVAD treatment. Kidney function was recorded prior to LVAD implantation, immediately afterwards and after 30 days, noting the need for hemodialysis. Median pre-operative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) classification was 3.47 ± 1.08. 30 days after implantation there was a significant improvement of estimated glomerular filtration rate (eGFR) and reduction of blood urea nitrogen (BUN). Of pre-operative RF parameters, BUN was associated with increased mortality and need for early post-operative hemodialysis. Post-operative hemodialysis was associated with significantly lower short-term survival, while pre-operative hemodialysis did not impact mortality. Post-operative acute kidney injury (AKI) requiring hemodialysis can be regarded as a strong negative prognostic marker for short-term survival. The absence of a clear correlation between most routine RF parameters and survival or the need for early post-operative hemodialysis calls into question the predictive value of pre-operative RF. The negative association of only post-operative hemodialysis on short-term survival emphasises the impact of the occurrence of AKI.

Prognostic relevance of hemodialysis for short-term survival in patients after LVAD implantation.

Modern left ventricular assist devices (LVAD) have evolved to become standard of care in severe heart failure (HF) patients. Right HF (RHF) is a major complication responsible for early mortality. Several techniques for temporary right ventricular assist device (t-RVAD) have been described before, baring relevant disadvantages such as limited mobilization or the need for re-thoracotomy. We describe the results of an alternative technique for t-RVAD using the Tandem Heart™ with ProtekDuo™ cannula.

Results of concomitant groin-free percutaneous temporary RVAD support using a centrifugal pump with a double-lumen jugular venous cannula in LVAD patients.

Article	Year
[Stent implantation or surgical treatment for chronic and acute aortic dissection - For surgical treatment]. Deutsche medizinische Wochenschrift (1946)\| PubMed ID: 20333597	2010
Computational fluid dynamics in patients with continuous-flow left ventricular assist device support show hemodynamic alterations in the ascending aorta. The Journal of thoracic and cardiovascular surgery\| PubMed ID: 24345553	2014
Surgical treatment of infective endocarditis in active intravenous drug users: a justified procedure? Journal of cardiothoracic surgery\| PubMed ID: 24661344	2014
Electrically contractile polymers augment right ventricular output in the heart. Artificial organs\| PubMed ID: 24689769	2014
Review of recent results using computational fluid dynamics simulations in patients receiving mechanical assist devices for end-stage heart failure. Methodist DeBakey cardiovascular journal\| PubMed ID: 25574347	2014
Custodiol-N, the novel cardioplegic solution reduces ischemia/reperfusion injury after cardiopulmonary bypass. Journal of cardiothoracic surgery\| PubMed ID: 25890005	2015
Resection of thoracic malignancies infiltrating cardiac structures with use of cardiopulmonary bypass. Journal of cardiothoracic surgery\| PubMed ID: 26109311	2015
Mild type 2 diabetes mellitus improves remote endothelial dysfunction after acute myocardial infarction. Journal of diabetes and its complications\| PubMed ID: 26219999	2015
Prognostic relevance of hemodialysis for short-term survival in patients after LVAD implantation. Scientific reports\| PubMed ID: 29867122	2018
Results of concomitant groin-free percutaneous temporary RVAD support using a centrifugal pump with a double-lumen jugular venous cannula in LVAD patients. Journal of thoracic disease\| PubMed ID: 31183170	2019

Matthias Karck

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