The past, present and future of heart transplantation / 器官移植

Heart transplantation is one of the most effective strategies to treat end-stage heart failure. Multiple challenges, such as difficulty in preservation of heart allograft, rejection and postoperative complications, emerge in heart allotransplantation. After decades of research and practice, most problems have been resolved. Nevertheless, the shortage of donor organs has become increasingly prominent. To alleviate the shortage of donor organs, artificial heart and heart xenotransplantation have captivated attention, and obtained significant progress in recent years. The application of artificial heart in clinical practice has significantly enhanced the survival rate of patients with end-stage heart failure, which is expected to become the standard treatment for end-stage heart failure. Heart xenotransplantation still faces many challenges, which is still far from clinical application. In this article, the history of heart transplantation, development of heart allotransplantation, use of artificial heart and research progress on heart xenotransplantation were reviewed, and the future development direction of heart transplantation was predicted.

Latest research progress on expansion of the donor pool for heart transplantation / 器官移植

With gradual maturity of surgical technique of heart transplantation, extensive use of immunosuppressants and the improvement of organ distribution system, the shortage of donor heart has become a bottleneck issue restricting the development of heart transplantation in clinical practice. How to expand the donor pool for heart transplantation remains to be urgently solved. In recent years, with the development of science and technology and the application of new technology, groundbreaking progresses have been made on how to expand the donor pool for heart transplantation within the transplantation community. Multiple research results have been gradually translated into clinical practice, driving the development of heart transplantation in clinical settings. In this article, the latest technologies and strategies to expand the donor pool for heart transplantation were reviewed, the roles of organ preservation technology, use of marginal donor heart, xenotransplantation, artificial heart and bioartificial heart in alleviating the shortage of donor heart were investigated, and existing challenges and future directions to expand the donor pool for heart transplantation were summarized, aiming to provide reference for subsequent development of heart transplantation in clinical practice.

The progress of mechanical circulatory support devices / 中国胸心血管外科临床杂志

@#As a global disease, heart failure affects at least 26 million people, and its prevalence is still rising. Besides, the mortality rate and readmission rate remain high. Advanced heart failure is the terminal stage of various heart diseases, and often requires some treatments other than drug intervention, such as heart transplantation which is the gold standard for treatment of heart failure. However, limited by the number of donors, the number of heart transplants in the world has reached a bottleneck. There is a huge gap between the number of patients who need heart transplants and patients who get hearts for survival successfully in reality. With the exploration and development of mechanical circulation support devices for more than half a century, they have become a wonderful treatment for patients with advanced heart failure. This article will introduce the latest progress of mechanical circulatory support devices at home and abroad from the aspects of temporary and long-term devices.

Current status and progress on the application of ventricular assist device / 器官移植

At present, heart transplantation is the most effective treatment for end-stage heart failure. Nevertheless, the shortage of donors is becoming an increasingly severe challenge. In recent years, rapid development of mechanical circulatory support technologies has provided multiple therapeutic options for patients with end-stage heart failure. As an important mechanical circulatory support device, ventricular assist device (VAD) are divided into durable VAD (dVAD) and temporary VAD (tVAD) according to the duration of assistance. dVAD shows application potential in bridging heart transplantation, destination therapy and bridge to decision. With technological progress and experience accumulation in clinical application, VAD is evolving towards the direction of more biocompatible, lighter, more bionic and intelligent. In this article, the development of VAD, application status at home and abroad and the overall application of VAD in our hospital were reviewed, aiming to provide reference for promoting the clinical application of VAD in China.

Perfil dos usuários de dispositivos cardíacos eletrônicos implantavéis em um hospital universitário / Perfil de usuario de dispositivos cardíacos electrónicos implantables en un hospital universitario / User profile of implantable electronic cardiac devices in a university hospital

Objetivo:Identificar o perfil dos pacientes submetidos à inserção de dispositivos cardíacos eletrônicos implantáveis em um hospital de referência do Rio Grande do Norte.Método:Trata-se de um estudo descritivo, exploratório, retrospectivo dos últimos 03 anoscom abordagem quantitativa. Amostragem foiselecionada por conveniência. A coleta de dados ocorreu entre outubrode 2017 a março de 2018.Resultados: A amostra foi composta por 215prontuários,destes 182 foram analisados.Implantarammarca-passos63,7% e 28% cardiodesfibriladores, corresponderam ao sexo masculino69,3%,com média de idade 65 e 49.Entre as comorbidades,a Hipertensão Arterial Sistêmicaabrangeu 87,4%.Evidenciaram-se os bloqueios atrioventriculares como principal causa para implantes (35%), seguidos das miocardiopatias (12%).Conclusão:Percebeu-se que, os indivíduos que implantaram marcapassos eram acometidos por bradiarritmias,enquanto cardiodesfibriladores por taquiarritmias. As complicações pós-operatórias e intercorrências durante o procedimento foram de baixo risco. Salienta-se, que no manejo desses usuários é fundamental a elaboração de um protocolo, visando aperfeiçoar o cuidado.(AU)

Objective: Toidentifytheprofileofpatientsundergoinginsertionof implantable electroniccardiacdevices in a reference hospital in Rio Grande do Norte. Method: Thisis a descriptive, exploratory,retrospective studyofthelastthreeyearswith a quantitativeapproach. Samplingwasselectedby convenience. Data collectionoccurredbetweenOctober 2017 to March 2018. Results: Samplecomposedof 215 medical records, ofthese 182 wereanalyzed. Implantedpacemakers 63.7% and 28% cardiodesfibrillators, corresponded tothe male gender 69.3%, withaverageage 65 and 49. Amongthecomorbidities, Systemic Arterial Hypertensioncovered 87.4%. Theatrioventricular blocks wereevidenced as themain cause forimplantation (35%), followedbymyocardiopathies (12%). Conclusion: Itwasnoticedthatindividualswhoimplantedpacemakerswereaffectedbybradyarrhythmias, whilecardioverter-defibrillatorswereaffe ctedbytachyarrhythmias. Thepostoperativecomplications and complicationsduringtheprocedurewerelowrisk. Itisemphasizedthat in themanagementoftheseusersitisessentialtodevelop a protocol, aimingtoimprove care.(AU)

Objetivo: identificar el perfil de los pacientes sometidos a la inserción de dispositivos cardíacos electrónicos implantables en el hospital de referencia de Rio Grande do Norte. Método: se trata de un estudio descriptivo, exploratorio, retrospectivo de los últimos 3 años con enfoque cuantitativo. El muestreo fue seleccionado por conveniencia. La recolección de datos se llevó a cabo entre octubre de 2017 y marzo de 2018. Resultados: muestra compuesta por 215 historias clínicas, de las cuales se analizaron 182. Marcapasos implantados 63,7% y desfibriladores cardioversores 28%, correspondieron al sexo masculino 69,3%, con una edad media de 65 y 49 años. Entre las comorbilidades, la Hipertensión Arterial Sistémica cubrió el 87,4%. Los bloqueos auriculoventriculares se evidenciaron como la principal causa de implantes (35%), seguida de las miocardiopatías (12%). Conclusión: se notó que, los portadores de marcapasos se vieron afectados por bradiarritmias, mientras que los desfibriladores cardioversores por taquiarritmias. Las complicaciones postoperatorias y las complicaciones durante el procedimiento fueron de bajo riesgo. Cabe señalar que en el manejo de estos usuarios es fundamental la elaboración de un protocolo, con el fin de mejorar la atención.(AU)

Multiplicidade e instabilidade ontológica nos corações não-humanos / Multiplicity and ontological instability in nonhuman hearts

Resumo O artigo reflete sobre as relações entre corpos biológicos e artefatos tecnológicos, a partir da pesquisa etnográfica sobre o desenvolvimento de tecnologias de assistência circulatória, conhecidas como corações artificiais. Para compreender as corporeidades que tais dispositivos mecânicos ajudam a produzir, buscamos aqui caracterizar dois tipos de corpos instituídos a partir de práticas médicas e biotecnologias projetadas para pacientes com insuficiência cardíaca avançada. Os corpos imunológicos, produzidos a partir dos transplantes de coração, serão contrastados aos corpos biônicos, compostos pelo arranjo com corações artificiais. Propomos que é preciso considerar que cada uma dessas tecnologias se coproduz com distintas naturezas, sustentadas em materialidades, práticas, moralidades e pressupostos específicos. A atenção dada às práticas e à materialidade permitirá destacar os diversos entrelaçamentos materiais-semióticos. Resgatar a trajetória de desenvolvimento desse campo nos permitirá explorar o imaginário a partir do qual tais intervenções emergem, assim como as transformações ocorridas, ressaltando o vínculo ao corpo-máquina tecido no âmbito biomédico.

Abstract This paper reflects on the relationship between biological bodies and technological artifacts, based on ethnographic research on the development of circulatory assist technologies, known as artificial hearts. To understand the embodiment that such mechanical devices help to produce, we aim to characterize two types of bodies enacted from medical practices and biotechnologies designed for patients with advanced heart failure. The immunological bodies, produced from heart transplantation, will be contrasted with the bionic bodies, composed of the assembly with artificial hearts. We propose that it is necessary to consider each of these technologies as co-produced with different natures, supported by specific materialities, practices, moralities and assumptions. The attention given to practices and materiality will allow to highlight the various material-semiotic intertwinings. Tracing the development trajectory of this field will allow exploring the imagination from which such interventions emerge and the transformations that have occurred, emphasizing the link to the body-machine woven in the biomedical scope.

Next Generation of Artificial Heart: Permanent Maglev LVAD or TAH under 10k USDs

The main obstacle of artificial heart in extending its applications in clinic has been its overhigh price rather than technical property. The new generation of artificial heart must enable the patients to be able to afford it. The author's permanent maglev pumps, both VAD(ventricular assist device) and TAH(total artificial heart), reduce their price to lower than 10 USDs, ca.1/10 of the third generation of artificial heart electric maglev pump. Moreover, thepermanent maglev pump not only retains all the advantages of the electric maglev pump, but also has many innovations: its impeller vane was designed according to the streamlines in the pump, so that the blood damage was reduced as low as possible; It can produce either nonpulsatile or pulsatile flow; It can be made in LVAD or TAH, as wish. Besides, it needs no rotor position detector, no electric magnetic push and pull device for rotor suspension, and no feed-back controller for levitation. This is why itscosts can remarkably reduced. Animal experiments for up to two months and clinical trial lasted 43 hours of permanent maglev LVAD demonstrated that the performances were excellent and perfect

Development and Application of Permanent Magnet Motor and Its Control in the Field of Artificial Blood Pump / 中国医疗器械杂志

Permanent magnet motor has been widely used in the field of artificial heart pump due to its high power density, high stability and easy control. In this paper, the development history and research progress of permanent magnet motor for blood pump were described. Firstly, the motors were classified according to their structures and application scenarios. And then, the measures taken by different types of motors to meet the corresponding performance requirements were introduced, and the specific application cases were given. After that, commonly used control algorithms of these motors were enumerated. What's more, the advantages and disadvantages of the control algorithms and their application emphasis were carefully explained. Finally, the paper was summarized in short.

A Review on Mock Circulatory Systems for in vitro Hemodynamic Performance Evaluation of Ventricular Assist Devices / 医用生物力学

Mock circulatory system (MCS) is an experimental platform for simulating hemodynamic performance of human circulatory system, and has been widely used in in-vitro hemodynamic performance evaluation of passive devices such as ventricular assist devices (VADs), artificial valves, as well as hemodynamic responses of mock circulation loop. MCSs are capable of simulating various physiological conditions, including health, exercise, and heart failure, by adjusting drive element of heart simulator and lumped-parameter element of vasculature components. Since 1 960 s, the research and development target of MSCs has evolved from meeting the basic performance evaluation requirement of VADs and mechanical valve to mimicking local hemodynamic characteristics in vital organs. This review summarizes the design principles, system construction of MCSs as well as its research progress and future prospects.

Dispositivos de assistência ventricular e cuidados de enfermagem / Dispositivos de asistencia ventricular y cuidados de enfermeria / Ventricular assist devices and nursing care

RESUMO Objetivo: descrever o funcionamento, os benefícios e as complicações associadas ao uso de dispositivos de assistência ventricular e identificar as intervenções realizadas por enfermeiros no cuidado ao paciente com este dispositivo, de acordo com as evidências. Método: revisão integrativa, com artigos coletados em bases de dados da saúde, em fevereiro de 2015. Os descritores utilizados foram heart diseases, heart-assist devices e nursing. Identificaram-se 34 artigos, os quais foram submetidos à análise temática. Resultados: os dispositivos de assistência ventricular funcionam como bombas mecânicas promotoras de débito cardíaco adequado. Seu principal benefício é a estabilização hemodinâmica. A complicação mais comum é a infecção. Educação em saúde, suporte emocional, cuidados com sítio de saída e realização de curativo são os principais cuidados realizados por enfermeiros. Conclusão: as evidências comprovam a melhoria da sobrevida de pacientes com insuficiência cardíaca grave com o uso dos dispositivos de assistência ventricular, reiterando a importância da ampliação dessa tecnologia no Brasil como possibilidade de tratamento.

RESUMO Objetivo: describir el funcionamiento, los beneficios y las complicaciones asociadas con el uso de dispositivos de asistencia ventricular e identificar las intervenciones de enfermería en la atención al paciente con este dispositivo, de acuerdo con la evidencia. Método: revisión integrativa, con los artículos recolectados en las bases de datos de salud en febrero de 2015. Los descriptores utilizados fueron heart deseases, heart-assist devices e nursing. Se identificaron 34 artículos, que fueron sometido al análisis temático. Resultados: los dispositivos de asistencia ventricular actúan como bombas mecánicas que promueven gasto cardíaco adecuado. Su ventaja principal es la estabilización hemodinámica. La complicación más común es la infección. educación para la salud, el apoyo emocional, la atención y la realización de vendajes del orificio de salida son la atención primaria por parte de enfermería. Conclusión: la evidencia apoya la mejora de la supervivencia de los pacientes con insuficiencia cardíaca grave con el uso de dispositivos de asistencia ventricular, reiterando la importancia de la expansión de esta tecnología en Brasil como un posible tratamiento.

ABSTRACT Objective: describing the functioning, benefits and complications associated with the use of ventricular assist devices and identifying the interventions performed by nurses in the care of patients using this device, according to presented evidence. Method: an integrative review of articles collected in health databases conducted in February 2015. The descriptors used were heart diseases, heart-assist devices and nursing. We identified 34 articles, which were then submitted to thematic analysis. Results: ventricular assist devices function as mechanical pumps promoting adequate cardiac output. Their main benefit is hemodynamic stabilization. The most common complication is infection. Health education, emotional support, outpatient care and curative care are the main care actions performed by nurses. Conclusion: evidence confirms improvement in survival rates of patients with severe heart failure with the use of ventricular assist devices, reiterating the importance of expanding this technology in Brazil as a possibility for treatment.

The effect of LVAD cannula anastomosis location on micro-emboli movement in the aorta / 医用生物力学

Objective To clarify the influence from left ventricular assist device （LVAD） cannula anastomosis on micro-emboli movement by numerical simulation methods. Methods Firstly, a patient-specific aorta geometric model was reconstructed based on CT scan images of a patient with heart failure. Three geometric models of LVAD support were established according to clinical practice, and the outflow cannula of LVAD was anastomosed at the three different locations of ascending aorta (the anterior wall, between anterior wall and lateral wall, the lateral wall of ascending aorta). Secondly, the computational fluid dynamic (CFD) approach combined with the discrete phase theory was used to calculate the hemodynamic states, and Fluent finite element software was used for numerical simulation of the fluid. Finally, the micro-emboli distribution flow pattern, wall shear stress (WSS) and velocity vector were extracted to evaluate the hemodynamic state. Results The probability of micro-emboli entering the brain vessel at the three different anastomosis locations were 23.6%, 33.8% and 36.7%, respectively. Besides, vortex was observed around the anastomosis locations. Conclusions The different anastomosis locations of LVAD cannula can significantly change the hemodynamic environment, which will influence micro-emboli movement in the aorta. The research findings provide some insights and theoretical support for optimizing the anastomosis to decrease occurrence risk of stroke in clinic.

Surgical treatment for prosthetic valve endocarditis / 中华胸心血管外科杂志

Objective To report the clinical characteristics and surgical treatment of prosthetic valve endocarditis (PVE).Methods A retrospective review of 20 consecutive patients,who underwent surgery for PVE between Jan 2003 and Dec 2012,was conducted.Excision of infected prosthetic valves and radical debridement of the infected tissues were completed under hypothermic cardiopulmonary bypass.Six patients were treated by the Bentall procedure,4 patients by the modified Cabrol procedure,4 patients by aortic valve replacement,3 patients by mitral valve replacement and 3 patients by double valve replacement.Results One patient died within 30 days after surgery due to severe sepsis complicated with multiple organ failure and other 19 patients discharged smoothly.A further 2 patients died 2 and 4 months after surgery due to recurrence of fungal infection.Fourteen patients were followed up for 20-124 (59.0 ± 31.8) months.No patient died and no relapse of endocarditis occurred during the period of follow-up.Conclusion Optimal timing of surgical intervention and radical debridement of all infected tissues are the keys to success.

Risk factors for healthcare-associated infection in patients after extracorporeal membrane oxygenation procedure / 中国感染控制杂志

Objective To realize the incidence of healthcare-associated infection(HAI)in patients after receiving extracorporeal membrane oxygenation(ECMO)procedure,and to evaluate the related factors for HAI.Methods Clinical data of patients receiving ECMO from January 2003 to December 2012 were collected and analyzed retro-spectively.Results Of 43 patients receiving ECMO,15 (34.88% )developed 24 times(55.81% )of HAI. The main HAI site was lower respiratory tract(n= 12,50.00% ),followed by blood stream(n= 6,25.00% ),skin and soft tis-sue(n= 5,20.83% ).A total of 28 isolates of pathogens were detected,gram-negative bacilli were 19(67.86% )iso-lates,gram-positive cocci 7(25.00% ),and fungi 2(7.14% );pathogens were mainly isolated from specimens of sputum(n= 12,42.86% ),blood (n= 9,32.14% )and wound secretion(n= 6,21 .43% ). The incidence of postopera-tive HAI in ECMO patients was related with patients’age,duration of ECMO,complication,mechanical ventila-tion,tracheal intubation or tracheotomy,and indwelling urinary catheter.Conclusion HAI in patients receiving EC-MO is high,hospital should take corresponding prevention and control measures targeting to the related risk factors of infection,so as to reduce the incidence of HAI after the ECMO.

Adult cardiac transplantation: A review of perioperative management (Part - II).

Heart transplant is the definitive therapy for end-stage heart failure. This two part review article focussed first on the perioperative management of patients for heart transplantation. This part II will be a comprehensive review of the current status of mechanical assist device therapy for surgical management of the patient with refractory end-stage heart failure.

A Study on an Effective Decellularization Technique for a Xenograft Cardiac Valve: the Effect of Osmotic Treatment with Hypotonic Solution / 대한흉부외과학회지

BACKGROUND: Cellular remnants in the bioprosthetic heart valve are known to be related to a host's immunologic response and they can form the nidus for calcification. The extracellular matrix of the decellularized valve tissue can also be used as a biological scaffold for cell attachment, endothelialization and tissue reconstitution. Thus, decellularization is the most important part in making a bioprosthetic valve and biological scaffold. Many protocols and agents have been suggested for decellularization, yet there have been few reports about the effect of a treatment with hypotonic solution prior to chemical or enzymatic treatment. This study investigated the effect of a treatment with hypotonic solution and the appropriate environments such as temperature, the treatment duration and the concentration of sodium dodecylsulfate (SDS) for achieving proper decellularization. MATERIAL AND METHOD: Porcine aortic valves were decellularized with sodium dodecylsulfate at various concentrations (0.25%, 0.5%), time durations (6, 12, 24 hours) and temperatures (4degrees C, 20degrees C)(Group B). Same the number of porcine aortic valves (group A) was treated with hypotonic solution prior to SDS treatment at the same conditions. The duration of exposure to the hypotonic solution was 4, 7 and 14 hours and the temperature was 4degrees C and 20degrees C, respectively. The degree of decellularization was analyzed by performing hematoxylin and eosin staining. RESULT: There were no differences in the degree of decellularization between the two concentrations (0.25% 0.5%) of SDS. Twenty four hours treatment with SDS revealed the best decellularization effect for both groups A and B at the temperature of 4degrees C, but there was no differences between the groups at 20degrees C. Treatment with hypotonic solution (group A) showed a better decellularization effect at all the matched conditions. Fourteen hours treatment at 4degrees C with hypotonic solution prior to SDS treatment revealed the best decellularization effect. The treatment with hypotonic solution at 20degrees C revealed a good decellularization effect, but this showed significant extracellular matrix destruction. CONCLUSION: The exposure of porcine heart valves to hypotonic solution prior to SDS treatment is highly effective for achieving decellularization. Osmotic treatment with hypotonic solution should be considered for achieving decellularization of porcine aortic valves. Further study should be carried out to see whether the treatment with hypotonic solution could reduce the exposure duration and concentration of chemical detergents, and also to evaluate how the structure of the extracellular matrix of the porcine valve is affected by the exposure to hypotonic solution.

Prospect of artificial muscle in medical applications / 国际生物医学工程杂志

Artificial muscle can be sorted into two classes. Electron transported materials were powered by electron field at high voltage including electric field responsive elastomer, piezoelectric and ferroelectric polymer. Other new materials are phase electrolytic phase transformation actuators, liquid crystal, molecular actuator, ets. Ion transported materials works at low voltage, pH response gels, ionic polymer metal composites, conductive polymers, as well as carbon nanotubes are belong to this type. Some of the artifrcial muscle designs showed potential application in assay sampling, eye muscle, limb prosthesis muscles, and artificial heart materiales.

Affection of guiding vane on axial flow pump heart assist device and its clinical relevancy / 医疗卫生装备

Objective To observe the response of the guiding vane to axial flow pump by testing two types of miniature axial flow pump,which have been developed by our group in recent years.Methods Two types of axial flow pump were tested in a mock circulation apparatus.Results The outputs of the two types of miniature axial flow pump all attain 5L/min against the pressure of 13.332kPa,which is enough for left ventricular assistance.The outputs are similarly related to their pre-load and after-load pressure.In this study,the guiding vane does not produce a significant affection on the hydrodynamic characteristic of the axial follow pump.Conclusion The guiding vane may be neglected in the design to improve the blood compatibility of a axial flow pump heart assist device.

Cadaver Fitting Test of Mechanical Circulatory Assist Device Including Korean Artificial Heart (AnyHeart) in Korea / 대한해부학회지

Preclinical cadaver fitting study is paramount in the development of various implantable medical devices. It helps to evaluate the fitness of the size, shape, structure of the devices in the human anatomy, to locate the most optimal site for implantation, and to develope the clinically available surgical techniques. The purpose of this study was to observe the anatomical feasibility of Korean artificial heart (AnyHeart) in 12 human cadavers after obtaining the permission from the Korea University Anatomical Research Committee. The observation was focused on proper position of the artificial heart in various thoracic incisions (median sternotomy, right thoracotomy, left thoracotomy, transsternal incision), localization of inflow as well and outflow tract, cannulation sites, and so on. Results showed that Korean artificial heart had excellent anatomical feasibility in the human body and that a novel surgical technique of right thoracotomy approach was proved to be clinically applicable. Conclusively, the above results will provide the rationales of clinical trial and demonstrate the significance of human cadaver study in development of implantable medical devices.

Clinical research of the effects of carbon dioxide pneumoperitoneum on cardiovascular function in geriatric cholelithiasis / 中国现代普通外科进展

Objective: To explore the effect of CO 2 pneumoperitoneum in laparoscopic surgery on the cardiovascular function of the geriatric cholelithiasis.Methods:Sixty aged patients undergone laparoscopic surgery were selected.During various stage of CO 2 insufflation,the heart rate(HR),blood pressure,oxygen saturation ,electrocardiogram(ECG),and myocardial enzymes were dected,and the clinical values of these changes were analyzed.Results: when CO 2 pneumoperitoneum established ,the HR and blood pressure were increased obviously .The incidence of arrhythmia was 36% and the incidence of changes of ST segment was 30%,10 minutes after pneumoperitoneum eliminated,these changes were restored. The myocardial enzymes and the oxygon saturation of blood had no distinct changes. Conclusion: The procedure of CO 2 pneumoperitoneum caused temporany changes of the HR ,SBP/DSP and ECG.The laparoscopic surgery is effective and safe for geriatric cholelithiasis.It suggests that the dynamic monitoring of electrocardiogram is necessary,especially for those with abnormal heart function.