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Imaoka S, Nishinaka T, Mizuno T, Umeki A, Murakami T, Tsukiya T, Kawamura M, Miyagawa S. Feasibility of an animal model for long-term mechanical circulatory support with Impella 5.5 implanted through carotid artery access in sheep. J Artif Organs 2024:10.1007/s10047-024-01444-0. [PMID: 38642185 DOI: 10.1007/s10047-024-01444-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/16/2024] [Indexed: 04/22/2024]
Abstract
Impella is a mechanical circulatory support device of a catheter-based intravascular microaxial pump for left ventricular support and unloading. However, nonclinical studies assessing the effects of the extended duration of left ventricular unloading on cardiac recovery are lacking. An animal model using Impella implanted with a less invasive procedure to enable long-term support is required. This study aimed to evaluate the feasibility of an animal model for long-term support with Impella 5.5 implanted through carotid artery access in sheep.Impella 5.5 was implanted in four sheep through the proximal region of the left carotid artery without a thoracotomy, and myocardial injuries were induced by coronary microembolization. Support by Impella 5.5 was maintained for 4 weeks, and the animals were observed. The position of Impella 5.5 and cardiac function was evaluated using cardiac computer tomography at 2 and 4 weeks after implantation.All four animals completed the 4-week study without major complications. The discrepancy in the Impella 5.5 flow rate between the conscious and anesthetized states was observed depending on the device's position. Animals in whom the inflow was above the left ventricular papillary muscle had a relatively high flow rate under the maximum performance level without a suction alarm during the conscious state. Pathological changes in the aortic valve were observed. Cardiac function under the minimum performance level was observed with no remarkable deterioration.The animal model with myocardial injuries supported for 4 weeks by Impella 5.5 implanted through carotid artery access in sheep was feasible.
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Affiliation(s)
- Shusuke Imaoka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan.
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan.
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Akihide Umeki
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Takashi Murakami
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Masashi Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Tanaka S, Nishinaka T, Umeki A, Murakami T, Imaoka S, Mizuno T, Tsukiya T, Ono M. Hemodynamic Evaluation of Asynchronous Speed Modulation of a Continuous-Flow Left Ventricular Assist Device in an Acute-Myocardial Injury Sheep Model. Ann Biomed Eng 2024; 52:364-375. [PMID: 37851145 DOI: 10.1007/s10439-023-03383-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
Asynchronous rotational-speed modulation of a continuous-flow left ventricular assist device (LVAD) can increase pulsatility; however, the feasibility of hemodynamic modification by asynchronous modulation of an LVAD has not been sufficiently verified. We evaluated the acute effect of an asynchronous-modulation mode under LVAD support and the accumulated effect of 6 consecutive hours of driving by the asynchronous-modulation mode on hemodynamics, including both ventricles, in a coronary microembolization-induced acute-myocardial injury sheep model. We evaluated 5-min LVAD-support hemodynamics, including biventricular parameters, by switching modes from constant-speed to asynchronous-modulation in the same animals ("acute-effect evaluation under LVAD support"). To determine the accumulated effect of a certain driving period, we evaluated hemodynamics including biventricular parameters after weaning from 6-hour (6 h) LVAD support by constant-speed or asynchronous-modulation mode ("6h-effect evaluation"). The acute-effect evaluation under LVAD support revealed that, compared to the constant-speed mode, the asynchronous-modulation mode increased vascular pulsatility but did not have significantly different effects on hemodynamics, including both ventricles. The 6 h-effect evaluation revealed that the hemodynamics did not differ significantly between the two groups except for some biventricular parameters which did not indicate negative effects of the asynchronous-modulation mode on both ventricles. The asynchronous-modulation mode could be feasible to increase vascular pulsatility without causing negative effects on hemodynamics including both ventricles. Compared to the constant-speed mode, the asynchronous-modulation mode increased pulsatility during LVAD support without negative effects on hemodynamics including both ventricles in the acute phase. Six hours of LVAD support with the asynchronous-modulation mode exerted no negative effects on hemodynamics, including both ventricles, after weaning from the LVAD.
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Affiliation(s)
- Shun Tanaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan.
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Akihide Umeki
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Takashi Murakami
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Shusuke Imaoka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo , Tokyo, 113-8654, Japan
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Inatomi A, Nishinaka T, Umeki A, Tsukiya T, Katagiri N, Fujii M, Kobayashi F, Imaoka S, Tanaka S, Mizuno T, Murakami T. Feasibility study of an artificial placenta system consisting of a loop circuit configuration extracorporeal membrane oxygenation with a bridge circuit in the form of the umbilical arterial-venous connection. J Artif Organs 2023; 26:287-296. [PMID: 36227380 DOI: 10.1007/s10047-022-01370-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/02/2022] [Indexed: 11/25/2022]
Abstract
We developed a new artificial placenta (AP) system consisting of a loop circuit configuration extracorporeal membrane oxygenation (ECMO) with a bridge circuit designed to be applied to the fetus in the form of an umbilical arterial-venous connection. We aimed to evaluate the feasibility of the AP system by performing a hydrodynamic simulation using a mechanical mock circulation system and fetal animal experiment. The effect of the working condition of the AP system on the fetal hemodynamics was evaluated by hydrodynamic simulation using a mechanical mock circulation system, assuming the weight of the fetus to be 2 kg. The AP system was introduced to two fetal goats at a gestational age of 135 days. The general conditions of the experimental animals were evaluated. The mock simulation showed that in an AP system with ECMO in the form of an umbilical arterial-venous connection in series, it could be difficult to maintain fetal hemodynamics when high ECMO flow was applied. The developed AP system could have high ECMO flow with less umbilical blood flow; however, the possibility of excessive load on the fetal right-sided heart should be noted. In the animal experiment, kid 1 (1.9 kg) was maintained on the AP system for 12 days and allowed to grow to term. In kid 2 (1.6 kg), the AP system could not be established because of the occlusion of the system by a thrombus. The developed AP system was feasible under both in vitro and in vivo conditions. Improvements in the AP system and management of the general fetal conditions are essential.
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Affiliation(s)
- Ayako Inatomi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan.
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan.
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan.
| | - Akihide Umeki
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Nobumasa Katagiri
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Masahiko Fujii
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Futoshi Kobayashi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Syusuke Imaoka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Shun Tanaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
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Tanaka S, Nishinaka T, Umeki A, Imaoka S, Murakami T, Mizuno T, Tsukiya T, Ono M. Impact of Asynchronous Rotational Speed Modulation of Continuous Flow Left Ventricular Assist Device on Cardiac Condition. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Tanaka S, Nishinaka T, Umeki A, Fujii M, Imaoka S, Kobayashi F, Inatomi A, Katagiri N, Tsukiya T, Mizuno T, Ono M. Coronary microembolization sheep model by adjusting the number of microspheres based on coronary blood flow. Artif Organs 2023; 47:138-147. [PMID: 35962546 DOI: 10.1111/aor.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND A heart failure (HF) model using coronary microembolization in large animals is indispensable for medical research. However, the heterogeneity of myocardial response to microembolization is a limitation. We hypothesized that adjusting the number of injected microspheres according to coronary blood flow could stabilize the severity of HF. This study aimed to evaluate the effect of microsphere injection based on the left coronary artery blood flow in an animal model. METHODS Microembolization was induced by injecting different numbers of microspheres (polystyrene, diameter: 90 μm) into the left descending coronary artery of the two groups of sheep (400 and 600 times coronary blood flow [ml/min]). Hemodynamic parameters, the pressure-volume loop of the left ventricle, and echocardiography findings were examined at 0.5, 1.5, 3.5, and 6.5 h after microembolization. RESULTS End-diastolic pressure and normalized heart rate increased over time, and were significantly higher in 600 × coronary blood flow group than those in 400 × coronary blood flow group (p = 0.04 and p < 0.01, respectively). The maximum rate of left-ventricular pressure rise and normalized stroke volume decreased over time, and were significantly lower in 600 × coronary blood flow group than those in 400 × coronary blood flow group (p < 0.01 and p < 0.01, respectively). The number of microspheres per coronary blood flow was significantly correlated with the decrease in stroke volume and the maximum rate of left ventricular pressure rise in 6.5 h (r = 0.74, p = 0.01 and r = 0.71, p = 0.02, respectively). CONCLUSIONS Adjusting the number of injected microspheres based on the coronary blood flow enabled the creation of HF models with different degrees of severity.
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Affiliation(s)
- Shun Tanaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akihide Umeki
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masahiko Fujii
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shusuke Imaoka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Futoshi Kobayashi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Ayako Inatomi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Nobumasa Katagiri
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo, Tokyo, Japan
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Fujii M, Nishinaka T, Inatomi A, Katagiri N, Kobayashi F, Imaoka S, Tanaka S, Mizuno T, Tsukiya T, Umeki A, Matsumiya G. Impact of Left Ventricular Unloading Under Circulatory Support with Venoarterial ECMO in Heart Failure Animal Model. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Umeki A, Yamamoto T. Analysis of systemic vascular resistance after cardiac surgery: a retrospective cohort study. J Thorac Dis 2022; 14:4341-4351. [PMID: 36524063 PMCID: PMC9745537 DOI: 10.21037/jtd-22-325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/13/2022] [Indexed: 11/15/2022]
Abstract
Background Hypotension is a dangerous vital sign frequently encountered during the postoperative management of cardiac surgery. However, factors influencing the systemic vascular resistance index (SVRI), which is strongly related to hypotension, are not well understood. This study evaluated the characteristics of the SVRI according to the type of cardiac surgery. Methods During this retrospective cohort study, we used the clinical data of patients who underwent cardiac surgery at Asahi General Hospital from April 2014 to August 2020. We analyzed their vital signs during the first 12 hours after surgery and evaluated the differences in vital signs among four types of surgery: mitral valve (MV) surgery; aortic valve (AV) surgery; coronary artery bypass grafting (CABG); and thoracic aorta (TA) surgery. Data were compared among these four groups using one-way analysis of variance every 2 hours postoperatively. Those with significant differences were further compared using the post hoc Tukey-Kramer test. Results A total of 493 patients participated in this study. Overall, the SVRI decreased within 2 hours after the cardiopulmonary bypass surgery. The SVRI after MV surgery was significantly lower than that after other surgery types. The doses of inotropes used for MV surgery and TA surgery were significantly greater than those used for the other surgery types. Conclusions The SVRI changes significantly after cardiac surgery and may decrease, especially after MV surgery. For better results, it is necessary to consider the differences in the SVRI that are associated with different types of cardiac surgery.
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Arima D, Umeki A, Yamamoto T. [Ruptured Coronary Artery Aneurysm Associated with Coronary Artery Fistula;Report of a Case]. Kyobu Geka 2018; 71:1122-1124. [PMID: 30587755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We report a case of a ruptured coronary artery aneurysm associated with coronary artery fistula. A 63-year-old man was suffering from cardiac tamponade due to a ruptured coronary artery aneurysm. An emergency operation was performed to repair the aneurysm. Under cardiopulmonary bypass, all inlet and outlet vessels were sutured and closed. The patient recovered uneventfully. A postoperative coronary computed tomography(CT) angiogram showed extinction of the aneurysm.
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Affiliation(s)
- Daisuke Arima
- Department of Cardiac Surgery, Asahi General Hospital, Asahi, Japan
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Abstract
Acquired von Willebrand syndrome (AVWS) is a bleeding disorder caused by an acquired deficiency of von Willebrand factor (vWF). Some patients with AVWS show a low bleeding tendency and are diagnosed by the presence of a mild prolongation of activated partial thromboplastin time (APTT) preoperatively. Another cause of APTT prolongation is the presence of antiphospholipid antibody (aPL). We experienced a case of AVWS due to aortic valve stenosis in a patient with aPL in whom aortic valve replacement surgery was successful with vWF replacement. In patients with AVWS-associated disorders who are identified based on APTT prolongation at the preoperative examination, both vWF and aPL screening tests must be performed.
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Affiliation(s)
| | - Yurie Nagai
- Department of Hematology, Asahi General Hospital, Japan
| | | | - Ryo Shimizu
- Department of Hematology, Asahi General Hospital, Japan
| | - Akihide Umeki
- Department of Cardiovascular Surgery, Asahi General Hospital, Japan
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Naito N, Nishimura T, Iizuka K, Fujii Y, Takewa Y, Umeki A, Ando M, Ono M, Tatsumi E. Novel Rotational Speed Modulation System Used With Venoarterial Extracorporeal Membrane Oxygenation. Ann Thorac Surg 2017; 104:1488-1495. [DOI: 10.1016/j.athoracsur.2017.04.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/01/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
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Naito N, Nishimura T, Iizuka K, Takewa Y, Umeki A, Ando M, Ono M, Tatsumi E. Rotational speed modulation used with continuous-flow left ventricular assist device provides good pulsatility†. Interact Cardiovasc Thorac Surg 2017; 26:119-123. [DOI: 10.1093/icvts/ivx236] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/18/2017] [Indexed: 11/12/2022] Open
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Date K, Nishimura T, Arakawa M, Takewa Y, Kishimoto S, Umeki A, Ando M, Mizuno T, Tsukiya T, Ono M, Tatsumi E. Changing pulsatility by delaying the rotational speed phasing of a rotary left ventricular assist device. J Artif Organs 2016; 20:18-25. [DOI: 10.1007/s10047-016-0920-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
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Naito N, Nishimura T, Takewa Y, Kishimoto S, Date K, Umeki A, Ando M, Ono M, Tatsumi E. What Is the Optimal Setting for a Continuous-Flow Left Ventricular Assist Device in Severe Mitral Regurgitation? Artif Organs 2016; 40:1039-1045. [PMID: 27199010 DOI: 10.1111/aor.12702] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/07/2015] [Accepted: 12/30/2015] [Indexed: 11/29/2022]
Abstract
Excessive left ventricular (LV) volume unloading can affect right ventricular (RV) function by causing a leftward shift of the interventricular septum in patients with mitral regurgitation (MR) receiving left ventricular assist device (LVAD) support. Optimal settings for the LVAD should be chosen to appropriately control the MR without causing RV dysfunction. In this study, we assessed the utility of our electrocardiogram-synchronized rotational speed (RS) modulation system along with a continuous-flow LVAD in a goat model of MR. We implanted EVAHEART devices after left thoracotomy in six adult goats weighing 66.4 ± 10.7 kg. Severe MR was induced through inflation of a temporary inferior vena cava filter placed within the mitral valve. We evaluated total flow (TF; the sum of aortic flow and pump flow [PF]), RV fractional area change (RVFAC) calculated by echocardiography, left atrial pressure (LAP), LV end-diastolic pressure (LVEDP), LV end-diastolic volume (LVEDV), and LV stroke work (LVSW) with a bypass rate (PF divided by TF) of 100% under four conditions: circuit-clamp, continuous mode, co-pulse mode (increased RS during systole), and counter-pulse mode (increased RS during diastole). TF tended to be higher in the counter-pulse mode. Moreover, RVFAC was significantly higher in the counter-pulse mode than in the co-pulse mode, whereas LAP was significantly lower in all driving modes than in the circuit-clamp condition. Furthermore, LVEDP, LVEDV, and LVSW were significantly lower in the counter-pulse mode than in the circuit-clamp condition. The counter-pulse mode of our RS modulation system used with a continuous-flow LVAD may offer favorable control of MR while minimizing RV dysfunction.
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Affiliation(s)
- Noritsugu Naito
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Research Institute, Osaka
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Yoshiaki Takewa
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Research Institute, Osaka
| | - Satoru Kishimoto
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Research Institute, Osaka
| | - Kazuma Date
- Department of Cardiothoracic Surgery, The University of Tokyo, Tokyo, Japan
| | - Akihide Umeki
- Department of Cardiothoracic Surgery, The University of Tokyo, Tokyo, Japan
| | - Masahiko Ando
- Department of Cardiothoracic Surgery, The University of Tokyo, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiothoracic Surgery, The University of Tokyo, Tokyo, Japan
| | - Eisuke Tatsumi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, Research Institute, Osaka
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Date K, Nishimura T, Takewa Y, Kishimoto S, Arakawa M, Umeki A, Ando M, Mizuno T, Tsukiya T, Ono M, Tatsumi E. Shifting the pulsatility by increasing the change in rotational speed for a rotary LVAD using a native heart load control system. J Artif Organs 2016; 19:315-321. [DOI: 10.1007/s10047-016-0906-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 05/08/2016] [Indexed: 10/21/2022]
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Naito N, Mizuno T, Nishimura T, Kishimoto S, Takewa Y, Eura Y, Kokame K, Miyata T, Date K, Umeki A, Ando M, Ono M, Tatsumi E. Influence of a Rotational Speed Modulation System Used With an Implantable Continuous-Flow Left Ventricular Assist Device on von Willebrand Factor Dynamics. Artif Organs 2016; 40:877-83. [DOI: 10.1111/aor.12666] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Noritsugu Naito
- Department of Artificial Organs; National Cerebral and Cardiovascular Center, Research Institute; Osaka Japan
| | - Toshihide Mizuno
- Department of Artificial Organs; National Cerebral and Cardiovascular Center, Research Institute; Osaka Japan
| | - Takashi Nishimura
- Department of Cardiac Surgery; Tokyo Metropolitan Geriatric Hospital; Tokyo Japan
| | - Satoru Kishimoto
- Department of Artificial Organs; National Cerebral and Cardiovascular Center, Research Institute; Osaka Japan
| | - Yoshiaki Takewa
- Department of Artificial Organs; National Cerebral and Cardiovascular Center, Research Institute; Osaka Japan
| | - Yuka Eura
- Department of Molecular Pathogenesis; National Cerebral and Cardiovascular Center, Research Institute; Osaka Japan
| | - Koichi Kokame
- Department of Molecular Pathogenesis; National Cerebral and Cardiovascular Center, Research Institute; Osaka Japan
| | - Toshiyuki Miyata
- Department of Molecular Pathogenesis; National Cerebral and Cardiovascular Center, Research Institute; Osaka Japan
| | - Kazuma Date
- Department of Cardiothoracic Surgery; The University of Tokyo; Tokyo Japan
| | - Akihide Umeki
- Department of Cardiothoracic Surgery; The University of Tokyo; Tokyo Japan
| | - Masahiko Ando
- Department of Cardiothoracic Surgery; The University of Tokyo; Tokyo Japan
| | - Minoru Ono
- Department of Cardiothoracic Surgery; The University of Tokyo; Tokyo Japan
| | - Eisuke Tatsumi
- Department of Artificial Organs; National Cerebral and Cardiovascular Center, Research Institute; Osaka Japan
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Ando M, Yamauchi H, Morota T, Taketani T, Shimada S, Nawata K, Umeki A, Ono M. Long-term outcome after the original and simple modified technique of valve-sparing aortic root reimplantation in Marfan-based population, David V University of Tokyo modification. J Cardiol 2015; 67:86-91. [PMID: 25920727 DOI: 10.1016/j.jjcc.2015.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/10/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In valve-sparing aortic root replacement (VSARR), how to reproduce Valsalva sinus has been an issue. In the original David V procedure, they put plication stitches at sinotubular junction level, although the reefing effect is limited and distal graft remains larger than native. Other modified techniques are two-grafts technique and ready-made Valsalva graft. However, the former needs graft-graft anastomosis and may not be cost-effective, while in the latter, the shape of sinus is fixed and minor adjustment is difficult. David V University of Tokyo modification (David V-UT) is our original solution to that, creating pseudosinus with one straight graft by longitudinal size-reduction running sutures above each pseudosinus. The purpose of the present study is to investigate long-term outcome of David V-UT. METHODS We analyzed 59 David V-UT patients from February 2004 to February 2013 and long-term outcomes were investigated by Kaplan-Meier methods. Risk factors for adverse events "death or recurrent aortic insufficiency (AI) with or without aortic valve reoperation" were analyzed by using Cox proportional hazard models. RESULTS Mean age was 33.1±14.5 years, and 38 patients (64%) were male. Marfan syndrome (MFS) accounts for 47 patients (80%). Only one patient was with bicuspid aortic valve. No in-hospital mortality was observed. Mean follow-up was 4.9±2.4 years. Estimated survival was 94.0±3.4% at 5 years. Freedoms from aortic valve reoperation and recurrent AI greater than mild were 95.7±3.0% and 88.9±4.7% at 5 years, respectively. In Cox proportional hazard analysis, preoperative AI greater than mild and Z score of annular diameter were significant risks for adverse events (p=0.027 and 0.045, hazard ratio 6.084 and 1.432, 95% C.I. 1.225-30.21 and 1.008-2.035, respectively). CONCLUSIONS Even in Marfan-characterized population, David V-UT provided satisfactory long-term outcome, comparable to other VSARR modifications. It is simple but can freely reproduce trilobed sinus with one straight graft.
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Affiliation(s)
- Masahiko Ando
- The University of Tokyo, Department of Cardiac Surgery, Tokyo, Japan.
| | - Haruo Yamauchi
- The University of Tokyo, Department of Cardiac Surgery, Tokyo, Japan
| | - Tetsuro Morota
- Nippon Medical School Hospital, Department of Cardiovascular Surgery, Tokyo, Japan
| | - Tsuyoshi Taketani
- Mitsui Memorial Hospital, Department of Cardiovascular Surgery, Tokyo, Japan
| | - Shogo Shimada
- The University of Tokyo, Department of Cardiac Surgery, Tokyo, Japan
| | - Kan Nawata
- The University of Tokyo, Department of Cardiac Surgery, Tokyo, Japan
| | - Akihide Umeki
- The University of Tokyo, Department of Cardiac Surgery, Tokyo, Japan
| | - Minoru Ono
- The University of Tokyo, Department of Cardiac Surgery, Tokyo, Japan
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Arakawa M, Nishimura T, Takewa Y, Umeki A, Ando M, Adachi H, Tatsumi E. Alternation of left ventricular load by a continuous-flow left ventricular assist device with a native heart load control system in a chronic heart failure model. J Thorac Cardiovasc Surg 2014; 148:698-704. [DOI: 10.1016/j.jtcvs.2013.12.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 12/12/2013] [Accepted: 12/20/2013] [Indexed: 11/26/2022]
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Arakawa M, Nishimura T, Takewa Y, Umeki A, Ando M, Kishimoto Y, Fujii Y, Kyo S, Adachi H, Tatsumi E. Novel control system to prevent right ventricular failure induced by rotary blood pump. J Artif Organs 2014; 17:135-41. [DOI: 10.1007/s10047-014-0757-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
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Arakawa M, Nishimura T, Takewa Y, Umeki A, Ando M, Kishimoto Y, Kyo S, Adachi H, Tatsumi E. Active Control of Left Ventricular Load by a Continuous-flow LVAD with a Native Heart Load Control System for Longtime Use. J Card Fail 2013. [DOI: 10.1016/j.cardfail.2013.08.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kishimoto Y, Takewa Y, Arakawa M, Umeki A, Ando M, Nishimura T, Fujii Y, Mizuno T, Nishimura M, Tatsumi E. Development of a novel drive mode to prevent aortic insufficiency during continuous-flow LVAD support by synchronizing rotational speed with heartbeat. J Artif Organs 2013; 16:129-37. [DOI: 10.1007/s10047-012-0685-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 12/25/2012] [Indexed: 01/05/2023]
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Umeki A, Nishimura T, Ando M, Takewa Y, Yamazaki K, Kyo S, Ono M, Tsukiya T, Mizuno T, Taenaka Y, Tatsumi E. Change of Coronary Flow by Continuous-Flow Left Ventricular Assist Device With Cardiac Beat Synchronizing System (Native Heart Load Control System) in Acute Ischemic Heart Failure Model. Circ J 2013; 77:995-1000. [DOI: 10.1253/circj.cj-12-0676] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihide Umeki
- Department of Cardiothoracic Surgery, The University of Tokyo
- Department of Artificial Organ, National Cerebral and Cardiovascular Center
| | | | - Masahiko Ando
- Department of Cardiothoracic Surgery, The University of Tokyo
| | - Yoshiaki Takewa
- Department of Artificial Organ, National Cerebral and Cardiovascular Center
| | - Kenji Yamazaki
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Shunei Kyo
- Department of Cardiothoracic Surgery, The University of Tokyo
| | - Minoru Ono
- Department of Cardiothoracic Surgery, The University of Tokyo
| | - Tomonori Tsukiya
- Department of Artificial Organ, National Cerebral and Cardiovascular Center
| | - Toshihide Mizuno
- Department of Artificial Organ, National Cerebral and Cardiovascular Center
| | - Yoshiyuki Taenaka
- Department of Artificial Organ, National Cerebral and Cardiovascular Center
| | - Eisuke Tatsumi
- Department of Artificial Organ, National Cerebral and Cardiovascular Center
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Umeki A, Nishimura T, Ando M, Takewa Y, Yamazaki K, Kyo S, Ono M, Tsukiya T, Mizuno T, Taenaka Y, Tatsumi E. Alteration of LV end-diastolic volume by controlling the power of the continuous-flow LVAD, so it is synchronized with cardiac beat: development of a native heart load control system (NHLCS). J Artif Organs 2011; 15:128-33. [PMID: 22080357 DOI: 10.1007/s10047-011-0615-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 10/26/2011] [Indexed: 11/30/2022]
Abstract
There are many reports comparing pulsatile and continuous-flow left ventricular assist devices (LVAD). But continuous-flow LVAD with the pulsatile driving technique had not been tried or discussed before our group's report. We have previously developed and introduced a power-control unit for a centrifugal LVAD (EVAHEART®; Sun Medical), which can change the speed of rotation so it is synchronized with the heart beat. By use of this unit we analyzed the end-diastolic volume (EDV) to determine whether it is possible to change the native heart load. We studied 5 goats with normal hearts and 5 goats with acute LV dysfunction because of micro-embolization of the coronary artery. We used 4 modes, "circuit-clamp", "continuous", "counter-pulse", and "co-pulse", with the bypass rate (BR) 100%. We raised the speed of rotation of the LVAD in the diastolic phase with the counter-pulse mode, and raised it in the systolic phase with the co-pulse mode. As a result, the EDV decreased in the counter-pulse mode and increased in the co-pulse mode, compared with the continuous mode (p < 0.05), in both the normal and acute-heart-failure models. This result means it may be possible to achieve favorable EDV and native heart load by controlling the rotation of continuous-flow LVAD, so it is synchronized with the cardiac beat. This novel driving system may be of great benefit to patients with end-stage heart failure, especially those with ischemic etiology.
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Affiliation(s)
- Akihide Umeki
- Department of Artificial Organ, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
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Inoue T, Nishimura T, Murakami A, Itatani K, Takaoka T, Kitahori K, Umeki A, Takezoe T, Kashiwa K, Kyo S, Ono M. Left ventricular assist device support with a centrifugal pump for 2 months in a 5-kg child. J Artif Organs 2011; 14:253-6. [DOI: 10.1007/s10047-011-0572-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 04/26/2011] [Indexed: 11/28/2022]
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Sato E, Suzuki M, Umeki A, Hoshi S, Kosaka M. [Nursing of patients with non-compensatory liver cirrhosis. Nursing of patients with liver cirrhosis and ascites]. Kango Gijutsu 1986; 32:1368-71. [PMID: 3640035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Umeki A, Hoshi S, Kobayashi K. [Nursing plans for patients with liver cirrhosis]. Kurinikaru Sutadi 1986; 7:525-30. [PMID: 3637560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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26
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Sato I, Suzuki M, Umeki A, Hoshi S, Ogawa A. [Nursing of patients with liver cirrhosis: possibilities in nursing and guidance of patients without support from family members]. Kurinikaru Sutadi 1986; 7:540-3. [PMID: 3637562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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27
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Sato I, Suzuki M, Umeki A, Hoshi S, Ogawa A. [Nursing of a liver cirrhosis patient with refractory complications and personal problems at home]. Kurinikaru Sutadi 1986; 7:531-9. [PMID: 3637561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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