Early Outcomes of COVID-19 Lung Transplantation Recipients in Korea: A Single-Center Study
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- Journal of Chest Surgery
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- v.56 no.1
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- pp.6-13
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- 2023
Background: Coronavirus disease 2019 (COVID-19) has been found to cause life-threatening respiratory failure, which can progress to irreversible lung damage. Lung transplantation can be a life-saving treatment in patients with terminal lung disease (e.g., acute respiratory distress syndrome caused by infection). This study aimed to present the clinical course and results after initial lung transplantation in patients with severe COVID-19 who did not recover even with optimal medical care. Methods: From August 2019 to February 2022, this study enrolled 10 patients with COVID-19 (5 men; median age, 55.7 years) who underwent lung transplantation at a single center in Korea. All patients' characteristics, clinical pathway, overall survival, complications, and operative data were collected and analyzed. Results: Veno-venous extracorporeal membrane oxygenation or an oxygenator in a right ventricular assist device circuit was applied to 90% of the patients, and the median length of extracorporeal life support before operation was 48.5 days. There were no cases of mortality after a median follow-up of 372.8 days (interquartile range, 262.25-489 days). The major complications included the requirement for postoperative extracorporeal membrane oxygenation support in 2 cases (20%), re-transplantation in 1 case (10%), and re-exploration due to bleeding in 2 cases (20%). During the follow-up period, 3 out of 10 patients died. Conclusion: Excellent early outcomes were observed for patients who underwent lung transplantation. Thus, lung transplantation can be an effective and feasible treatment for patients with end-stage lung disease caused by COVID-19.
In this article, we present and analyze the results of the three consecutive in vivo experiments of the LVAD to evaluate the function of the LVAD and the adverse effects on living animals. We applied the LVAD consecutively to three mongrel dogs and the circulation of the blood was assisted under the anesthesia. We used in general both the asynchronous mode and the synchronous mode to drive the LVAD. During the experiments we monitored the dogs with a polygraph to evaluate the function of the LVAD and the additional effects on the natural hearts. We also examined several clinical pathologic tests in order to see the effects of the LVAD to the red blood cells and the other internal organs. The dogs survived for two to there days. The LVAD assisted the circulatory system at the maximum assist flow rate of 3.0 1/min. Although the red blood cells of the dogs had mechanical damages by the LVAD to result in the hemolysis, the degree of the hemolysis was not so high and the damages caused by the hemolysis on the dogs were not serious. The myocardium of the first dog was gradually worsened and eventually failed. The damage of the myocardium was due to the asynchronous driving mode of the LVAD. The other organs did not have serious damages due to the application of the LVAD. The main purpose of this paper is to evaluate the results of the in vivo experiments of the LVAD and to find better ways to the application of the LVAD to human beings.
An electromechanical type is the most useful mechanism in the various pumping mechanisms. It, however, requires a movement converting system including a ball screw, a helical cam, or a solenoid-beam spring, which makes the device complex and may lessen reliability. Thus, the authors have hypothesized that an electromagnetic actuator mechanism can eliminate the movement converting system and that thereby enhance the mechanical reliability and operative simplicity of an electropneumatic pump. The purpose of this study was to show a novel application of electromagnetic actuator mechanism in pulsatile pump and to provide preliminary data for further evaluations. The electromagnetic actuator consists of stators with a single winding excitation coil and movers with a high energy density neodymium-iron-boron permanent magnet. A 0.5mm diameter wire was used for the excitation coil, and 1000 turns were wound onto the stators core with parallel. A prototype of extracorporeal electro-pneumatic pump was constructed, and the pump performance tests were performed using a mock system to evaluate the efficiency of the electromagnetic actuator mechanism. When forward and backward electric currents were supplied to the excitation coil, the mover effectively moved back and forth. The nominal stroke length of the actuator was 10mm. The actuator dimension was 120mm in diameter and 65mm in height with a mass of 1.4kg. The prototype pump unit was 150mm in diameter, 150mm in thickness and 4.5kg in weight. The maximum force output was 70N at input current of 4.5A and the maximum pump rate was 150 beats per minute. The maximum output was 2.0 L/minute at a rate of 80bpm when the afterload was 100mmHg. The electromagnetic actuator mechanism was successfully applied to construct the prototype of extracorporeal electropneumatic pump. The authors provide the above results as a preliminary data for further studies.
Background: We analyzed the clinical results and the factors for survival of patients who underwent extracorporeal life support system after adult cardiovascular surgery. Material and Method: We retrospectively reviewed the medical record of 44 patients (1.6% of the total adult cardiovascular surgical cases) who underwent the use of a ventricular assisted device or extracorporeal membrane oxygenation from January 2002 to August 2008. There were 32 (72.7%) males and their mean age was 61.7
Mechanical circulatory support (MCS) has been used for myocardium failure, but moreover, it may be essential for the life support in cardiac arrest or cardiogenic shock. Many commercial devices can be used effectively for the long-term support. However, there are some limitations in the aspects of the cost and technical support by production company. Short-term support with centrifugal type has been reported numerously with the purpose of bridging to heart transplantation or recovery. We successfully treated 5 patitents who were in the status of cardiogenic shock (n=3) or arrest (n=2) with the technique of extracorporeal life support system (ECLS) or left ventricular assist device (LVAD) using the centrifugal type pump. The MCS were performed emergently (n=2) under cardiac arrest caused by ischemic heart disease, and urgently (n=3) under cardiogenic shock with ischemic heart disease (n=1) or acute fulminant viral myocarditis (n=2). All patients were weaned from MCS. Complications related to the use of MCS were bleeding and acute renal failure, but there were no major complications related to femoral cannulations. Mechanical circulatory support may be essential for the life support and rescue in cardiac arrest or cardiogenic shock.
Mechanical valve is one of the most widely used implantable artificial organs of which the reliability is so important that its failure means the death of patient. Therefore early noninvasive detection is essentially required, though mechanical valve failure with thrombosis is the most common. The objective of this paper is to detect the thrombosis formation by spectral analysis and neural network. Using microphone and amplifier, we measured the sound from the mechanical valve which is attached to the pneumatic ventricular assist device. The sound was sampled by A/D converter(DaqBook 100) and the periodogram is the main algorithm for obtaining spectrum. We made the thrombosis models using pellethane and silicon and they are thrombosis model on the valvular disk, around the sewing ring and fibrous tissue growth across the orifice of valve. The performance of the measurment system was tested firstly using 1 KHz sinusoidal wave. The measurement system detected well 1KHz spectrum as expected. The spectrum of normal and 5 kinds of thrombotic valve were obtained and primary and secondary peak appeared in each spectrum waveform. We find that the secondary peak changes according to the thrombosis model. So to distinguish the secondary peak of normal and thrombotic valve quantatively, 3 layer back propagation neural network, which contains 7, 000 input node, 20 hidden layer and 1 output was employed The trained neural network can distinguish normal and valve with more than 90% probability. As a conclusion, the noninvasive monitoring of implanted mechanical valve is possible by analysing the acoustical spectrum using neural network algorithm and this method will be applied to the performance evaluation of other implantable artificial organs.
Background: The number of heart transplantations (HTx) is increasing annually. Due to advances in medical and surgical support, the outcomes of HTx are also improving. Extracorporeal circulatory life support (ECLS) provides patients with decompensated heart failure a chance to undergo HTx. A medical approach involving collaboration among experienced experts in different fields should improve the outcomes and prognosis of ECLS-bridged HTx. Methods: From December 2003 to December 2018, 1,465 patients received ECLS at Samsung Medical Center. We excluded patients who had not undergone HTx or underwent repeated transplantations. Patients younger than 18 years were excluded. We also excluded patients who received an implantable durable left ventricular assist device before HTx. In total, 91 patients were included in this study. A multidisciplinary team approach began in March 2013 at our hospital. We divided the patients into 2 groups depending on whether they were treated before or after implementation of the team approach. Results: The 30-day mortality rate was significantly higher in the pre-ECLS team group than in the post-ECLS team group (n=5, 18.5% vs. n=2, 3.1%; p=0.023). The 1-year survival rate was better in the post-ECLS team group than in the pre-ECLS team group (n=57, 89.1% vs. n=19, 70.4%; p=0.023). Conclusion: We found that implementing a multidisciplinary team approach improved the outcomes of ECLS-bridged HTx. Team-based care should be adapted at HTx centers that perform high-risk HTx.
Background: Loss of cardiomyocytes in the myocardial infarction leads to regional contractile dysfunction, and necrotized cardiomyocytes in infracted ventricular tissues are progressively replaced by fibroblasts forming scar tissue. Although cardiomyoplasty, or implantation of ventricular assist device or artificial heart was tried in refractory heart failure, the cardiac transplantation was the only therapeutic modality because these other therapeutic strategies were not permanent. Cell transplantation is tried instead of cardiac transplantation, especially bone marrow is the most popular donated organ. But because bone marrow aspiration procedure is invasive and painful, and it had the fewer amounts of cellular population, the adipose tissue is recommended for harvesting of mesenchymal stem cells. Material and Method: After adipose tissues were extracted from abdominal subcutaneous adipose tissue and intra-abdominal adipose tissue individually, the cellular components were obtained by same method. These cellular components were tried to transformation with the various titers of 5-azacytidine to descript the appropriate concentration of 5-azacytidine and possibility of transformation ability of adipose tissue. Group 1 is abdominal subcutaneous adipose tissue and Group 2 is intra-abdominal adipose tissue-retroperitoneal adipose tissue and omentum. Cellular components were extracted by collagenase and
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70