Abstract:
:The therapy of terminal heart failure with left ventricular assist devices has become a standard in cardiac surgery. Yet the surgical implantation technique is not standardized and differs from center to center. Complications associated with left ventricular assist device (LVAD) inflow cannula placement are thrombosis, suction events, and flow disturbances. Within this in vitro study we aimed to investigate if the fixation technique of the sewing ring has an impact on the position of the inflow cannula. For this in vitro study the HeartMate III LVAD (Thoratec Corporation, Pleasanton, CA, USA) was used. In five sessions, two approaches were considered for coring of the ventricle for LVAD inflow cannula insertion: "sew-then-core" and "core-then-sew." In the "sew-then-core" technique, the sewing cuff is first affixed to the heart, usually with 8-16 interrupted pledgeted mattress sutures. Subsequently, a cylindrical knife is used to resect a cylindrical core of myocardium to permit cannula insertion. In the "core-then-sew" technique, the sequence is reversed such that the knife is used before the suture ring is affixed. When the "sew-then-core" technique is used, the mattress sutures may be placed with full-thickness bites that penetrate the endocardium (i.e., transmural stitching) or partial-thickness bites that do not penetrate the endocardium (i.e., epicardial stitching). When the "core-then-sew" technique is used, the suture is passed fully into the ventricular lumen and fed back through the cored hole, at which point the needle may be reinserted into the freshly cored myocardium such that it exits the epicardium (i.e., transmural stitching with back stitch) or not (i.e., transmural stitching without back stitch). These four different sewing ring fixation suturing techniques were tested by experienced surgeons to affix the sewing ring: transmural stitching, epicardial stitching, transmural stitching with back stitch, and transmural stitching without back stitch. The sewing ring was sewed onto a silicone dummy designed to simulate the left ventricle with standard 2-0 Ethibond sutures (Ethicon, Somerville, NY, USA). Afterward, the dummies were measured and documented via photography. In addition, porcine hearts were used to simulate the suturing techniques in a physiological setting. The setting of the inflow cannula is substantially influenced by the fixation method of the sewing ring. Epicardial stitching showed the best results with stable cannula fixation, minimal gap around the cannula and no contact between the sutures and sewing ring with blood. The method of transmural stitching without back stitch showed the worst results by creating the biggest epithelial gap between inflow cannula and tissue as well as proving the biggest surface for blood contact between sewing ring and sutures. In general, both "sew-then-core" techniques resulted in a greater degree of apposition between the cuff and epicardial tissue. Within the study we revealed that the surgical fixation of the sewing ring has a significant impact on the inflow cannula stability, position, and tissue apposition in LVAD implantation surgery. Epicardial stitching of the sewing ring provides the best results in order to prevent suction events as well as thrombosis formation.
journal_name
Artif Organsjournal_title
Artificial organsauthors
Hanke JS,Krabatsch T,Rojas SV,Deniz E,Ismail I,Martens A,Shrestha M,Haverich A,Netuka I,Schmitto JDdoi
10.1111/aor.12735subject
Has Abstractpub_date
2017-03-01 00:00:00pages
272-275issue
3eissn
0160-564Xissn
1525-1594journal_volume
41pub_type
杂志文章abstract::The use of and demand for functional electrical stimulation (FES) systems and conventional orthoses in the spinal cord lesioned population was assessed. The assessment was conducted by a postal survey of the members of the spinal injury associations in the U.K. Out of all the respondents, only 2% had used an FES syste...
journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1046/j.1525-1594.1999.06361.x
更新日期:1999-05-01 00:00:00
abstract::To develop an effective hybrid bioartificial liver (BAL) device, the material of the scaffold is very important to support hepatocytes that have both growth ability and hepatic differentiated functions. In this study we used paper (Kimwipe, Kimberly-Clark Corp., Roswell, GA, U.S.A.) as a scaffold. Primary hepatocytes ...
journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1046/j.1525-1594.2000.06506.x
更新日期:2000-04-01 00:00:00
abstract::A method of creating multifocal ischemia in animals leading to left ventricular (LV) functional impairment is described. In a series of 10 mongrel dogs, electrodes were implanted in multiple branches of the coronary arteries. Subsequently, in seven animals, an 800-microA anodal current was applied for 3 h repeatedly o...
journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1984.tb04321.x
更新日期:1984-11-01 00:00:00
abstract::Controlled and repeatable in vitro evaluation of cardiovascular devices using a mock circulation loop (MCL) is essential prior to in vivo or clinical trials. MCLs often consist of only a systemic circulation with no autoregulatory responses and limited validation. This study aimed to develop, and validate against huma...
journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.13636
更新日期:2020-06-01 00:00:00
abstract::The durability of ventricular assist device (VAD) therapy improved steadily over the past years. However, driveline infections remain a challenge. To test whether an improved surgical implantation technique may lower the incidence of infections, we analyzed all patients receiving a VAD implantation in the years 2008 a...
journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.12036
更新日期:2013-01-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1988.tb02795.x
更新日期:1988-10-01 00:00:00
abstract::In patients undergoing exchange-transfusion with hemoglobin (Hb)-based oxygen (O₂) carriers (HBOC), native Hb coexists with newly transfused Hb. The two Hb types share the same arterial and venous PO₂, but their affinities for O₂ vary. A simple spreadsheet model is described aiming at evaluating the contribution of ea...
journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.2011.01296.x
更新日期:2012-02-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1980.tb03929.x
更新日期:1980-08-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.12653
更新日期:2016-05-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.2009.00838.x
更新日期:2010-03-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.12121
更新日期:2013-12-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.12993
更新日期:2018-02-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章,随机对照试验
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更新日期:2010-11-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1989.tb01579.x
更新日期:1989-12-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1977.tb00984.x
更新日期:1977-11-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.12380
更新日期:2014-09-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1046/j.1525-1594.2000.06611.x
更新日期:2000-12-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.2007.00482.x
更新日期:2007-12-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.2007.00438.x
更新日期:2007-08-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
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更新日期:2010-05-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
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journal_title:Artificial organs
pub_type: 杂志文章
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1997.tb03754.x
更新日期:1997-07-01 00:00:00
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journal_title:Artificial organs
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更新日期:2014-12-01 00:00:00
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journal_title:Artificial organs
pub_type: 临床试验,杂志文章
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更新日期:1997-03-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
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更新日期:2005-04-01 00:00:00
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journal_title:Artificial organs
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journal_title:Artificial organs
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abstract::Midsize molecule retention is related with renal-failure-associated mortality. Here, the authors describe a new dialysis modality, pulse push/pull hemodialysis (PPPHD), which increases convective clearance. Blood and dialysate are circulated by a pulsatile pump, but with pulsatile flow patterns that are 180 degrees ou...
journal_title:Artificial organs
pub_type: 杂志文章
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journal_title:Artificial organs
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更新日期:2017-06-01 00:00:00