Device-Induced Hemostatic Disorders in Mechanically Assisted Circulation

Wang, Shigang; Griffith, Bartley P.; Wu, Zhongjun J.

doi:10.1177/1076029620982374

Cited by 36 publications

(34 citation statements)

References 170 publications

(220 reference statements)

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“…These three options come with their own advantages and disadvantages. The tradeoff for hemodynamic stability in mechanical circulatory support (MCS) is the risk of cannulation, heparinization, and the known effects of non-physiological shear stress and artificial surfaces [ 25 , 26 ]. While sequential OLV avoids these pitfalls, hemodynamic instability may ensue, or there may be severe hypotension following pressure on the heart [ 25 ].…”

Section: Intraoperative Machine Supportmentioning

confidence: 99%

Taking a Deep Breath: an Examination of Current Controversies in Surgical Procedures in Lung Transplantation

et al. 2022

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Purpose of Review This article reviews controversial questions within the field of lung transplantation, with a focus on data generated within the last 3 years. We aim to summarize differing opinions on a selection of topics, including bridge-to-transplantation, intraoperative machine circulatory support, bronchial anastomosis, size mismatch, delayed chest closure, and ex vivo lung perfusion. Recent Findings With the growing rate of lung transplantations worldwide and increasing numbers of patients placed on waiting lists, the importance of determining best practices has only increased in recent years. Factors which promote successful outcomes have been identified across all the topics, with certain approaches promoted, such as ambulation in bridge-to-transplant and widespread intraoperative ECMO as machine support. Summary While great strides have been made in the operative procedures involved in lung transplantation, there are still key questions to be answered. The consensus which can be reached will be instrumental in further improving outcomes in recipients.

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Section: Intraoperative Machine Supportmentioning

confidence: 99%

Taking a Deep Breath: an Examination of Current Controversies in Surgical Procedures in Lung Transplantation

et al. 2022

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“…EVs have been described to be increased in the circulation of LVAD patients [ 16 , 17 , 20 , 21 ]. However, to our knowledge, no study has yet investigated the influence of the LVAD pump itself on EV release.…”

Section: Discussionmentioning

confidence: 99%

“…As a novel biomarker of interest to evaluate the hemocompatibility of LVADs, extracellular vesicles (EVs) are focused on in recent publications [ 16 , 17 ]. EVs are small lipid structures (<1 µm) released by all types of blood cells.…”

Section: Introductionmentioning

confidence: 99%

“…Generally, EVs contain cargo, such as proteins [ 18 ] and miRNAs [ 19 ], which can mediate physiological changes in their target cells—beneficial or detrimental. LVADs are known to increase circulating EVs in the blood [ 16 , 17 , 20 , 21 ]. Whether EVs released due to LVADs could be biomarkers of adverse events needs to be investigated in more detail and, therefore, is included in this study.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Hemocompatibility of an Axial and a Centrifugal Left Ventricular Assist Device in an In Vitro Test Circuit

Borchers

Winnersbach

Kraemer

et al. 2022

JCM

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Background: Hemocompatibility of left ventricular assist devices is essential for preventing adverse events. In this study, we compared the hemocompatibility of an axial-flow (Sputnik) to a centrifugal-flow (HeartMate 3) pump. Methods: Both pumps were integrated into identical in vitro test circuits, each filled with 75 mL heparinized human blood of the same donor. During each experiment (n = 7), the pumps were operated with equal flow for six hours. Blood sampling and analysis were performed on a regular schedule. The analytes were indicators of hemolysis, coagulation activation, platelet count and activation, as well as extracellular vesicles. Results: Sputnik induced higher hemolysis compared to the HeartMate 3 after 360 min. Furthermore, platelet activation was higher for Sputnik after 120 min onward. In the HeartMate 3 circuit, the platelet count was reduced within the first hour. Furthermore, Sputnik triggered a more pronounced increase in extracellular vesicles, a potential trigger for adverse events in left ventricular assist device application. Activation of coagulation showed a time-dependent increase, with no differences between both groups. Conclusions: This experimental study confirms the hypothesis that axial-flow pumps may induce stronger hemolysis compared to centrifugal pumps, coming along with larger amounts of circulating extracellular vesicles and a stronger PLT activation.

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“…We hope that the developed approach may find its further application for the assessment of patient-specific thrombotic risk factors in haemodialysis patients with AVFs. Also the approach might be extended to several other clinically valid settings with increased risk of thrombosis (for example, in circulatory assist devices) [ 41 , 42 ].…”

Section: Introductionmentioning

confidence: 99%

Patient specific approach to analysis of shear-induced platelet activation in haemodialysis arteriovenous fistula

et al. 2022

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Shear-induced platelet activation (SIPAct) is an important mechanism of thrombosis initiation under high blood flow. This mechanism relies on the interaction of platelets with the von Willebrand factor (VWF) capable of unfolding under high shear stress. High shear stress occurs in the arteriovenous fistula (AVF) commonly used for haemodialysis. A novel patient-specific approach for the modelling of SIPAct in the AVF was proposed. This enabled us to estimate the SIPAct level via computational fluid dynamics. The suggested approach was applied for the SIPAct analysis in AVF geometries reconstructed from medical images. The approach facilitates the determination of the SIPAct level dependence on both biomechanical (AVF flow rate) and biochemical factors (VWF multimer size). It was found that the dependence of the SIPAct level on the AVF flow rate can be approximated by a power law. The critical flow rate was a decreasing function of the VWF multimer size. Moreover, the critical AVF flow rate highly depended on patient-specific factors, e.g., the vessel geometry. This indicates that the approach may be adopted to elucidate patient-specific thrombosis risk factors in haemodialysis patients.

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Device-Induced Hemostatic Disorders in Mechanically Assisted Circulation

Cited by 36 publications

References 170 publications

Taking a Deep Breath: an Examination of Current Controversies in Surgical Procedures in Lung Transplantation

Taking a Deep Breath: an Examination of Current Controversies in Surgical Procedures in Lung Transplantation

Comparison of the Hemocompatibility of an Axial and a Centrifugal Left Ventricular Assist Device in an In Vitro Test Circuit

Patient specific approach to analysis of shear-induced platelet activation in haemodialysis arteriovenous fistula

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