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Background: Beginning in 2000 and accelerating in 2004, the Berlin Heart EXCOR (Berlin Heart Inc Woodlands, TX) became the first pediatric-specific ventricular assist device (VAD) applied throughout North America for children of all sizes. This retrospective study analyzed the initial Berlin Heart EXCOR pediatric experience as a bridge to transplantation. Methods: Between June 2000 and May 2007, 97 EXCOR VADs were implanted in North America at 29 different institutions. The analysis is limited to 73 patients (75%) from 17 institutions, for which retrospective data were available. Results: Median age and weight at VAD implant were 2.1years (range, 12 days–17.8 years) and 11 kg (range, 3–87.6 kg), respectively. The primary diagnoses were dilated cardiomyopathy in 42 (58%), congenital heart disease in 19 (26%), myocarditis in 7 (10%), and other cardiomyopathies in 5 (7%). Pre-implant clinical condition was critical cardiogenic shock in 38 (52%), progressive decline in 33 (45%), or other in 2 (3%). Extracorporeal membrane oxygenation was used as a bridge to EXCOR in 22 patients (30%). Device selection was left VAD (LVAD) in 42 (57%) and biventricular assist devices (BiVAD) in 31 (43%). The EXCOR bridged 51 patients (70%) to transplant and 5 (7%) to recovery. Mortality on the EXCOR was 23% (n = 17) overall, including 35% (11 of 31) in BiVAD vs 14% (6 of 42) in LVAD patients (p = 0.003). Multivariate analysis showed younger age and BiVAD support were significant risk factors for death while on the EXCOR. Conclusions: This limited but large preliminary North American experience with the Berlin Heart EXCOR VAD as a bridge to cardiac transplantation for children of all ages and sizes points to the feasibility of this approach. The prospective investigational device evaluation trial presently underway will further characterize the safety and efficacy of the EXCOR as a bridge to pediatric cardiac transplantation. [ABSTRACT FROM AUTHOR]

Introduction: The National Comprehensive Cancer Network and the European Organization for Research and Treatment of Cancer recommend extracorporeal photopheresis (ECP) as systemic therapy for cutaneous T-cell lymphoma (CTCL). Objective: To investigate real-world use of ECP in CTCL patients in the US. Methods: Data from the Truven MarketScan ® database (2010-2015) were used to create a cohort of CTCL patients receiving systemic treatment. Multivariable regressions were performed to compare health care resource utilization between ECP and propensity score-matched non-ECP patients. Results: Of the 1106 eligible patients, 117 (10.6%) received ECP, with an average treatment duration of 13.6 months. Psoriasis, organ transplant, graft versus host disease, and scleroderma were the most common comorbidities. ECP was used as monotherapy in 76 patients (65.0%) and combination in 41 patients (35.0%), mostly with interferon and/or a retinoid. Higher Charlson Comorbidity Index (2.6 vs 2.2, p  < .05), rates of organ transplant (49.6% vs 7.8%, p  < .001), and graft vs host disease (41.9% vs 3.4%, p  < .001) were observed in ECP versus non-ECP patients. Post-matching analyses showed that ECP patients had shorter all-cause inpatient stay (6.67 vs 11.80 days, p  = .001). Conclusions: Approximately 1 out of 10 CTCL patients receiving systemic treatment were on ECP treatment in the US. Post-matching analysis showed ECP was associated with a shorter hospital stay.

Background: Extracorporeal membrane oxygenation (ECMO) is an emerging option for cardio-pulmonary support for patients with massive pulmonary emboli (PE) as a bridge to definitive treatments. Goal of this study is to assess the national trends of use, demographics and in-patient mortality of patients managed with ECMO for PE associated with acute right ventricular failure and shock. Methods: The National Inpatient Sample database was queried for patients above 18 years of age hospitalized between 2011-2014 with pulmonary emboli (ICD diagnoses codes 415.1, 415.11, 415.19). Patients with acute right ventricular failure and shock with hemodynamic instability were identified (ICD diagnoses codes 415.0, 785.59, 785.51, 785.50). Patients treated with ECMO were identified using the procedure code 39.65. SPSS version 24 was used for statistical analysis. Results: During the study period, there were 1,262,542 admissions with pulmonary emboli, out of which 32,978 had acute right ventricular failure and shock. ECMO was used in 450 patients and that showed an increasing trend over the years (figure 1), with an in-patient mortality rate of 59.2%. Mean length of stay was 23 days. More than 90% of these patients were managed in large urban teaching hospitals with bed-size more than 500. Around half (43%) of these were in the Southern US hospitals. Factors associated with higher mortality were male sex (68.8%), age >80 years (100%), Hispanic race (65%), lack of insurance (71.4%) and low socio-economic strata (income quartile 1st, 74.4%), p<0.05. Conclusion: Use of ECMO for cardio-pulmonary support in patients hospitalized for PE with acute right ventricular failure and shock is increasing over the years. Among these patients, male sex, age >80 years, Hispanic race, lack of insurance and lower socio-economic strata are associated with higher mortality. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used in resuscitation of critically ill patients with documented improved survival. Few studies describe ECMO use in cardiogenic shock. This study examines ECMO use and identifies variables associated with mortality in patients treated for cardiogenic shock in US hospitals.Methods: A retrospective observational study of the US Nationwide Emergency Department Sample (NEDS) database of 2013 was conducted. Weighted visits for cardiogenic shock (discharge diagnosis) with ECMO use were included. Collected data was analyzed and variables associated with mortality were identified.Results: A total of 922 weighted patients with cardiogenic shock and ECMO were included. Mean age was 50.8 years. They were more commonly males (66.3%; n = 658). Slightly over half (51.0%, n = 506) survived to hospital discharge. Mean charges per patient were $589,610.5. Mean length of stay was 21.8 days. Increased mortality was associated with presence of respiratory diseases (OR = 3.83), genitourinary diseases (OR = 4.97), undergoing an echocardiogram (OR = 4.63), and presenting during seasons other than Fall. Lower mortality was noted in patients with injury and poisoning (OR = 0.47), in those who underwent certain vascular procedures (OR = 0.49) and those with increasing length of stay (OR = 0.90).Conclusion: Mortality in patients with cardiogenic shock remains high despite ECMO use. Season of admission (other than Fall) and presence of specific comorbidities (Respiratory and genitourinary diseases) are associated with increased mortality in this population. Familiarity with these variables can help identify patients at higher risk of death and can help improve outcomes further in cardiogenic shock. [ABSTRACT FROM AUTHOR]

After mentioning the importance of implementing these techniques, frecuently used both in USA and Spain, he refers to his experience on 70 dogs since the end of the 50's in the last century. Not only does he refer to the heterotopic transplant, on the neck, undertaken to test the importance of the denervation, maintenance of the viability of the organ using hypothermia, and the anatomopathologic study of the inmunologic rejection, but also to the orthotopic transplant, this is the replacement of one heart by other, using extracorporeal circulation. He refers to the first transplant practiced by Hardy, on the 23rd of January 1964, in which he unsuccessfully used the heart of a chimpanzee and to the one performed by Barnard the 3rd of December 1967, with a survival span of 18 days. He mentions current techniques to preserve the replacement heart, using POPS, as well as the procedures to avoid the rejection and the clinical experience in Spain until now, including the obtained results. Thereafter, he makes a detailed description of the Liotta's artificial heart, the Jarvik 7 (Symbyon, CardioWest), which provided a survival period of 112 days. Also he refers to the Jarvik 2000, the model of DeBakey, the Novacor, the AbioCor, explaining the experience achieved with them, ending with the description with the model proposed by Schenk, in Cleveland, the MagScrew TAH.

A new generation of coating extracorporeal circuitry with biocompatible polymers has entered the North American perfusion market. This new biomimetic coating process uses synthetic phosphorylcholine (PC) containing polymers to bond covalently to the surface of the Sorin Monolyth oxygenator, under the brand name of Mimesys. In part one of a three-part investigation, 160 Mimesys-coated oxygenators were randomly evaluated against 36 uncoated oxygenators for blood flow, hemodynamic resistance, and pressure differentials. In part two, retrospective analysis of platelet data collected in this study was compared with platelet data collected from a previous investigation using uncoated Monolyth oxygenators with albumin and crystalloid perfusates. Part three examined the risk-adjusted clinical outcomes of 71 patients treated with Mimesys-coated oxygenators, compared with 71 case-matched patients treated with uncoated oxygenators. There was no difference found in the Mimesys-coated group, when compared to the control group, with regard to pressure differentials or hemodynamic resistance. However, we conclude that platelet protection with PC-coated Monolyth's using crystalloid perfusates, was similar to platelet protection with albumin perfusates, and significantly better than uncoated Monolyths using crystalloid perfusates.

For the past 35 years the use of the extracorporeal bypass circuit has been a mainstay for coronary artery bypass grafting (CABG) in cardiac surgery arena. Since John Gibbon's early design, evolution of the pump has expanded rapidly with new techniques and engineering. The cardiopulmonary bypass (CPB) circuit has allowed cardiovascular surgeons to perform complete revascularization in a motionless and bloodless field. Presently, there is a new focus on CABGs because of new engineering designs of retractors and stabilizers, robotic techniques, and the monetary issues of cost and length of stay. Surgeons at our hospital perform 70% of CABG procedures off pump. We have developed a coronary-assisted perfusion system called CAPS. This is a simple shunt system that uses existing pump hardware to deliver arterial blood to the myocardium after the completion of the distal anastomosis. Flow is regulated by monitoring a pressure-sensing display either at systemic or suprasystemic pressure. Temperature of the blood is maintained with a Vanguard BCD heat exchanger (COBE Cardiovascular Inc., Arvada, CO) with a built-in temperature probe port. This system is capable of delivering optional agents for coronary vasodilatation, myocardial resuscitation, and performance through a connection to any standard medication infusion pump. The advantages of this system are that it is safe, requires no additional perfusion hardware, cost effective, easy to setup, has a low and rapid prime, has both inflow and outflow pressure monitoring sites, has heat a exchanger with temperature monitor, and has a drug additive port for pharmacologic infusion.

Surgical attempts to open obstructed heart valves in the 1940s led to the eventual development of valvular prostheses, accompanied by the parallel development of methods of sustaining extracorporeal circulation; biocompatible materials; and engineering designs. Early problems encountered included the incidence of thrombotic phenomena, audibility of valvular noise, impaired flow dynamics, and hemo-incapability. These problems have been solved with increasing success with the creation of new plastics, the ball valve design, and improved manufacturing processes.

In 1931, after witnessing the death of a patient from pulmonary embolectomy, Dr. John Gibbon had an idea for a machine that could take deoxygenated blood, oxygenate it, and pump it back into the arterial system. Collaborating with his wife Mary, Dr. Gibbon worked from 1934 to 1942 to develop an extracorporeal circulatory device. By 1942, he was able to keep cats alive on his experimental devices, with continued survival after bypass. In 1950, he received support from IBM to build a heart-lung machine on a more sophisticated scale. Finally, on May 6, 1953, Dr. Gibbon performed his first successful operation using an extracorporeal circuit on an 18-year-old woman with a large atrial septal defect and a large left-to-right shunt.

The development of outfits for ancillary circulation is oriented towards improvement and construction of new pneumatic, hydraulic and electromechanical actuating systems--units intended for an optimal disposition of pressure waves moving from the pump to the aorta, etc. An inference is drawn about advantages and perspectives offered by functionally monitored actuating units, as well as about the need for the pulsating stream to pass through the low-power side intended to pre-set the shape of the pressure curve.