The International Journal of Artificial Organs

Normothermic machine for liver perfusion (NMP) has emerged as a promising technique for dynamic preservation and functional assessment of liver grafts. However, red blood cell hemolysis is a frequently underestimated complication that may impair the interpretation of viability metrics. This study aims to determine the impact of rising free hemoglobin levels (fHb) on hepatic perfusion during NMP.

Fifteen healthy female porcine livers were perfused for 18 hours using a NMP circuit primed with autologous whole blood. Hourly measurements included fHb levels, total hepatic, portal, and arterial flows, as well as biochemical parameters. Correlations between fHb and perfusion parameters were evaluated using Spearman’s rank test.

All livers were successfully perfused for 18 h. Free hemoglobin levels progressively increased over time. Significant inverse correlations were observed between fHb and portal vein flow (ρ = −0.772) and total hepatic flow (ρ = −0.650). Among biochemical markers, only GGT and CK showed positive correlations with fHb.

Progressive hemolysis during NMP is associated with impaired hepatic perfusion, affecting the portal system, and correlates with selective biochemical injury markers. These findings highlight the need for systematic monitoring of fHb in NMP protocols to ensure viability assessment and optimize graft preservation.

The assessment of dialysis adequacy is of great clinical importance. However, it depends on the nonlinear effects of numerous confounding factors and is therefore difficult to predict using traditional statistical methods. In this study, we used Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Least Absolute Shrinkage and Selection Operator Regression (LASSO) to assess dialysis adequacy.

A training set (70%) and a test set (30%) were randomly selected from the 264 dialysis patient case records collected for this study. We compared the machine learning models with statistical logistic regression prediction models. In addition, we performed fivefold cross internal validation and external validation.

The test dataset showed sensitivity values of 0.86 (95% CI = 0.75–0.96), 0.81 (95% CI = 0.69–0.93), and 0.72 (95% CI = 0.58–0.85) for the RF, XGBoost, and LASSO models, respectively. The matched specificity was 0.73 (95% CI = 0.58–0.87), 0.81 (95% CI = 0.67–0.93), and 0.83 (95% CI = 0.71–0.95). Accuracy was 0.80 (95% CI = 0.71–0.89), 0.81 (95% CI = 0.72–0.90), and 0.77 (95% CI = 0.68–0.86). F1 scores were 0.83 (95% CI = 0.72–0.90), 0.82 (95% CI = 0.73–0.91), and 0.78 (95% CI = 0.67–0.87). The receiver operating characteristic curves (AUROC) were 0.88 (p < 0.05, 95% CI = 0.70–0.88), 0.86 (p = 0.12, 95% CI = 0.72–0.90), and 0.88 (p < 0.05, 95% CI = 0.69–0.86). The mean absolute errors (MAE) of the calibration curves were 0.15, 0.11, and 0.07. In addition, the decision curve analysis (DCA) showed wide intervals of net clinical benefit for the models.

Machine learning can be used to predict dialysis adequacy for optimal RF performance.

Ongoing donor-organ shortage has limited transplantation making LVADs an effective alternative therapy for patients with end-stage heart failure. When LVAD-associated complications arise device exchange is a feasible and safe alternative. This study addresses the factors that impact survival post-LVAD exchange.

Our decoded database was constructed retrospectively. Surgical details, device features, and re-intervention information were studied. The primary outcome was mortality. Kaplan-Meier estimators were used for post-pump exchange survival analysis. Pairwise log-rank tests compare the survivals between different groups within each variable. p-Value <0.05 was considered significant. Backward-stepwise regression was used to construct the multivariable model using a subset of variables, retaining only variables with a p-value <0.1. Hazard ratios, their 95% confidence intervals, and p-values of the significant variables were reported.

Analysis of factors impacting survival post-pump exchange study showed a poor survival probability of only primary midline-sternotomy/redo (p = 0.005). Multivariable analysis showed that bridging with ECMO was protective with a hazard ratio of 0.16 (0.03–0.86, p = 0.03).

The overall survival probability is 50% at 4 years post-pump exchange. This study highlights the differences in post-exchange outcomes depending on the device types and surgical approaches used. LVAD exchange for device-related complications can be performed in high-risk patients as a viable alternative to heart transplantation in the setting of the current heart allocation prioritization systems.

We present the case of a 68-year-old patient who underwent secondary thoracotomy, implantation of a continuous-flow ventricular assist device (VAD) in a biventricular configuration, and aortic valve replacement (AVR) 2 years after receiving a continuous-flow left ventricular assist device (LVAD) and coronary artery bypass grafting (CABG), due to right ventricular failure, moderate aortic insufficiency, and damage to the original LVAD device cable.

The patient initially received a Corheart 6 LVAD, CABG, and tricuspid annuloplasty due to end-stage heart failure resulting from ischemic cardiomyopathy and severe tricuspid regurgitation. Following the surgery, the patient was discharged with favorable outcomes. However, 2 years later, the patient was readmitted with severe right heart failure. Given the current shortage of heart donors, the decision was made to implant a Corheart 6 biventricular VAD (BiVAD) as destination therapy.

Severe right ventricular failure is a well-recognized complication following continuous-flow LVAD implantation. In this case, it was successfully managed with BiVADs as destination therapy for this high-risk patient.

Patients on veno-venous extracorporeal membrane oxygenation (VV ECMO) have shown to have higher intravenous (IV) sedation requirements and prolonged mechanical ventilation (MV) time. Literature suggests that early extubation and mobility improve survival; however, inability to wean IV analgosedation is a barrier. A strategy to decrease IV sedation is the use of adjunct enteral sedative, anxiolytic, and analgesic agents, although there is limited supportive data. The objective of this study was to assess the impact of early versus late (⩽72 h vs >72 h from time of cannulation) addition of enteral adjunct agents on continuous sedation/analgesic requirements in VV ECMO patients.

The study included 61 patients in the early group and 59 patients in the late. There was no difference in the primary outcome of time to ⩽1 continuous infusion analgosedation agent from ECMO cannulation. Incidence of adverse drug events were not shown to be increased between groups. No difference was seen in MV duration; however, early initiation of adjuncts resulted in a shorter intensive care unit length of stay.

While early adjunct use did not impact weaning of IV sedation, the lack of major safety events and potential benefits seen may support adjunct use in this patient population.