All existing left ventricular assist devices (LVADs) need inlet and outlet connecting con-duits and the assist pumping blood flows through the bypass circuit from left ventricle to aorta. It will result in some most l...All existing left ventricular assist devices (LVADs) need inlet and outlet connecting con-duits and the assist pumping blood flows through the bypass circuit from left ventricle to aorta. It will result in some most likely sites of thrombosis and brings about physiological dis-turbance to natural circulation, as well as addi-tional need for anatomic occupation in chest. The author developed a trans-apical and cross-valvular intra-ventricular axial pump and an aortic valvo- pump to solve these problems. The intra-ventricular pump weighing 53g has a length of 115mm and its largest O.D. is 13mm. The motor is 60mm long and the pump 55mm. In both sides of motor, specially designed needle bearings are devised and a purge system keeps the motor together with bearings working in sa-line. The device is inserted into the ventricle by trans-apex and then into the aorta by cross-valve. It is used for recovery therapy or bridge to transplantation. The bearing-less valvo-pumps have an outer diameter of 21mm, 23mm or 25mm for patients with different body weights. The weight of the devices is 27g, 31g or 40g respectively. Used for destination therapy it can be easily sewed onto the aortic valve annu-lus, delivers blood from ventricle to aorta di-rectly. These two novel mini LVADs may reduce thrombosis risk in clinical applications.展开更多
Treatment of ischemic stroke for a patient on left ventricular assist device (LVAD) by neurointerventional means is rare and many anesthesia providers are unfamiliar with both LVAD and neurointerventional protocols. E...Treatment of ischemic stroke for a patient on left ventricular assist device (LVAD) by neurointerventional means is rare and many anesthesia providers are unfamiliar with both LVAD and neurointerventional protocols. Examples of this include: 1) filling for continuous-flow LVAD depend on preload and the flow is inversely related to afterload;as mean arterial pressure (MAP) increases above 80 to90 mmHg, flow decreases;2) there may be no palpable pulse in patients with continuous flow LVADs;3) pulse oximetry may not work when pump flow is high and native myocardial function is minimal;4) increasing MAP above80 mmHg potentially will maintain ischemic brain tissue—the penumbra—until flow is restored. This latter example creates a paradoxical management goal: increasing the mean arterial pressure (MAP) above80 mmHg while maintaining ischemic brain tissue, may decrease flow to the LVAD. Finally, there is controversy regarding which type of anesthesia is most efficacious for neuro interventional procedures. We describe three patients on LVAD suffering ischemic stroke requiring anesthesia for embolectomy and angioplasty during neruointeventioal radiology procedures.展开更多
心力衰竭（心衰）患者延长左室辅助装置（LVAD）使用，可能有助于成人心肌再生。德克萨斯大学西南医学中心Hesham A. Sadek博士，“新数据表明，去负荷后的逆重构可能代表了心肌从肥厚到增生的转换”。该结果发表在2015年的JACC杂志上...心力衰竭（心衰）患者延长左室辅助装置（LVAD）使用，可能有助于成人心肌再生。德克萨斯大学西南医学中心Hesham A. Sadek博士，“新数据表明，去负荷后的逆重构可能代表了心肌从肥厚到增生的转换”。该结果发表在2015年的JACC杂志上。 成人心肌细胞不能分裂，因此成人心脏在大量心肌细胞损失后不能再生。既往研究证实，线粒体介导的氧化DNA损伤在出生后心肌细胞周期停滞中发挥重要作用。Sadek和同事开展的这项研究旨在观察机械负荷是否在其中也起作用，并假设机械负荷的生理性增加导致了线粒体含量增多，使DNA损伤应答激活，带来永久性心肌细胞周期停滞。展开更多
文摘All existing left ventricular assist devices (LVADs) need inlet and outlet connecting con-duits and the assist pumping blood flows through the bypass circuit from left ventricle to aorta. It will result in some most likely sites of thrombosis and brings about physiological dis-turbance to natural circulation, as well as addi-tional need for anatomic occupation in chest. The author developed a trans-apical and cross-valvular intra-ventricular axial pump and an aortic valvo- pump to solve these problems. The intra-ventricular pump weighing 53g has a length of 115mm and its largest O.D. is 13mm. The motor is 60mm long and the pump 55mm. In both sides of motor, specially designed needle bearings are devised and a purge system keeps the motor together with bearings working in sa-line. The device is inserted into the ventricle by trans-apex and then into the aorta by cross-valve. It is used for recovery therapy or bridge to transplantation. The bearing-less valvo-pumps have an outer diameter of 21mm, 23mm or 25mm for patients with different body weights. The weight of the devices is 27g, 31g or 40g respectively. Used for destination therapy it can be easily sewed onto the aortic valve annu-lus, delivers blood from ventricle to aorta di-rectly. These two novel mini LVADs may reduce thrombosis risk in clinical applications.
文摘Treatment of ischemic stroke for a patient on left ventricular assist device (LVAD) by neurointerventional means is rare and many anesthesia providers are unfamiliar with both LVAD and neurointerventional protocols. Examples of this include: 1) filling for continuous-flow LVAD depend on preload and the flow is inversely related to afterload;as mean arterial pressure (MAP) increases above 80 to90 mmHg, flow decreases;2) there may be no palpable pulse in patients with continuous flow LVADs;3) pulse oximetry may not work when pump flow is high and native myocardial function is minimal;4) increasing MAP above80 mmHg potentially will maintain ischemic brain tissue—the penumbra—until flow is restored. This latter example creates a paradoxical management goal: increasing the mean arterial pressure (MAP) above80 mmHg while maintaining ischemic brain tissue, may decrease flow to the LVAD. Finally, there is controversy regarding which type of anesthesia is most efficacious for neuro interventional procedures. We describe three patients on LVAD suffering ischemic stroke requiring anesthesia for embolectomy and angioplasty during neruointeventioal radiology procedures.
文摘心力衰竭（心衰）患者延长左室辅助装置（LVAD）使用，可能有助于成人心肌再生。德克萨斯大学西南医学中心Hesham A. Sadek博士，“新数据表明，去负荷后的逆重构可能代表了心肌从肥厚到增生的转换”。该结果发表在2015年的JACC杂志上。 成人心肌细胞不能分裂，因此成人心脏在大量心肌细胞损失后不能再生。既往研究证实，线粒体介导的氧化DNA损伤在出生后心肌细胞周期停滞中发挥重要作用。Sadek和同事开展的这项研究旨在观察机械负荷是否在其中也起作用，并假设机械负荷的生理性增加导致了线粒体含量增多，使DNA损伤应答激活，带来永久性心肌细胞周期停滞。
