Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly used to bridge critically ill candidates to lung transplantation, with reported outcomes approaching those of non-ECMO recipients. However, factors associated with early mortality in this high-risk subpopulation remain incompletely defined, particularly when postoperative complications occur after transplantation and may introduce time-dependent bias. We aimed to explore factors associated with 1-year survival among VV-ECMO–bridged lung transplant recipients. We performed a single-center retrospective cohort study of adult lung transplant recipients bridged with preoperative VV-ECMO between January 2018 and May 2024. The primary endpoint was 1-year overall survival. Associations with primary graft dysfunction grade 3 were assessed using logistic regression. Because postoperative complications occurred after transplantation, landmark Kaplan–Meier analyses were performed to explore their associations with subsequent survival while reducing immortal time bias. Forty recipients were included, and 1-year mortality was 20
Venovenous extracorporeal membrane oxygenation (VV-ECMO) bridging to lung transplant has the potential to reduce mortality among patients awaiting transplant. However, there continue to be notable morbidity risks, including acute kidney injury (AKI). This paper seeks to evaluate both short and long-term morbidity and mortality trends related to AKI development post-transplant, among VV-ECMO bridged and non-ECMO bridged patients respectively. We performed a retrospective cohort study of adult patients (≥ 18 years) who underwent lung transplantation at a single tertiary care center between January 2018 and May 2024. 443 lung transplant recipients were included: 46 were bridged with preoperative VV-ECMO, and 397 underwent transplantation without ECMO bridge. Univariate logistic regression was used to evaluate predictors of postoperative AKI. A multivariable logistic regression model was then constructed using clinically relevant covariates and variables associated with AKI in univariate analyses. The initial incidence of post-operative AKI was significantly higher among patients bridged with VV-ECMO (67
A 4-year-old boy with a diagnosis of right-sided heterotaxy syndrome was transferred to our hospital under the extracorporeal membrane oxygenation (ECMO). He had undergone an extracardiac total cavopulmonary connection (TCPC) with a fenestration. Approximately 6 months after the TCPC procedure, common atrioventricular valve regurgitation worsened and persisted despite multiple valve repair procedures. ECMO support was initiated 318 days after the TCPC procedure for progressive heart failure and multiple organ dysfunction. Although ECMO was initially discontinued after transient improvement, recurrent circulatory failure necessitated reinitiation, and the patient remained ECMO-dependent thereafter. We implanted a Berlin Heart EXCOR® Pediatric ventricular assist device. In the operation, the fenestration of the TCPC conduit was closed. An expanded polytetrafluoroethylene conduit for the arterial cannula was anastomosed to the ascending aorta in an end-to-side fashion. The apex of the left-sided ventricle was incised, followed by the meticulous resection of residual ventricular septal tissue to obtain effective venting from both ventricles. An inflow cannula was anastomosed to the coring site. Ventricular assist support was initiated without complications. On the postoperative day 433, intracerebral hemorrhage was abruptly developed, necessitating management in the intensive care unit. Two hematoma evacuation procedures of decompressing surgery for intracerebral hemorrhage were required. Despite these interventions, the patient ultimately died on postoperative day 488. The autopsy confirmed that the residual ventricular septum-like tissue had been almost completely resected and that the inflow cannula tip was positioned away from any muscular structures, suggesting that the resection enabled effective ventricular drainage without obstruction or suction.
This study aimed to clarify perioperative changes in ionized magnesium levels (iMg), a physiologically active fraction, and particularly the persistence of hypermagnesemia at the time of extubation in cardiac surgery using magnesium-enriched cardioplegia. We conducted a prospective observational study of 48 patients undergoing elective cardiac surgery. iMg was measured at three time points: induction of anesthesia, intensive care unit (ICU) admission, and extubation. The median duration of postoperative mechanical ventilation was 17 h. iMg increased markedly to 1.49 [1.23–1.85] mmol/L at ICU admission and remained significantly elevated at extubation (0.97 [0.80–1.14] mmol/L), exceeding the physiological reference value in 46 patients (96
Vaccination is among the cornerstones of infectious disease prevention in heart transplant candidates and recipients. Guidelines recommend an inactivated hepatitis A virus vaccine for heart transplant candidates, many of whom are on ventricular assist devices and at risk of hepatitis A virus exposure. However, data on the immunogenicity and safety of hepatitis A virus vaccines in these patients are lacking.This retrospective, observational, single-center study was conducted at our outpatient clinic between December 2019 and December 2025. The study participants were heart transplant candidates with ventricular assist devices aged ≥16 years who tested negative for anti-hepatitis A virus immunoglobulin G at baseline and completed the inactivated hepatitis A virus vaccination series. Anti-hepatitis A virus immunoglobulin G titers were measured after vaccination using a chemiluminescent immunoassay. Thirty-five individuals were included in the study. Immunosuppressive agents were used in four patients (11.4
When blood flow cannot be raised to the 150–200 mL/min threshold required for membrane-based therapeutic plasma exchange, centrifugation-based therapeutic plasma exchange represents the only mechanistically viable option—yet this specific clinical scenario has not been reported. We describe an 86-year-old man with IgM-κ multiple myeloma who developed hyperviscosity syndrome. Sequential membrane-based approaches failed owing to blood flow restriction: double-filtration plasmapheresis was discontinued when secondary membrane pressure reached 277 mmHg, and membrane-based therapeutic plasma exchange achieved only a 20.1
An intermittent infusion during dialysis therapy across the membrane by backfiltration is expected to have a cleaning effect on the membrane in addition to stabilizing blood pressure. In this study, the effect of backfiltration infusion on the solute removal performance was investigated for both diafilters with polysulfone (PSf) and polymethylmethacrylate (PMMA) membrane in vitro experiment using bovine whole blood. To clarify the infusion method with a high cleaning effect, the infusion was performed under two conditions for dialysate flow: countercurrent and parallel flow to blood flow, aiming to induce backfiltration at different area in a diafilter. A scanning electron microscope (SEM) and a scanning probe microscope (SPM) were used for evaluation of the degree of fouling on the membrane after experiments. Although intermittent backfiltration did not show any effect on the removal efficiency of creatinine and inulin, it was slightly effective in maintaining protein permeability under certain conditions. SEM observations and SPM measurements revealed that protein adsorption to the membrane caused the macropore blocking, and the fouling was partly removed by intermittent infusion primarily in areas where backfiltration mainly occurs. In conclusion, backfiltraion had an effect on resolving fouling and recovering solute removal performance for both membrane materials; however, its effect was limited.
We report a rare device fracture during Impella 5.5 explantation for cardiogenic shock in a 77-year-old man with prolonged device support. Following stabilization, device removal was attempted on day 50. During withdrawal, marked resistance was encountered and the cannula tip fractured, remaining within the prosthetic graft. The tip was surgically retrieved following extension of the dissection. Post-explantation, the patient developed acute right upper extremity ischemia, likely due to vasospasm, which resolved spontaneously. This case underscores the importance of recognizing marked resistance during Impella explantation, as excessive stress concentration and mechanical shearing forces may contribute to device fracture.
Impella is increasingly used as a bridge to durable left ventricular assist device (dLVAD) implantation in patients with advanced heart failure. However, Impella support may worsen aortic insufficiency (AI), raising concerns regarding both AI progression during support and subsequent late AI progression after dLVAD implantation. This study evaluated the impact of Impella bridging on AI progression and clinical outcomes after dLVAD implantation. This retrospective single-center study included 64 patients who underwent primary dLVAD implantation and consisted of three analyses. First, baseline characteristics, perioperative variables, and early postoperative outcomes were compared between the aortic valve (AV) Intervention (n = 12) and No AV Intervention (n = 52) groups at dLVAD implantation. Second, changes in AI severity during Impella support were evaluated in patients with preoperative Impella support (n = 19). Third, long-term outcomes were compared between the Impella Bridging (n = 14) and No Impella Bridging (n = 38) groups after excluding patients who underwent concomitant AV intervention. Preoperative clinical severity was generally comparable between the AV Intervention and No AV Intervention groups, although hospital mortality was higher in the AV Intervention group. AI severity worsened significantly during Impella support (p < 0.001), whereas AV intervention rates did not differ significantly according to preoperative Impella support status (p = 0.32). During long-term follow-up, no statistically significant association was observed between Impella bridging and subsequent AI progression or clinical outcomes. Impella support as a bridge to dLVAD implantation was associated with significant worsening of AI during support. Under the current treatment strategy, including careful assessment of AV function and selective concomitant AV intervention at dLVAD implantation, no statistically significant association was observed between prior Impella bridging and subsequent late AI progression or adverse clinical outcomes. However, given the significantly higher in-hospital mortality in the AV Intervention group, careful patient selection for concomitant AV intervention remains essential.
Clot-fibrinolysis waveform analysis (CFWA) enables the simultaneous assessment of coagulation and fibrinolytic functions within a short timeframe. We evaluated the effects of commonly used anticoagulants on coagulation-fibrinolysis balance using CFWA in anticoagulant-supplemented model plasma and explored its potential clinical application during extracorporeal circulation. Nafamostat mesylate (NM), unfractionated heparin (UFH), and low-molecular-weight heparin (LMWH) were added to normal plasma to establish each model. Coagulation function was assessed using clotting time (CT) and maximum clotting velocity (min1), whereas fibrinolytic function was evaluated using fibrinolysis onset time (FLT) and total fibrinolysis (EFP).Increasing NM concentrations prolonged CT and reduced min1 while prolonging FLT and decreasing EFP, indicating suppression of both coagulation and fibrinolysis. UFH prolonged CT and reduced min1 but shortened FLT and increased EFP, suggesting enhanced fibrinolytic susceptibility. LMWH produced milder anticoagulant effects with minimal influence on fibrinolytic parameters.As an exploratory clinical application, CFWA was applied to a patient undergoing hemodialysis with suspected heparin resistance and recurrent circuit clotting. CFWA detected persistent hypercoagulability despite prolonged APTT after high-dose UFH administration, providing additional functional information not captured by conventional coagulation tests.CFWA may provide a sensitive and comprehensive assessment of coagulation-fibrinolysis balance and serve as a complementary monitoring tool during extracorporeal circulation.
This systematic review and meta-analysis aim to synthesize evidence comparing normothermic regional perfusion (NRP) and direct procurement and perfusion (DPP) in donation after circulatory death (DCD) heart transplantation, providing evidence-based guidance for optimizing donor heart procurement and transplantation protocols. A systematic literature review was conducted following PRISMA guidelines. PubMed, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform were systematically searched. Two reviewers independently applied eligibility criteria, evaluated quality, and extracted data. The primary outcome was the 30-day survival rate. The 30-day survival rates for NRP and DPP patients were 96.58
Coronary artery bypass grafting (CABG) with temporary micro-axial ventricular assist device (Impella, Johnson and Johnson, Danvers, MA, USA) for peri-operative recovery has been utilized among patients with reduced left ventricular ejection fraction (LVEF). We hypothesized that Impella recovery CABG would be associated with increased two-year survival, compared to traditional intra-aortic balloon pump (IABP) recovery CABG. 151 patients with low LVEF (≤ 25
Bleeding complications remain a major concern in patients supported by long-term left ventricular assist devices (LVADs). Although gastrointestinal bleeding is common, hemobilia due to rupture of a hepatic artery aneurysm is extremely rare. A 47-year-old man with end-stage heart failure underwent implantation of a continuous-flow LVAD as a bridge to transplantation and was maintained on long-term anticoagulation therapy. He developed anemia with abdominal pain and melena. Imaging at the first hospitalization revealed a hepatic artery aneurysm with suspected hemobilia. After temporary stabilization, he was readmitted with recurrent melena and abdominal pain. Subsequent imaging demonstrated rapid aneurysmal enlargement with rupture into the biliary tract. Emergency angiography followed by transcatheter arterial embolization using detachable coils and n-butyl cyanoacrylate achieved complete hemostasis while preserving hepatic arterial flow. Anticoagulation was resumed without thrombotic complications, and the patient subsequently underwent successful transplantation without recurrence. Hepatic artery aneurysm rupture into the biliary tract is a rare but life-threatening complication in patients receiving long-term LVAD support. Prompt multidisciplinary management and endovascular intervention are essential for favorable outcomes.
Brain organoids have progressed from simple three-dimensional neuroepithelial aggregates to increasingly sophisticated systems that recapitulate key aspects of human neurodevelopment and disease. Despite rapid biological advances, their translational potential remains constrained by challenges in maturation, vascular integration, reproducibility, and scalable standardization. Recent innovations, including microfluidic perfusion platforms, synthetic extracellular matrices, vascularization strategies, and modular assembloid assembly, illustrate a shift from descriptive modeling to functionally integrated and experimentally controllable neural systems. However, increasing biological complexity introduces ethical and regulatory considerations that must be incorporated into translational research frameworks. These advances provide new opportunities to investigate human-specific developmental mechanisms and bridge the gap between in vitro modeling and in vivo neurobiology. Future progress will depend on balancing two complementary objectives: enhancing biological fidelity and improving experimental utility through increasingly controllable and design-driven organoid platforms with defined architecture, functionality, and reproducibility. In this context, brain organoids are emerging as bioengineered neural tissue systems that share important conceptual and technological foundations with next-generation artificial organ technologies. Continued advances in bioengineering, standardization, and systems-level integration are essential to maximize their translational impact on disease modeling, therapeutic testing, and regenerative neuroscience.
Venoarterial Extracorporeal Membrane Oxygenation (ECMO) is a life-support therapy for critical cardiac or respiratory failure, and decannulation requires arterial access closure. The traditional surgical repair is effective but carries risks inherent to invasive procedures. Percutaneous vascular access closure has been developed as a less invasive alternative, though direct comparative evidence has been limited. We performed a systematic review and meta-analysis of 10 studies published between 2011 and 2024, encompassing 1074 patients and comparing surgical closure versus percutaneous closure. Outcomes assessed included limb infection, ischemia, pseudoaneurysm, bleeding events, ECMO duration, and in-hospital mortality. Results demonstrated no statistically significant differences across most outcomes, including limb ischemia (OR = 0.79; 95
Closed suction drainage has been used after total hip arthroplasty (THA) to prevent hematoma, muscle swelling, and complications, but its effectiveness remains controversial. This study evaluated the effects of drains on postoperative hematoma, muscle swelling, and clinical outcomes. A total of 168 patients who underwent unilateral cementless THA via the posterior approach for secondary hip osteoarthritis due to developmental dysplasia were retrospectively reviewed. Among them, 60 matched pairs, with and without drains, were selected using propensity score matching based on age, sex, body mass index, operative time, and femoral stem type. The primary outcome was the percentage increase in under-fascial area (UFA) measured on axial computed tomography at the teardrop level. UFA was used as a surrogate marker of postoperative hematoma and muscle swelling and was assessed preoperatively and on postoperative day 7. Secondary outcomes included postoperative estimated blood loss (PEBL), pain (assessed using the numeric rating scale), and laboratory parameters (albumin, hemoglobin, white blood cell count, creatine kinase, and C-reactive protein) on postoperative days 1, 4, 7, and 14. The mean percentage increase in the UFA did not differ between groups (10.7
Robot-assisted gait training may improve walking recovery after total knee arthroplasty (TKA). However, optimal intervention durations and early postoperative feasibility remain unclear. We evaluated a short-term, early postoperative gait-training program’s effects on walking-speed recovery using a lightweight, hip-wearable assistive device. In this pilot study, patients who underwent TKA were allocated preoperatively to receive either HWA-01 gait training plus standard rehabilitation (HGT) or standard rehabilitation alone (control). HGT was delivered during postoperative weeks 1–3 (8–10 sessions; ≤ 20 min/session, excluding rest). Outcomes were assessed at baseline, 2, 4, and 8 weeks; generalized linear mixed models were used to analyze gait speed, knee function, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) outcomes, and Patient Acceptable Symptom State (PASS) achievement for self-selected walking speed (SWS) (≥ 1.2 m/s) was compared between groups. Forty patients (52 knees) were analyzed (HGT, 13 patients/13 knees; control, 29 patients/39 knees). Significant time × group interactions were observed at 2 weeks for SWS (p = 0.045) and maximum walking speed (p = 0.044), indicating an attenuation of the early postoperative walking-speed decline in the HGT group. At 4 weeks, more patients in the HGT group achieved the PASS threshold (p = 0.013). No significant group or interaction effects were observed for the range of motion, torque, or WOMAC outcomes. A 2-week, early postoperative HGT program using a lightweight hip-assist device may mitigate early walking-speed decline after TKA and promote earlier attainment of a patient-acceptable walking speed with favorable safety and tolerability. Trial registration: UMIN Clinical Trials Registry (UMIN-CTR), UMIN000054889, https://www.umin.ac.jp/ctr/ .
HeartMate 3 (HM3) has demonstrated excellent outcomes in adults, and its use in pediatric patients has recently increased. In small pediatric patients, previous studies have mainly focused on whether the device can be accommodated within the thoracic cavity. However, the physiological suitability of pump flow relative to body size and the potential mechanical effects of the device have not been well investigated. A 12-year-old girl (height 138 cm, weight 28.9 kg, body surface area 1.07 m2) with dilated cardiomyopathy and complete atrioventricular block developed progressive heart failure and became catecholamine dependent. HM3 implantation with pacemaker placement was performed. Preoperative pulmonary artery pulsatility index (PAPi) was 2.3, with no obvious right heart failure (RHF). Postoperatively, central venous pressure (CVP) remained elevated at 15–18 mmHg and PAPi decreased to 0.2, indicating severe RHF. Massive left pleural effusion and hypoxemia occurred, and extubation was delayed until postoperative day 7. Lymphangiography and treatment for subclavian vein occlusion did not improve the effusion, suggesting RHF as the primary cause. Adjustment of HM3 pump speed and pacemaker settings during cardiac catheterization reduced CVP and rapidly improved the pleural effusion. In small pediatric patients undergoing HM3 implantation, device-related mechanical effects within the limited thoracic cavity and relatively high circulatory support for patient body size may contribute to RHF even when anatomical accommodation is feasible. Careful optimization of pump speed and heart rate may therefore be important in small pediatric patients.
