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Resolution of hemolysis from pump thrombus during left ventricular assist device exchange

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World Journal of Clinical Cases 2014年第8期2卷 373-376页

作者： Shinya Unai hitoshi hirose John WC Entwistle III Louis E Samuels Division of Cardiothoracic Surgery Department of SurgeryThomas Jefferson UniversityPhiladelphiaPA 19107United States

A 50-year-old male who underwent a Heart Mate Ⅱ left ventricular assist device placement for ischemic cardiomyopathy presented with discolored urine and hemolysis 3 mo after the operation. His hemolysis was thought to be due to thrombosis within the pump. Imaging studies were not able to visualize a left ventricular thrombus. Medical management with anticoagulation failed and he underwent surgery for a pump exchange. Intraoperatively, a firm thrombus was found within the pump of the Heart Mate Ⅱ, and the color of the urine changed dramatically from cola-colored to yellow which enabled us to confirm the diagnosis.

关键词： Cardiac surgery Hemolysis Left ventricular assist device Thrombosis

Outcomes of Extracorporeal Membrane Oxygenation in Blood Culture Positive Septic Patients

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World Journal of Cardiovascular Surgery 2020年第8期10卷 158-166页

作者： Cameron Blazoski Qiong Yang hitoshi hirose Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia PA USA Department of Surgery Thomas Jefferson University Philadelphia PA USA

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is commonly used for refractory cardiac or respiratory failure. There are reported cases of successful use of ECMO in patients with septic shock;however, there is a lack of evidence to prove its overall efficacy. Thus, we conducted this study to analyze the relationship between sepsis and ECMO in our own patients. METHODS: 305 patients who were placed on ECMO between 2010 and 2020 were identified within an IRB-approved database. Their clinical outcomes were analyzed with a specific focus on patients who were septic before or during ECMO, defined as a positive blood culture. Group S was composed of patients with a positive blood culture before or during ECMO, while Group N was composed of all patients without a positive blood culture before or during ECMO. The primary outcome compared between groups was ECMO survival rate. RESULTS: Among the 305 patients on ECMO, 58 (19%) were in Group S and 247 (81%) were in Group N. ECMO survival rates were 45% in Group S and 62% in Group N (p = 0.017). CONCLUSION

Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement in Patients with Continuous-Flow Left Ventricular Assist Devices (LVAD)

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World Journal of Cardiovascular Surgery 2013年第2期3卷 97-99页

作者： Ryan Cobb Nicholas C. Cavarocchi hitoshi hirose Department of Surgery Thomas Jefferson University Philadelphia USA

Introduction: Inadequate nutritional support after LVAD placement is known to increase postoperative infections and to decrease survival. LVAD patients with prolonged mechanical ventilation and complicated postoperative recovery requiring prolonged mechanical ventilation may require long-term tube feedings. Placement of a PEG requires knowledge of the location of the LVAD pocket and driveline to avoid device infection and injury. Methods: Between August 2008 and December 2011, 39 patients underwent HeartMate II LVAD placement in our institution. Among them, 5 patients underwent PEG tube placement for long-term nutritional support. Procedure management consisted of cessation of anticoagulation and correction of abnormal coagulation;a cardiothoracic surgeon or intensivist in the operating room to communicate with the surgeon who performed the PEG procedure;and VAD coordinator or perfusionist in the operating room to assist in monitoring the VAD. Data were retrospectively analyzed to investigate complications related to the PEG placement. Results: The studied patients consisted of 3 males and 2 females with mean age of 58 +/﹣5.0. The interval of LVAD to PEG placement was a mean 21 +/﹣8.8 days. PEG was successfully performed in the operating room in all patients. There were no LVAD device or driveline injuries related to the PEG procedure. There were no postoperative short-term or long-term PEG related complications such as acute gastric bleeding or dislodgement of the PEG tube. Conclusions: PEG placement for HeartMate II LVAD patients can be done without increasing the risk of device or intraabdominal organ injury with carefully coordinated efforts from both the mechanical support team and surgical services.

关键词： Heart Failure Mechanical Support Device Nutrition PEG

Prone Position: Does It Help with Acute Respiratory Distress Syndrome (ARDS) Requiring Extracorporeal Membrane Oxygenation (ECMO)?

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Open Journal of Respiratory Diseases 2017年第1期7卷 18-24页

作者： Nava Azimzadeh Michael Baram Nicholas C. Cavarocchi hitoshi hirose Division of Cardiothoracic Surgery and Division of Critical Care and Pulmonary Medicine Thomas Jefferson University Philadelphia PA USA

Introduction: Lung protective ventilation therapy with low tidal volume-high PEEP is the standard treatment for the patients with acute respiratory distress syndrome (ARDS). Oscillators are occasionally used for salvage ventilation in cases where poor compliance restricts the use of traditional ventilation with ARDS. In addition to ventilator therapy, prone positioning has been used to improve oxygenation. We presented a challenging case of ARDS, which failed medical management extracorporeal membrane oxygenation (ECMO) support and oscillatory ventilation. Prone positioning was initiated which improved oxygenation, respiratory compliance and posterior atelectasis. Case presentation: A 41-year-old morbid obese female developed ARDS due to influenza pneumonia. The patient remained hypoxic despite optimum medical and ventilator management and required veno-venous extracorporeal membrane oxygenation (VV ECMO). CT scan of the chest showed ARDS with posterior consolidation. Despite ARDSnet ventilation support, antiviral therapy and ECMO support, there was no clinical improvement. High frequency oscillatory ventilation was initiated on ECMO day #13, which resulted in no respiratory improvement over the next 5 days. On ECMO day #18, the patient was placed on a Rotaprone? bed Therapy, utilizing a proning strategy of 16 hours a day. The clinical improvements observed were resolving of the consolidation on CXR, improvements in ventilatory parameters and decreased oxygen requirements. The patient was successfully weaned off ECMO on POD#25 (8 days post prone bed). Conclusions: Prone position improved oxygen saturation and pulmonary compliance in severe ARDS requiring ECMO and it might facilitate early weaning.

关键词： ARDS Prone Position ECMO Hypoxia Obesity

Role of Serum Cytokine Levels in Acute Respiratory Distress Syndrome Patients on Extracorporeal Membrane Oxygenation Support

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World Journal of Cardiovascular Surgery 2020年第1期10卷 1-10页

作者： Ena Gupta Kyle Carey Lydia McDermott Nicholas Cavarocchi hitoshi hirose Michael Baram Division of Pulmonary and Critical Care Thomas Jefferson University Philadelphia PA USA Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia PA USA Division of Cardiothoracic Surgery Thomas Jefferson University Philadelphia PA USA

Background: Even with the use of extracorporeal membrane oxygenation (ECMO) in acute respiratory distress syndrome (ARDS), mortality remains high. Also, prognostication of patients with ARDS and ECMO is difficult. Cytokines are thought to be markers of inflammation in both ARDS and in ECMO, however, understanding is limited. We aimed to study the association of three serum cytokine levels with mortality in these patients with ARDS on ECMO. Methods: We performed a retrospective chart review of ARDS patients on ECMO between 2011 and 2017. Patients with serum TNF-α, IL-6 and IL-2 measured while on ECMO were included, with measurements recorded weekly up to a maximum of 4 measurements. A multivariable regression analysis was performed and generalizing estimating equations were used to analyze longitudinal trend of cytokines with mortality. Results: There were 47 patients with ARDS on ECMO, of which 31 (68.9%) survived at 30 days and 2 were lost to follow up. Initial IL-2 levels were found to be significantly higher among those who were alive compared to those who died at 30 days (2720 ± 2432 pg/ml vs. 1293 ± 693 pg/ml);p = 0.0460. At any given time, an increase in IL-2 was associated with a decrease in odds of death at 30 days (adjusted odds ratio 0.98, 95% confidence interval 0.97 - 0.99, p = 0.08). There was no significant difference in average or initial levels of TNF-α and IL-6 among those who were alive vs. those who died at 30 days. There was no association between either of these cytokine levels with death while on ECMO. Conclusions: Higher levels of cytokine IL-2 were associated with lower 30-day mortality. Further studies are needed to elucidate the pathobiology of cytokines while on ECMO and their use in predicting outcomes.

关键词： Serum Cytokines ECMO ARDS Mortality

End Organ Recovery and Survival with the QuadroxD Oxygenator in Adults on Extracorporeal Membran Oxygenation

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World Journal of Cardiovascular Surgery 2012年第4期2卷 73-80页

作者： Joshua K. Wong Vei Shaun Siow hitoshi hirose Pawel Karbowski Joseph Miessau Michael Baram Matthew DeCaro Harrison T. Pitcher Nicholas C. Cavarocchi Division of Cardiology Department of Medicine Thomas Jefferson University Philadelphia USA Division of Cardiothoracic Surgery Department of Surgery Thomas Jefferson University Philadelphia USA Division of Pulmonary Medicine and Critical Care Department of Medicine Thomas Jefferson University Philadelphia USA

Introduction: Extracorporeal Membrane Oxygenation (ECMO) is used in selected patient with cardiogenic and/or re- spiratory shock. We report our experience with standardized management protocols and the application of the Qua- droxD oxygenator with a centrifugal pump to maximize end-organ recovery and improve survival. Methods: This is an Internal Review Board (IRB) approved, single institution retrospective study of end-organ recovery and survival in pa- tients who required ECMO for cardiogenic and/or respiratory shock between July 2010 and June 2011. Results: Sixteen patients (median age: 46 years) were initiated on either Veno-Arterial (VA) or Veno-Venous (VV) ECMO. Cardiogenic shock, acute respiratory distress syndrome (ARDS) and a combined respiratory and cardiogenic compromise were the primary indications for ECMO in 8 (50%), 5 (31%) and 3 (19%) patients respectively. The median time on ECMO was 8 days (range: 4 - 26 days). Twelve patients (75%) were successfully weaned off ECMO, of which four (25%) were bridged to a ventricular assist device (VAD) and eight (50%) were weaned to recovery. All eight patients (100%) that were weaned to recovery and two patients (50%) that were bridged to a VAD were successfully discharged from the hospital, resulting in a discharge rate of 63%. There was an improvement in pre- vs. post-ECMO AST (449 IU/L vs. 63 IU/L, p Conclusion: ECMO using the QuadroxD oxygenator and a centrifugal pump, coupled with standardized management protocols is beneficial in carefully selected patients. Improvement or main- tenance of end-organ function is associated with successful bridge to device therapy and/or increased survival.

关键词： Extracorporeal Membrane Oxygenation Adults End-Organ Recovery Mechanical Circulatory Support

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慢地震与深部不连续颤动和慢滑事件同时发生

国际地震动态 2009年第10期30卷 23-27页

作者： Yoshihiro Ito Kazushige Obara Katsuhiko Shiomi Shutaro Sekine hitoshi hirose 乔迎春日本国家地球科学与灾害防御研究所陕西省地震局

我们对日本西南部南海俯冲板块界面过渡带发生的超低频地震进行报道。由矩震级为3.1～3.5的超低频地震引起的地震波显示其卓越长周期约为20s。超低频地震活动伴随深源低频颤动和慢滑事件同时发生,并随之移动。慢地震一直被认为会增加向... 详细信息

我们对日本西南部南海俯冲板块界面过渡带发生的超低频地震进行报道。由矩震级为3.1～3.5的超低频地震引起的地震波显示其卓越长周期约为20s。超低频地震活动伴随深源低频颤动和慢滑事件同时发生,并随之移动。慢地震一直被认为会增加向上倾斜的大型逆冲地震断裂带上的应力,而这3种现象的同时发生提高了人们对慢地震的探测和特性鉴定水平。

关键词：慢地震事件颤动不连续深部地震断裂带超低频俯冲板块

骨骼化双侧乳内动脉在冠状动脉旁路移植术中的应用

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中国现代医学杂志 2008年第16期18卷 2374-2376页

作者：李儒正天野笃广濑仁吴朝光海南省人民医院心血管外科海南海口570311 日本顺天堂大学医院心血管外科

目的总结骨骼化双侧乳内动脉在冠状动脉旁路移植术中的使用经验和应用价值。方法回顾性分析日本顺天堂大学医院60例接受了骨骼化双侧乳内动脉血管桥进行单纯冠状动脉旁路移植术冠心病患者的临床资料及随访资料。结果左右乳内动脉长度分... 详细信息

目的总结骨骼化双侧乳内动脉在冠状动脉旁路移植术中的使用经验和应用价值。方法回顾性分析日本顺天堂大学医院60例接受了骨骼化双侧乳内动脉血管桥进行单纯冠状动脉旁路移植术冠心病患者的临床资料及随访资料。结果左右乳内动脉长度分别为(20.3±1.2)和(20.5±1.3)cm,远端吻合口平均(4.1±1.5)个。组合Y或I血管桥19例,序贯吻合34例,升主动脉不接触技术45例。术后并发严重心律失常2例,脑梗塞合并败血症、弥漫性血管内凝血合并多脏器功能衰竭各1例,肺部感染2例,手术死亡2例。术后随访(15.6±3.2)个月,远期无死亡或心脏性事件患者。结论骨骼化双侧乳内动脉在冠状动脉旁路移植中具有良好的早期效果。骨骼化法采取的乳内动脉长度更长,可以安全地利用双侧乳内动脉进行冠状动脉旁路移植。

关键词：冠状动脉旁路移植术冠状动脉疾病乳内动脉

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超声刀在骨骼化乳内动脉采取中的应用

中国医师杂志 2008年第9期10卷 1191-1193页

作者：李儒正天野篤廣瀬仁海南省人民医院心血管外科海南海口570311 日本顺天堂大学医院心血管外科

目的总结超声刀在骨骼化乳内动脉血管桥采取中的使用经验。方法回顾性分析日本顺天堂大学医院60例接受了超声刀采取的双侧乳内动脉血管桥进行单纯冠状动脉旁路移植术冠心病患者的临床资料及随访资料。结果远端吻合口平均（4．1±1．5）... 详细信息

目的总结超声刀在骨骼化乳内动脉血管桥采取中的使用经验。方法回顾性分析日本顺天堂大学医院60例接受了超声刀采取的双侧乳内动脉血管桥进行单纯冠状动脉旁路移植术冠心病患者的临床资料及随访资料。结果远端吻合口平均（4．1±1．5）个。术后并发严重心律失常2例，脑梗塞合并败血症、弥漫性血管内凝血合并多脏器功能衰竭各1例，肺部感染2例，手术死亡2例。术后随访（15．6±3．2）个月，远期无死亡或心脏性事件患者。结论超声刀的应用使乳内动脉的骨骼化采取变得安全、简单。骨骼化双侧乳内动脉在冠状动脉旁路移植中具有良好的早期效果。

关键词：超声疗法乳房动脉冠状动脉分流术