This retrospective observational study aimed to compare the effects of short inter-treatment interval treatment (SIIT) versus long inter-treatment interval treatment (LIIT) using the artificial liver support system (ALSS) on liver function recovery and 90-day transplant-free mortality in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). We retrospectively analyzed 149 HBV-ACLF patients selected from 166 patients who received comprehensive internal medicine therapy combined with ALSS. Patients were categorized into the SIIT group and the LIIT group. Laboratory test data were recorded both before ALSS treatment and the seventh day after the last ALSS treatment. The 90-day transplant-free mortality was compared between the two groups. Biochemical indicators reflecting patient's liver function including alanine aminotransferase, aspartate aminotransferase, serum total bilirubin (TBIL), direct bilirubin (DBIL), total bile acid, and coagulation function (prothrombin time activity, PTA) were significantly improved at posttreatment than pretreatment in both groups (p < 0.05). At Day 7 after the last ALSS treatment, TBIL and DBIL levels were significantly lower in the SIIT group than in the LIIT group (p < 0.01). The 90-day transplant-free mortality in the SIIT group and LIIT group was 12.8% and 29.6%, respectively (p < 0.001). Higher baseline MELD score was associated with increased 90-day transplant-free mortality (OR = 1.815, 95% CI: 1.466-2.247, p < 0.001). In patients with HBV-ACLF, SIIT with ALSS was associated with reduced 90-day transplant-free mortality compared with LIIT, although prospective studies are required to confirm causality.

Rotodynamic blood pumps (RBPs) must operate reliably across a wide range of clinical conditions, including off-design operating regimes. Although blade shape is known to influence off-design performance in conventional turbopumps, its impact on hydraulic performance and hemocompatibility in RBPs has not been systematically investigated. This study combines in silico and invitro analyses to assess the effects of leading-edge geometry and blade thickness on performance (pressure head-flow rate characteristics, efficiencies) and hemocompatibility (damage index, DI) across multiple RBPs and operating conditions. Three representative RBPs, a cavopulmonary assist device, the CentriMag RBP, and a novel ventricular assist device, were investigated. Semi-circular, elliptical, and wedge-shaped leading edges were implemented, whereas three blade thickness configurations were analyzed. Variations in leading-edge geometry resulted in minor differences in performance (< 3 percent in efficiency) and hemocompatibility (< 3% DI) across all devices and operating conditions. In contrast, blade thickness had a pronounced effect on performance under overload off-design operation, with thinner blades improving efficiency by up to 22%, while exhibiting only limited changes in hemocompatibility-related metrics (< 7% DI). The observed efficiency differences were primarily attributed to decreased friction losses caused by less channel blockage with thinner impeller blades. Overall, impeller blade shape plays a secondary role in hemocompatibility within the investigated pump types and operating conditions. This finding suggests that leading-edge optimization may be deprioritized relative to other hemocompatibility-critical geometry parameters in RBP design. Blade thickness, however, may lead to unfavorable channel blockage effects and therefore needs to be optimized with respect to manufacturing constraints and hydraulic performance.

De novo aortic insufficiency (AI) is a recognized complication in patients supported with continuous-flow durable left ventricular assist devices (LVADs), carrying important clinical consequences including heart failure progression and increased device-related morbidity. We report the case of a HeartMate 3 (Abbott Inc., Chicago, Illinois, USA) patient, previously supported with a micro-axial flow pump (mAFP), who developed severe AI within the first year of LVAD support and ultimately underwent urgent heart transplantation. Intraoperative inspection and histopathological analysis revealed mechanical injury of the aortic valve, likely initiated during mAFP implantation and subsequently exacerbated by LVAD-related turbulent flow. These findings suggest that even subtle valve trauma may evolve into clinically significant AI under continuous-flow support. This case underscores the need for a proactive strategy to minimize the risk of aortic valve micro-lesions during mAFP placement, including meticulous preprocedural assessment of aortic root and valve anatomy and careful intraprocedural technique.

Lung transplantation remains the primary option to treat end-stage lung disease, and treatments aiming to improve graft quality are necessary. Exvivo lung perfusion (EVLP) is a strategy that allows the organ to be assessed and reconditioned before transplantation. Treatment of the donor with a combination of 17β-estradiol (E2) and methylprednisolone (MP) has been shown to improve lung quality after brain death (BD). All considered, this study aimed to investigate E2 and MP association during EVLP. Males and females Wistar rats underwent BD induction and were maintained for 4 h. Naive animals were used as control. After BD, the pulmonary artery was cannulated, the heart-lung en bloc was collected, submitted to cold ischemia (1 h) and then placed in an EVLP system (4 h). Perfusion solution was home-made perfusate added or not with the treatment (T: MP, 40 mg; E2: 5 μg/mL). Groups were defined as male and female rats, divided as follows: BD (without perfusion), EVLP (without treatment), EVLP+Treat (with treatment). Male EVLP+Treat presented increased dynamic and static compliance, increased paO2, and reduced elastance. Treated males also presented reduced iNOS and MPO and increased perfusion flow. Both female perfused groups presented reduced MPO and adhesion molecules. Female EVLP+Treat also presented increased flow. No difference in lung function was observed in females. Our results point to a positive effect in the combined use of E2 and MP during EVLP by improving lung function and decreasing inflammation, especially in males.

This study aimed to compare the clinical outcomes of early versus conventional left ventricle (LV) unloading strategies using percutaneous transseptal left atrial cannulation during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). We retrospectively reviewed the records of patients who underwent ECPR and LV unloading at a single tertiary referral hospital between July 2013 and May 2024. Early LV unloading was defined as the procedure performed within 12 h of VA-ECMO initiation, while conventional unloading was performed after 12 h. Among 77 patients (mean age, 60.1 years; 56 males), 29 (37.7%) underwent early unloading and 48 (62.3%) underwent conventional unloading (median time to unloading: 2.5 days). The early group had significantly higher 30-day (58.6% vs. 33.3%, p = 0.030) and 1-year (75.9% vs. 52.7%, p = 0.038) mortality rates. Additionally, they had a lower rate of bridging to heart transplantation or LV assist device implantation (10.3% vs. 37.5%, p = 0.010), and a shorter VA-ECMO duration (6.0 days [3.0-9.0] vs. 12.0 days [7.0-23.5], p < 0.001). ECMO-related complications were comparable between groups (67.9% vs. 60.9%, p = 0.625), while poor neurologic outcomes (cerebral performance category ≥ 3) were more frequent in the early group (72.5% vs. 45.8%, p = 0.010). In patients treated with ECPR, early LV unloading was associated with worse survival outcomes and lower rates of transition to definitive therapies. These findings suggest that routine early LV unloading may not be beneficial in this population, and that the timing of unloading should be individualized based on the patient's clinical condition.

To investigate the dynamic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac Troponin I (cTnI) after left ventricular assist device (LVAD) implantation in patients with end-stage heart failure (ESHF), and to evaluate their prognostic value in predicting major adverse cardiac events (MACE), as well as to analyze the correlation between NT-proBNP and pump speed. A total of 78 ESHF patients implanted with the HeartCon LVAD between September 2020 and March 2025 were enrolled. Levels of NT-proBNP and cTnI were measured preoperatively and on postoperative days (POD) 1, 7, 30, 60, and 90. Patients were followed for MACE (death or rehospitalization for right heart failure) within 6 months. Receiver operating characteristic (ROC) analysis, Cox regression, and Kaplan-Meier (KM) survival curves were used to evaluate prognostic indicators. Spearman analysis was applied to assess the correlation between NT-proBNP and pump speed. NT-proBNP showed a significant reduction from a preoperative level of 4336.51 pg/mL to 2916.03 pg/mL on postoperative Day 1 (p = 0.01) and continued to decline, reaching 869.50 pg/mL by Day 90, although it remained above the upper reference limit. Total bilirubin (TBIL) increased markedly on Day 1 (from 16.60 to 32.70 μmol/L, p < 0.001) but returned to normal by Day 30 (11.30 μmol/L). cTnI peaked on Day 1 (from 0.58 to 18.93 ng/mL, p < 0.001), decreased significantly by Day 7 (to 2.24 ng/mL, p < 0.001), and normalized by Day 30 (0.15 ng/mL). ROC analysis showed that NT-proBNP on POD7 predicted MACE with an AUC of 0.749 (p = 0.004). Cox regression indicated that patients with NT-proBNP ≥ 2983 pg/mL on POD7 had a 6.2-fold higher risk of MACE (HR = 6.163, p = 0.001). Spearman analysis revealed a positive correlation between NT-proBNP and pump speed in the MACE(+) group (r = 0.314, p = 0.011). LVAD effectively unloaded the left ventricle, leading to a significant reduction in NT-proBNP. NT-proBNP on POD7 served as an independent predictor of MACE. Moreover, pump speed positively correlated with NT-proBNP levels. Our findings provided a clinical evidence base supporting the application of precision medicine in the management of ESHF patients with LVAD implantation.

Brain infarction (BI) is a severe complication of extracorporeal membrane oxygenation (ECMO) with high morbidity and mortality. We aimed to determine the incidence of BI and identify predictors in pediatric patients receiving ECMO. We performed a retrospective single-center cohort study including patients aged 29 days to < 18 years who underwent ECMO treatment at a tertiary center between January 2010 and October 2023. The primary outcome was BI during ECMO. Predictors of BI were analyzed using logistic regression. Among 179 included patients, BI was diagnosed in 51 (28%). Multivariable logistic regression identified venoarterial (VA) ECMO (OR 3.82, 95% CI 1.45-10.08; p = 0.007) and higher pre-ECMO arterial lactate (per mmol/L increase, OR 1.11, 95% CI 1.02-1.20; p = 0.01) as independent predictors of BI. The 30-day mortality was 67% among patients with BI compared with 15% among those without BI (p < 0.001). Brain infarction was more common than in most prior reports and was associated with high short-term mortality. VA ECMO mode, compared with venovenous ECMO, and higher pre-ECMO arterial lactate were independent predictors of BI. These findings support enhanced, standardized neurological monitoring and a liberal early brain CT strategy in pediatric ECMO patients, particularly those supported with VA ECMO.

Liver transplantation remains the only curative treatment for end-stage liver failure, yet its impact is constrained by organ shortages and graft non-utilization. Machine perfusion (MP) enables exvivo liver assessment; however, current viability criteria rely on intermittent sampling, limiting temporal resolution and accuracy. Indocyanine green (ICG), a clinically validated dye cleared exclusively by hepatocytes, provides a continuous index of hepatic function beyond initial injury. We present a non-invasive, clamp-on optical sensor that demonstrates the first continuous, real-time quantification of ICG clearance during MP. The sensor consists of a clamp-on module with an 808 nm laser and phototransistor connected to a microcontroller and computer for real-time plotting. The raw phototransistor signal was linearised to a unitless absorbance signal proportional to perfusate ICG; bi-exponential fitting yielded plasma disappearance rate (PDRbi, %/min) and the 15-min residual fraction (R15). Across 10 whole and 3 split human livers (45 boluses; 13 paired with spectrophotometry), the sensor closely matched spectrophotometric measurements (pooled R2 = 0.994; range 0.983-0.999). The sensor resolved expected physiological trends: ICG clearance rate increased from subnormothermic to normothermic temperatures (ΔPDRbi + 14.41% ± 9.53%/min, ΔR15 -22.35 ± 9.97 percentage points; n = 4). The continuous sensor signal also revealed early mixing dynamics and medication-related effects missed by intermittent sampling. This optical sensor enables accurate, real-time monitoring of ICG clearance during exvivo perfusion. The exvivo setting is uniquely positioned to validate ICG clearance models, enhance clinical interpretation, and support informed graft assessment during perfusion.