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Biomedical subjects

H Takano

Publications and source records attributed to H Takano.

At least 631 records · Page 35Linked to original sources
PubMedDate not supplied

Serum silicon levels in recipients of an electrohydraulic ventricular assist system.

This study was designed to determine the permeation rate of silicon oil from the authors' electrohydraulic ventricular assist system (EHVAS), and to evaluate influences on organ function. The permeation rate through the diaphragm of the EHVAS was determined by in vitro experiments. Influences on organ function were evaluated in three goats with EHVAS by monitoring blood chemical parameters and serum silicon levels (S-Si). The permeation rate from the EHVAS was about 0.2 ml/month, calculated from the data obtained in the in vitro experiments. S-Si levels did not increase during chronic animal implantation, and renal and hepatic function were not affected. The permeation rate through the diaphragm must, however, be taken into consideration.

Animals↗
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Hybrid respiratory support system with extracorporeal placental oxygenation.

The authors developed a novel hybrid system for long-term respiratory support with extracorporeal placental oxygenation. In this system, the patient's blood is oxygenated with O2 saturated artificial blood across the villous membrane during passage through the fetal circuit of the placenta, which is placed in a specially constructed artificial uterus. Human term placentas were obtained immediately after vaginal delivery and used for the experiments. The gas transfer performance of the current apparatus was 60 ml/min for O2 and 40 ml/min for CO2 at a blood flow rate of 1.0 L/min. From these results (and the assured blood compatibility of the placenta), the authors conclude that this system will become one of the most promising modalities for prolonged extracorporeal oxygenation.

Biocompatible Materials↗
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Practical assessment of natural heart function using echocardiography in mechanically assisted patients.

Left ventricular assist systems (LVAS) can maintain the systemic circulation of patients with acute, profound heart failure. The assessment of natural heart (NH) function, however, is difficult in the clinical setting. The authors introduced a new index, heart rate-corrected ejection time/left atrial pressure (ETc/LAP) using echocardiography to evaluate NH function in 15 adult patients on the original LVAS for greater than 2 days. Bypass flow (BF) was gradually decreased according to the recovery of NH. Five patients were weaned from LVAS within 15 days, and LV function was well maintained (Group 1). Another six patients were weaned from LVAS within 21 days but died within 2 weeks (Group 2). The other four patients died on LVAS without recovery of NH (Group 3). In Group 1 patients, ejection time/pre-ejection period (ET/PEP) with LVAS assist increased continuously. In Groups 2 and 3, ET/PEP increased slowly and reached a plateau at approximately 10 days or remained low. Group 1 patients reached an ETc/LAP of 35 +/- 10 on LVAS within 7 days. Group 2 and Group 3 patient values were 18 +/- 2 (p less than 0.05) and 9 +/- 6 (p less than 0.01), respectively, on the seventh day. Based on these data, this new index provides an estimate of global NH function and a prediction of the probability of NH recovery.

Adult↗
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A VAD and novel high performance compact oxygenator for long-term ECMO with local anticoagulation.

A novel method of long-term ECMO was designed and evaluated experimentally. Special features of this ECMO method include: 1. using a pneumatic diaphragm type VAD with excellent blood compatibility as a pump system; 2. using a newly developed, high performance, compact oxygenator, with a novel gas exchange membrane in which micropores are blind at the blood contacting surface; 3. regional anticoagulation within the ECMO circuit with short-acting protease inhibitor FUT-175; and 4. right heart bypass with direct cannulation through a thoracotomy. Four goats implanted with a VAD between the right atrium and the pulmonary artery underwent ECMO by interposing a compact oxygenator in the return cannula for as long as 14 days. Blood clotting was regulated with continuous infusion of FUT-175 from the inflow cannula of the ECMO circuit. In this system, 2 to 4 L/min of bypass flow, 80 to 120 ml/min of O2, and 40 to 80 ml/min of CO2 gas exchange were obtained. Serum leakage in the oxygenator did not occur, and various blood chemical and hematologic parameters were maintained within the normal range. Regional anticoagulant therapy was successfully achieved with a significant difference of activated clotting time between the blood samples from the systemic circulation and those from the ECMO circuit. These results indicate that this method overcomes several problems with ECMO, and has the capacity for long-term respiratory assistance.

Animals↗
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Chronic in vivo evaluation of a portable electrohydraulic ventricular assist system with a linear actuator.

Chronic experiments of the electrohydraulic ventricular assist system with a linear motor actuator were performed in two goats weighing 54 kg and 56 kg, and the system was used for more than 30 days. The actuator was designed to be fixed on the goat's back with a saddle. The pump was connected between the left atrium and descending aorta and placed paracorporeally on the chest wall. Linear action of an actuator bellows was delivered by silicone oil in a U-shaped polyvinylchloride tube to activate the pump. The maximum output in the 56 kg goat was 5.0 L/min. Goats could stand and sit freely. The first goat with a pusher-plate type pump died on the fifth day because of thromboembolism, but the second goat with a diaphragm type pump survived for 42 days. Blood chemistries remained within normal limits. Pump control was easy in both the duty-control mode and the stroke-control mode. With the automatic negative pressure control (ANPC) to prevent atrial wall sucking, the left atrial pressure was kept within +/- 10 mmHg, although left atrial pressure sometimes went below -80 mmHg without ANPC. Considering reliability, automaticity, and portability, the electrohydraulic ventricular assist system has become another choice for a practical, electrically driven ventricular assist system.

Animals↗
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Bioenergetic recovery processes of injured myocardium.

We employed cervically transplanted nonworking myocardium to simulate the condition of a heart supported by a ventricular assist device, and to investigate the bioenergetic recovery processes of injured myocardium with 31P nuclear magnetic resonance (NMR) techniques. A heterotopic graft was placed in the cervical portion of a recipient rat. One week later, a control 31P NMR spectrum was obtained from the graft. On the same day, the aorta of the graft was clamped for 30 minutes at room temperature. After this procedure, 31P NMR measurements of the graft were performed for 1 week. The phosphocreatine (PCr)/Inorganic phosphate (Pi) ratio, and beta-phosphate from adenosine triphosphate (beta-ATP)/Pi ratio on the first and second day after injury were significantly lower than control (p less than 0.05). However, these ratios recovered to a significant extent on the third and fourth day. These results suggest that 3 or 4 days are required for bioenergetic recovery of reversibly injured myocardium, even under nonworking conditions.

Adenosine Triphosphate↗
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A composite driving system for LVAS and IABP: practical and effective driving and weaning.

We have devised a new method, termed alternate synchronous driving (ASD), to wean patients from a left ventricular assist system (LVAS) to a pressure assist intraaortic balloon pump (IABP). We have built a new drive unit, VCT200, to apply ASD easily and automatically. After IABP insertion in the final weaning stage, this method drives the LVAS and IABP alternately, with electrocardiogram (ECG) synchronization. The pumping ratio of IABP increases while that of LVAS decreases according to recovery of natural heart function. In in vitro studies, ASD was effective when bypass flow (BF) was less than 50% of total flow (TF) (TF:BF + cardiac output [CO]), and its advantages increased under lower BF conditions. Mean aortic pressure (mAP) and CO increased 10 mmHg and 15%, respectively, with this method (IABP:LVAS = 1:1) when BF was 30% of TF. During in vivo studies, mAP increased 75.7 +/- 6.7 mmHg to 80.1 +/- 3.6 mmHg (p less than 0.001), and the CO increased from 3.1 +/- 0.5 L/min to 3.3 +/- 0.5 L/min (p less than 0.001), while the endocardial viability ratio (DPTI/TTI) increased 20-30%. This method was used in a 62-year-old man in which LVAS was applied after ventricular aneurysmectomy, BF was reduced from 2.2 L/min to 1.1 L/min by using ASD without any change in systemic perfusion. This reduction of BF could not be achieved with LVAS alone. From these data, this system could wean patients from LVAS and then switch to IABP smoothly, easily, and automatically, without hemodynamic instability.

Combined Modality Therapy↗
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Physiologic reactions of awake animals to an immediate switch from a pulsatile to nonpulsatile systemic circulation.

The purpose of this study is to clarify physiologic reactions to an immediate switch of flow pattern from pulsatile to nonpulsatile. A pulsatile ventricular assist device (VAD) was implanted in four 40-64 kg goats. Blood was drawn from the left atrium and ventricle and expelled into the aorta. After 2 weeks the VAD was quickly replaced by a centrifugal pump, MD-10 (Iwaki Pump, Tokyo, Japan), 760 g in weight and phi 70 mm x 84 mm in size, set on the back, without anesthesia. A 100% nonpulsatile bypass flow was immediately obtained, and the pump was set to maintain the same mean aortic pressure as before the switch; central venous pressure, cardiac output, systemic vascular resistance, oxygen consumption, blood lactate, plasma adrenalin, noradrenalin, renin activity, angiotensin II, and aldosterone were measured. Behavior of the goats did not change, and fluid infusion and higher cardiac outputs were not required. Most of the parameters did not deviate from control levels after the switch. In conclusion, a mammal immediately accommodates well to nonpulsatile flow.

Aldosterone↗
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Thrombus in a natural left ventricle during left ventricular assist: another thromboembolic risk factor.

Systemic thromboembolism is one of the serious complications during use of a left ventricular assist system (LVAS). The authors' original LVAS has excellent antithrombogenicity to reduce this risk, but thrombus formation in a natural left ventricle (LV) is another risk factor for systemic embolization. We used our LVAS in 22 patients. Of these, LV wall motion was studied in 15, and a smoke-like echo disclosed thrombus in the LV in eight. When LVAS sufficiently supported the systemic circulation, LV wall motion was irregular upon closure of the aortic valve. Upon recovery of LV function and decrease of LVAS flow, the smoke-like echo diminished and LV thrombus decreased in one, but LV thrombus remained unchanged or increased in seven. Systemic administration of antithrombotic agents had an unclear effect. Seven of eight patients with LV thrombus on echo died during or after LVAS. In these seven, a high incidence of LV thrombus (71%), and systemic embolism to the brain (29%) or kidney (86%), were revealed at necropsy. We subsequently used local heparinization to prevent LV thrombus formation. One patient with a smoke-like echo had no evidence of LV thrombus or systemic embolism. During LV assist, careful management of the LVAS, and intra-LV heparinization should be considered to reduce the risk of thrombus formation in the natural LV.

Adult↗
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Myocardial metabolism during prolonged selectived hypothermic coronary perfusion.

In the study discussed below, we assessed the myocardial protection provided by our method of selective hypothermic coronary perfusion. Using arterial and coronary venous blood samples, the following biochemical aspects of myocardial metabolism were calculated: 1) coronary arteriovenous (A-V) pH difference, 2) O2 difference, 3) CO2 difference, 4) respiratory quotient, 5) coronary A-V pyruvate difference, 6) lactate difference, 7) cardiac excess lactate, and 8) redox potential difference. Results indicate that, during coronary perfusion performed according to out method, metabolic changes are minimal and easily reversible shortly after coronary perfusion is terminated.

Adult↗
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Computed simulationgraphy: concept and method of clinical application.

The beam's eye view is one of the methods for transferring a patient's computed tomography information to the actual treatment position. We have developed a system for producing beam's eye projections through axial computed tomography data. The treatment field boundary, whose display is applicable to the multi-leaf collimator system, is superimposed upon the image. Data for the treatment set-up and coordinate transfer are also displayed on the image. Conventional X-ray simulators have fallen into disuse for marking the treatment field on the patient's skin. The process and the image completely take the place of simulation and the simulation film made by a conventional X-ray simulator; consequently, we have named the process computed simulationgraphy.

Computer Graphics↗
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Altered humoral control of circulating volume during artificial circulation.

UNLABELLED: Plasma atrial natriuretic polypeptide (ANP) levels and plasma renin activity (PRA) were measured in six left ventricular assist device (LVAD) goats, four single artificial heart (SAH) goats, i.e., LVAD animals with fibrillated hearts, and 3 total artificial heart (TAH) calves. During the 4 week experiment, the ANP levels in the SAH goats increased to 516 pg/ml from the control value of 61.8 pg/ml because of an elevated CVP of 13-21 mmHg, while those of the LVAD goats were near the lower limit of the control values. The TAH calves had slightly decreased ANP levels at 23-46 pg/ml after the third postoperative week, which did not increase after the steep increase in CVP induced by the changes in the driving conditions. The PRA levels were 10-50 times higher than control in the SAH goats and a TAH calf whose CVP rose to 19 mmHg, although the cardiac output was within normal limits. IN CONCLUSION: 1) The secretion of ANP secondary to alteration in CVP was preserved in the LVAD recipients and enhanced diuresis, while it was compromised in the TAH cases. 2) The PRA levels in cases with elevated CVPs were high enough to suppress diuresis.

Animals↗
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Cardiac disuse atrophy during LVAD pumping.

The authors investigated morphologic changes of myocardial tissue of goats supported with a long-duration left ventricular assist device (LVAD). The bypass flow rates of the LVAD were kept at maximum levels (about 80% of total cardiac output) in four goats for 30 days, and at a limited flow rate (around 60%) in one goat each for 30 and 90 days. Morphometric studies using light and electron microscopy were performed on the left ventricles, comparing them to those in the four control studies. The results disclosed: 1) relative volume densities of the myocytes and interstitial tissue in the myocardium were unchanged; 2) cross-sectional areas of the myocytes in the maximum bypass cases were significantly reduced in comparison with pre-experimental data; 3) relative myocyte volumes, calculated by myocytes and nuclear volume densities, were reduced in three goats in the maximum bypass group; and 4) relative volume density of myofibrils was reduced in the maximum and 90 day bypass groups, whereas that of mitochondria was reduced only in the 90 day bypass case. These results indicate that LVADs cause cardiac atrophy which correlates with bypass flow rate and duration of assistance.

Animals↗
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Myocardial free fatty acid metabolism of the ischemic heart treated by left ventricular assist device.

Three-beta-methyl-iodophenyl-pentadecanoic acid (BMIPP), a newly developed radiographic probe of metabolic processes in tissue free fatty acid (FFA), was applied to a study analyzing the effect of a left ventricular assist device (LVAD) on impaired dog hearts. The radiographic image obtained with BMIPP was compared with 201thallium chloride (TL) imaging, which indicates tissue perfusion. In the myocardial infarction (MI) model, the BMIPP and TL uptake were equally increased with the use of LVAD in the marginal area of the MI. In another model using the reperfused myocardium after ischemia, the BMIPP and TL uptake were increased in the reperfused area by LVAD pumping. On the other hand, BMIPP uptake in the residual myocardium of both models was decreased by LVAD pumping when compared with TL uptake. This discrepancy between these radiographic tracers in the residual myocardium suggests that tissue metabolic processes may be suppressed as result of a decrease in the energy demand by the myocardium caused by LVAD pumping. The results of this study showed that use of LVADs for the impaired heart improved cell function of "stunned" myocardium and also unloaded the excess work from the residual myocardium as judged by FFA metabolism.

Animals↗
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Development of an anaphylatoxin scavenging device. Principle, surface molecular design, and selective adsorption.

The anaphylatoxins (C3a and C5a) generated upon extracorporeal circulation often cause adverse reactions at local and systemic levels. In this paper, the principle surface molecular design and highly selective adsorptional behaviors of anaphyatoxin-scavenging materials were demonstrated. Both C3a and C5a are highly basic proteins, whereas most plasma proteins are negatively charged in blood. This indicates that negatively charged surfaces could preferentially adsorb these basic proteins from plasma. Based on the above working hypothesis, surface molecular designs aiming at incorporation of negatively charged groups such as carboxylate and sulfonate groups on surfaces were attempted. The control of surface density at the outermost layer was assessed by x-ray photoelectron spectroscopy. The designed surfaces preferentially adsorbed C3a and C5a from activated serum. This provides a rational basis for the extracorporeal anaphylatoxin-scavenging device under development.

Adsorption↗
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A hybrid artificial vascular graft based upon an organ reconstruction model. Significance and design criteria of an artificial basement membrane.

The design of an artificial basement membrane is one of the central concerns in a hybrid artificial vascular graft. The design criteria defined here include 1) structural matrix, 2) enhanced adhesion and growth of endothelial cells, and 3) ensured antithrombogenicity. The designed artificial basement membrane is a complex gel of type I collagen with dermatan sulfate that drastically alters the cellular responses for both endothelial cells and platelets. The incorporation of a very small amount of dermatan sulfate was sufficient to enhance adhesion and growth of endothelial cells and to suppress platelet adhesion and activation.

Animals↗
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Chronic effect of left ventricular assist pumping on right ventricular function.

We evaluated right ventricular (RV) function during left ventricular assist device (LVAD) pumping during acute and chronic experiments in both normal hearts and hearts with left ventricular failure. An LVAD was implanted between the left atrium and the descending aorta of goats. The LVAD was pumped in a counterpulsation mode and at maximum bypass flow for 4-6 weeks in chronic experiments. The following results were obtained: 1) LVAD pumping itself did not affect RV function, even after 6 weeks of pumping, 2) the dimensions of the RV free-wall segments measured by sonomicrometers showed a gradual and small increase during the early postoperative days, which was due to an increase in volume returned to the RV and the deformity of the RV cavity derived from reduction in LV volume, and 3) the same tendencies were seen even with LV failure hearts. These results suggested that 1) LVADs can assist not only the LV but also the RV by reducing RV afterload, 2) excessive and prolonged assistance by an LVAD seems to dilate the RV free-wall, and 3) preexisting RV dysfunction is the main cause of signs of RV failure during LV pumping.

Animals↗