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Biomedical subjects

Y Taenaka

Publications and source records attributed to Y Taenaka.

At least 55 records · Page 3Linked to original sources
PubMed1996

Tandem operation of a turbo blood pump (BP-80--type centrifugal pump) to reduce hemolysis.

When operating turbo blood pumps in tandem, the strength of shear stress is reduced, but the exposure duration of the stress is increased. The purpose of this experiment was to compare the degree of contribution of these two factors on hemolysis as well as to evaluate the effectiveness of the tandem operation of turbo blood pumps. Tandem operation of two Bio-pumps (BP-80; Medtronics Bio-medicus, Inc., Eden Prairie, Minnesota, U.S.A.) were compared with single operation of a BP-80 in in vitro hemolysis tests in three different driving conditions, that is, pumping heads of 200, 350, and 500 mm Hg under a pump flow rate of 5 L/min. The Allen's hemolytic indexes of the tandem operation at pumping heads of 200, 350, and 500 mm Hg were 0.014, 0.020, and 0.080 mg/dl, respectively. The hemolytic indexes of the single operation at pumping heads of 200, 35, and 500 mm Hg were 0.014, 0.056, and 0.12 mg/dl, respectively. These results indicate that tandem operation is a useful method of reducing hemolysis with the BP-80 under high pumping heads and that the effect on hemolysis of exposure to higher shear stresses may be more serious than that of longer durations of exposure to shear stress in turbo blood pumps.

Animals↗
PubMed1995

Hemolysis and heat generation in six different types of centrifugal blood pumps.

What the most causative factor affecting hemolysis is still controversial. To resolve this problem, we investigated the relationship between hemolysis and heat generation in six types of centrifugal blood pumps (Bio-Pump, Delphin, Capiox, Nikkiso, Isoflow, and Toyobo). The analyzed parameters were index of hemolysis in fresh goat blood, pumping performance, and heat generation in a thermally isolated mock circuit. These parameters were analyzed at a flow rate of 5 L/min by changing the pressure head (100 mm Hg and 500 mm Hg). At 500 mm Hg of pressure head, the Bio-Pump needed the highest rotation number and showed the highest hemolytic rate and heat generation. The index of hemolysis is well correlated to heat generation (r2 = 0.721). Heat may originate from the motor by conduction, hydraulic energy loss, and mechanical friction between the shaft and seal. We strongly suspect that hemolysis was caused by a factor such as mechanical friction which generates heat locally.

Animals↗
PubMed1994

Novel method to determine instantaneous blood volume in pulsatile blood pump using electrical impedance.

A novel real-time volumetric method was developed for a pulsatile pump. This method, the impedance method, used electrical impedance change in the blood chamber according to volume change while pumping. This method was evaluated with two kinds of air-driven diaphragm pumps. During in vitro tests, the impedance method indicated real-time volume change, and there was excellent correlation between computed stroke volume with the impedance method and measured stroke volume with the electromagnetic flowmeter. In chronic animal tests with goats and in a clinical case, the impedance method measured pump output accurately, and it detected diaphragm motion in real-time. In addition, excellent durability was seen. Full-fill to full-empty drive was realized accurately with this method. Application of the impedance method was easy, and it did not deteriorate native antithrombogencity of the pump. The impedance method is practical and useful to estimate the pumping condition of a pulsatile blood pump, especially a diaphragm pump. This method would be useful in clinical application.

Aged↗
PubMed1994

A flow visualization study of the NCVC centrifugal blood pump.

A compact centrifugal pump, NCVC-1, has an open-type impeller with 6 curved vanes, and it is characterized by no shaft and no seal. A tunnel is placed in the center of the impeller-rotor assembly to irrigate the back space behind the rotor. To evaluate the flow, we performed 3 visualization methods: tracer, oil film, and injection streak line method. The flow, observed by the tracer method in NCVC-1, indicated little turbulence along vanes. A volute chamber proved effective to reduce vortex formation in the outlet. Oil film pattern revealed no flow separation on vanes at 5 L/min. Washout flow behind the rotor is essential to prevent thrombus formation and was shown as inward spiral flow without any stagnation. These data suggested that a combination of visualization techniques was useful to analyze various flow conditions, and the NCVC-1 has excellent flow characteristics with little turbulence and little flow stagnation, which must be beneficial to low hemolysis and high antithrombogenicity.

Heart-Assist Devices↗
PubMed1994

Influences of nonpulsatile pulmonary flow on pulmonary function. Evaluation in a chronic animal model.

To clarify the influences of nonpulsatile blood flow on the physiologic function of the lung, we established nonpulsatile pulmonary circulation with a centrifugal pump in a chronic animal model (adult goats, n = 6). As the initial phase, a pulsatile right ventricular assist device was implanted to bypass the whole blood supply from both the right atrium and right ventricle to the pulmonary artery. After 2 weeks of pumping, the pulsatile pump was replaced with a centrifugal pump without anesthesia, and nonpulsatile pulmonary circulation was instituted. In this experimental model, no significant change was observed in either mean pulmonary arterial pressure or pulmonary vascular resistance index during the pulsatile pumping compared with that on the fourteenth day of nonpulsatile pumping. Blood gas data, extravascular lung water content, and serum level of angiotensin-converting enzyme were maintained within normal ranges. There was also no significant change in the ventral to dorsal blood perfusion ratio of the lower lobe of the right lung. These results indicate that pulmonary functions are not affected by nonpulsatile pulmonary circulation for a period of 14 days in this animal model.

Animals↗
PubMed1993

Clinical experience with ventricular assist systems in Japan.

In Japan, five types of ventricular assist system, including the government-approved National Cardiovascular Center type and the Tokyo University type, were applied to 202 patients as of September 30, 1991. Adult-sized ventricular assist systems were used in 194 patients and a pediatric one in 8. The major primary diagnosis was ischemic heart disease (52.5%). Sixty-three patients in cardiogenic shock with acute myocardial infarction were treated using a ventricular assist system, and the results were fairly good. The predominant indication was failure to be weaned from cardiopulmonary bypass (72.8%), and there was no case of bridging to heart transplantation. Left ventricular assist was performed in most patients (85.1%). The duration of ventricular assist system application ranged from 1 hour to 70 days, and the mean duration was 6.8 +/- 9.6 days. Duration of circulatory support had no relation to the results, and the longest support in survivors was 25 days. The weaning rate was 50.0%, and the survival rate was 26.2%. Main causes of death were heart failure, including unrecoverable heart failure, and multiple organ failure. It should be kept in mind that the decision to use a ventricular assist system should be made quickly, before major organs, including the heart itself, are irreversibly damaged.

Adolescent↗
PubMed1993

A flow visualization study of centrifugal blood pumps developed for long-term usage.

We have developed centrifugal pumps for long-term circulatory assistance, with the final goal of a completely implantable ventricular assist device or total artificial heart. The previous model, NCVC-0, was characterized by a nonseal design and few flow-stagnating parts and acquired high durability and antithrombogenicity. To improve its pumping performance, NCVC-0 was modified. In the new model, NCVC-1, the profile shape of the impeller was changed from flat to conical, the number of vanes from 4 to 6, and the vane entrance angle from 30 degrees to 60 degrees. A flow visualization study performed by means of a combination of the polystyrene tracer method and the light-cutting method indicated decreased flow turbulence between vanes in NCVC-1, which corresponded well with the increased pumping performance. Flow visualization is a useful method to evaluate the design elements that are closely related to the pumping performance of a centrifugal blood pump.

Equipment Design↗
PubMed1992

Treatment of acute profound heart failure by ventricular assist device.

Sixteen patients with acute profound heart failure (HF) have been treated with the left ventricular assist device (LVAD), nine of them were successfully weaned from LVAD, and three of them were discharged and survived longer. Decompression of the left ventricle (LV) at the beginning will prevent overextension of impaired myocardium and accelerate scar formation. Gradual increase of LV work will promote the compensation ability of the residual myocardium. We found that continuous LVAD assistance can give time for the impaired heart to recover while maintaining normal circulation. For patients with profound HF which is beyond the limit of intra-aortic balloon pumping's (IABP) capability, LVAD is a more powerful and effective means. Although the heart recovered, many patients later died of multiple organ failure (MOF) which was probably caused by prolonged ischemia before LVAD application. For completely successful recovery from profound HF, diagnosis and deciding to use LVAD should not be delayed. It should be applied before major organs including the heart itself suffer irreversible damage. We have established a systematic therapeutic concept of treating acute HF patients using assisted circulation including LVAD.

Acute Disease↗
PubMed1992

Long-term circulatory maintenance with a left-sided single artificial heart.

The purpose of this study is to examine the feasibility of long-term circulatory maintenance with only a left-sided single artificial heart that is inserted between the left atrium and the aorta to assist a nonfunctioning heart. The basic hemodynamics were determined in short-term experiments in goats (n = 4), and feasibility studies of long-term circulatory maintenance with a single artificial heart during cardiac arrest were performed in long-term experiments (n = 12). When pulmonary vascular resistance was less than 15,000 dynes .sec.cm-5.kg, which was twice the normal value, the circulation was well maintained with the single artificial heart alone, so long as the right atrial pressure was kept at 14 to 16 mm Hg. Under such conditions the flow yielded by the single artificial heart fluctuated between 80 and 140 ml/kg/min depending on the animal's demand, while the mean arterial pressure was kept above 80 mm Hg. The goats behaved normally, although retention of pleural effusion was a serious problem in maintaining normal circulation over a long-term. Maintaining the plasma total protein level above 6.0 gm/dl delayed the onset of retention or even prevented pooling of pleural effusion. The longest survival period to date has been 38 days. We conclude that when the pulmonary vascular resistance is less than twice the normal value and the total protein level is above 6.0 gm/dl, a left-sided single artificial heart alone can maintain normal circulation and provide time for patients with a nonfunctioning heart to undergo a further treatment, such as heart transplantation.

Animals↗
PubMed1991

Long-term respiratory assistance using a right ventricular assist device system and a membrane oxygenator.

A new method for long-term respiratory assistance using a right ventricular assist device (RVAD) system and a membrane oxygenator (MO) was designed and evaluated. An air-driven RVAD was implanted between the right atrium and the pulmonary artery in five goats and an MO was set on the outlet conduit of the RVAD 2 weeks postoperatively. Two types of MOs [the SciMed (Life Systems) silicone sheet MO and a prototype MO using a novel multilayered composite membrane] were used in this study. Respiratory support with this system under systemic heparinization could be conducted for 4-8 days without major problems accompanied with conventional extracorporeal membrane oxygenation (ECMO) such as surgical bleeding, destruction of the blood components, serum leakage, insufficient bypass flow, and fatal systemic thrombosis. This method opened the possibility for ECMO to be used as a bridge before lung or heart-lung transplantation.

Animals↗
PubMed1991

[Human heart recovery during weaning from a left ventricular assist system: time course and outcome prediction].

To investigate the time course of recovery of a failing heart using the left ventricular assist system (LVAS) and to predict the outcome of weaning from the LVAS, 14 patients with a failing heart were studied. Among them, 5 had recovered and survived for more than 2 weeks after weaning from the LVAS (recovered group), while 9 could not be weaned or died within 2 weeks after weaning (unrecovered group). All patients were gradually weaned from the LVAS with adequate support for systemic circulation for 3 days. In the recovered group, indices of systolic time intervals (STIs) showed improvement within a week. However, improvement of STIs was slow reaching a plateau around the 10th day in the unrecovered group. On weaning from the LVAS, aortic systolic pressure and ejection time were regulated by the patients' own hearts and were nearly the same between the 2 groups. However, left atrial pressure was significantly higher in the unrecovered group than in the recovered group. These hemodynamic features were first present on the 7th day. Therefore, hemodynamic data on the 7th assistant day can be a reliable factor in predicting the possibility of successful weaning from the LVAS and recovery in patients with a failing heart.

Adult↗
PubMed1991

[The artificial heart: present status and future prospects].

Artificial heart (AH) and heart transplantation (HTx) are complementary means of cardiac assistance and replacement. Temporary use AH including ventricular assist systems (VASs) and total artificial hearts (TAHs) have been put into clinical use. VASs applied to 848 patients in the world and 187 in Japan with acute profound heart failure. The short-term survival rates are 23.3% and 27.3%, respectively. HTx has become an accepted therapeutic procedures. To date, 255 patients received VAS and 182 received TAH as a bridge to HTx, because the number of candidates exceeds the supply of donor hearts. Long-term implantable AH is the future alternatives for cardiac replacement. It is recognized that several key components will be necessary for development of an AH with high performance including biomaterial with antithrombogenecity and durability, an implantable actuator, a noninvasive monitoring system and sensors, a miniature auto-control system, and an energy converter. Another types of devices are on the horizon. These are a muscle-powered biomechanical AH, an AH powered by artificial muscle, and an integrated artificial heart-lung device. With remarkable progress in medicine and engineering, we can expect to see totally implantable permanent use cardiac assist and replacement devices as an alternative for HTx in the near future.

Heart, Artificial↗
PubMed1990

A pediatric ventricular assist device: its development and experimental evaluation of hemodynamic effects on postoperative heart failure of congenital heart diseases.

To evaluate the effectiveness of a pediatric ventricular assist device (VAD), hemodynamic effects of the VAD were investigated experimentally in two types of postoperative profound heart failure models of congenital heart disease. In the model I Fontan or modified Fontan operation model, right ventricular pump function was excluded surgically and a shunt between the right atrium and the pulmonary artery was constructed in four dogs. With a VAD between the left atrium and the aorta, pressure gradient across the lung and the cardiac output increased. Right ventricular failure was induced surgically and high pulmonary vascular resistance was made by injection of glass beads in five dogs in model II. Cardiac output increased and the right atrial pressure decreased when a VAD between the right atrium and the pulmonary arterial trunk was activated. In conclusion, the VAD will become a promising modality to manage pediatric profound heart failure cases.

Animals↗
PubMed1990

[Recovery of severely decompensated hearts with a left ventricular assist device].

We evaluated the limits of recovery of decompensated hearts experimentally and clinically and studied the problems of applying a left ventricular assist device (LVAD). In the chronic experiments, 16 adult goats were studied as follows: Group I consisted of seven with left ventricular infarction in a 70-80% area of the free wall induced by the multiple-ligation method; Group II, three with infarcted areas larger than 80% of the free wall; Group III, three with a 30 min anoxic arrest, and Group IV, a 45-min anoxic arrest. An LVAD was applied in all goats, and a right ventricular assist device was applied simultaneously for two goats in Group IV. Clinically, 21 patients receiving treatment with an LVAD from December 1982 to September 1988 in our center were examined. No goat in Groups II and IV could be weaned from the LVAD. Thus, the severity of artificial heart failure in Groups I and III was considered to be the limit for accomplishing restoration. In successfully-weaned cases, both in experimental and clinical settings, periods of LVAD therapy with or without IABP were less than two weeks, which was thought to be the upper time limits for LVAD application. All but one successfully-weaned patients were alive in the experiment, while clinically many patients died of multiple organ failures regardless of the results of the LVAD assistance. Analysis of data suggested that the difference was caused by the durations of the LVAD applications and weanings, the degree of right ventricular failure, the doses of catecholamine used, and the systemic care afforded, especially during tracheal intubation.

Animals↗
PubMed1989

[Development and evaluation of ventricular assist blood pump to salvage patients with profound heart failure].

One of the most important characteristics of a ventricular assist device (VAD) is good antithrombogenicity such that the circulating blood does not clot on the surface even when the bypass flow through the device is reduced at the time of weaning-off. A pneumatic and diaphragm-type VAD with excellent antithrombogenicity was developed for clinical use. The pump is made of Japanese-made segmented polyether polyurethane and the maximum output is 7.0 L/min. If the bypass flow was maintained above 2.0 L/min during early postoperative period, thrombus formation was rarely observed even when the flow rate decreased afterwards in chronic animal experiments using 30 goats. Experimental analyses suggested that a biolization mechanism of the material surface covered by absorbed plasma protein might play a major role in the establishment of antithrombogenicity of the pump. No mechanical failure, thrombosis, calcification, and complication in experimental animals occurred when the VAD manufactured under our good quality control system was driven adequately. These results proved that the VAD could be used reliably for at least 3 months. In conclusion, the VAD is safely applicable to clinical cases and contributes to treatments of profound heart failure patients.

Acute Disease↗
PubMed1989

[Experimental studies of prolonged circulatory maintenance with a left ventricular assistance in cardiac arrested goats].

Recently, various types of left ventricular assist systems (LVAS) have become available to treat the patients in profound heart failures beyond the limit of the effects of IABP. However, the occurrence of an intractable severe bi-ventricular failure, ventricular fibrillation (VF) or cardiac arrest during the time with left ventricular assistance became a more serious problem. Since during the usage of these assist devices, pulmonary venous return will decrease, consequently, LVAS will not be able to maintain sufficient systemic circulation over a extended duration. This study was intended to develop a method of prolonged circulatory maintenance only with a LVAS in cardiac arrested goats until the time when heart transplantation will be performed. In this study, our LVAS was implanted between the left atrium and the aorta in twelve goats in which the hearts were fibrillated. We have followed the principle of circulatory maintenance only with our LVAS in cardiac arrest based on the pressure gradient between the right and left atria and at the same time the pump suction effect through the lungs. The results showed that when pulmonary vascular resistances (PVRs) were kept within normal ranges (less than 15,000 dynes.sec.cm-5), systemic circulations were well maintained only with LVAS as long as RAPs were kept in 14-18 mmHg. Under these conditions, the systemic circulatory flows have fluctuated between 80-140 ml/kg/min depending on the animals demands. The mean arterial pressures were kept above 80 mmHg and the goats have shown quite normal behaviors. However, in goats which showed the presence of pleural effusions and ascites were found to be more difficult to maintain prolonged normal circulation. In our study, the maintenance of total serum protein level above 6.0 g/dl was found to be essential to prevent the development of both pleural effusions and ascites . The authors have achieved the longest survival goat for a duration of 38 days after implantation with our LVAS. We have concluded that when PVRs may be kept in normal ranges, our LVAS can maintain normal systemic circulation even in arrested hearts for a prolonged duration during which time heart transplantation or total artificial heart replacement can be performed.

Animals↗
PubMed1989

Prerequisites to salvage profound biventricular failure patients with ventricular assist devices.

We conducted chronic experiments to determine how to treat profound biventricular failure systematically with ventricular assist devices (VADs) and to analyze the factors that affect prognoses for this condition. Anoxic arrest was induced in ten goats by aortic cross-clamping under normothermic conditions (38.5 degrees C) for 30 (n = 3), 45 (n = 1), and 60 (n = 6) minutes. A left ventricular assist device (LVAD) was implanted in eight animals, and a biventricular assist device (BVAD) was used in two. Three goats--two of which had undergone anoxic arrest for 30 minutes and one for 60 minutes--whose right atrial pressure (RAP) was approximately 18 mm Hg during the acute stage, recovered in two to three weeks, and the pumps were successfully removed. Pathological findings in these animals showed scattered areas of surviving myocardium, with connective tissue replacing the degenerated myocardium. The remaining five LVAD goats required higher RAPs to maintain circulation and died from various causes. Maintaining circulation without volume loading, even in the presence of arrhythmias, was easier with the BVAD. One BVAD animal that underwent 45 minutes of anoxic arrest recovered from right ventricular failure, and the right pump was removed. The second goat (anoxic arrest, 60 min) on the BVAD failed to recover. Autopsy of the myocardium revealed a thin ventricular wall. Our studies show that the use of VADs allows time for a failing heart to recover, but the potential for healing is affected by the severity of myocardial damage prior to VAD application.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗