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Bioartificial organs
Published in Ronald L. Fournier, Basic Transport Phenomena in Biomedical Engineering, 2017
There are principally two types of liver failure: cirrhosis and fulminant hepatic failure. Cirrhosis of the liver accounts for over half of the deaths due to liver disease. In cirrhosis, fibrotic tissue forms in place of the damaged liver tissue severely compromising the liver’s ability to regenerate. Common causes of cirrhosis include alcoholism and chronic hepatitis. Fulminant hepatic failure is a rapidly progressing failure of the liver that can lead to death within several weeks of onset. It can be caused by chemical and viral hepatitis.
Biomedical Application of Membranes in Bioartificial Organs and Tissue Engineering
Published in Severian Dumitriu, Valentin Popa, Polymeric Biomaterials, 2020
Thomas Groth, Xiao-Jun Huang, Zhi-Kang Xu
Fulminant hepatic failure after intoxication or viral infections is distinguished by defective blood protein synthesis, gluconeogenesis, urogenesis, by impaired plasma detoxification, neurological complications (often associated with cerebral edema), and finally multiorgan failure (Atillasoy and Berk 1995). Contemporary therapies are based on hemodialysis, hemofiltration, and apheresis that have unfortunately a very poor outcome with low survival rates around 20% (Atillasoy and Berk 1995). Therefore, orthotopic liver transplantation is still the gold standard in medical therapy with survival rates higher than 90% after 1 year (Cacciarelli et al. 1997). However, access to donor organs is limited due to not only lack of immediate availability of organs but also immunological mismatch between donor and recipient. Therefore, development of BAL devices has been promoted to bridge the time to transplantation or to allow regeneration of the damaged liver tissue (Tzanakakis et al. 2000). BAL devices are primarily based on hepatocytes cultured in a bioreactor module. Different setups of BAL devices have been developed, which have been reviewed in more detail by others (Legallais et al. 2001; Park et al. 2005; Tzanakakis et al. 2000). Particularly, membrane-based systems may offer certain advantages because they (1) separate donor hepatocytes from the immune system of the recipient, (2) provide a substratum for cell attachment, and (3) have a large surface to volume ratio to make up a compact bioreactor design (Legallais et al. 2001). However, there are certain critical issues of membrane properties that must be considered. In particular, the ability of membranes to allow adequate adhesion for hepatocytes and the ability for bidirectional mass transfer have not been considered in the past to necessary extent. Transport properties of membranes are important not only for transfer of oxygen and nutrients but also for transfer of albumin-bound toxins, which normally reach hepatocytes through the fenestrated endothelium in the liver (Tzanakakis et al. 2000).
Pediatric ventricular assist devices: what are the key considerations and requirements?
Published in Expert Review of Medical Devices, 2020
Roland Hetzer, Mariano Francisco del Maria Javier, Eva Maria Javier Delmo
Between May 1986 and September 2014, 201 children with end-stage heart failure [mean age 9.4 (10.3 ± 7.6) years; IQR: 3.7–15.11 years] underwent heart transplantation [29]. Among these, VADs (LVAD = 21; BVAD = 57) were implanted in 78 children [38.8%; mean age 7.2 (7.8 ± 6.0) years; IQR: 2.6–11.8 years] as bridge to heart transplantation. Fourteen (17.9%) patients were less than 1-year old (median 0.33 days; range, 0.002–0.83 days); 15 (19.2%) children had a cardiac arrest and underwent cardiopulmonary resuscitation, with 7 of these patients also requiring ECMO support (median duration of support 5 days; range, 2–31 days), prior to implantation of a VAD. The etiology of heart failure included cardiomyopathy (dilative, restrictive from endocardial fibrosis, idiopathic, or toxin-induced) seen in 56 (71.8%), fulminant myocarditis in 14 (17.9%), end-stage CHD in 5 (6.4%), post-cardiotomy ischemic heart failure in 2 (2.6%), and tumor (LV fibroma) in 1 (1.2%). Two patients had an extremely high pulmonary vascular resistance. One patient had a previous heart transplantation 10 years before and two had anthracycline-induced cardiomyopathy. Mean duration of VAD support was 131 days (range, 1–945 days as of this report) before a donor heart became available. All 78 children supported with VAD pre-transplant eventually underwent orthotopic heart transplantation, after a mean duration of VAD support of 59 (133.37 ± 191.57) days (IQR: 23–133 days). Mean duration of follow-up is 9.4 (10.3 ± 7.6) years (IQR: 3.74–15.14 years; range, 3–29.9 years) [29].
Device profile of the Impella 5.0 and 5.5 system for mechanical circulatory support for patients with cardiogenic shock: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2022
Mohit Pahuja, Jaime Hernandez-Montfort, Evan H. Whitehead, Masashi Kawabori, Navin K. Kapur
Acute percutaneous mechanical circulatory support devices [pMCS] are increasingly utilized in cardiovascular critical care practice. These devices play an integral role in the management of cardiogenic shock [CS] due to acute decompensated heart failure [ADHF], acute myocardial infarction [AMI], fulminant myocarditis or after cardiac surgery and can be used to provide hemodynamic support during high-risk percutaneous coronary intervention or in patients with cardiac dysfunction despite reperfusion AMI. The main goals of acute MCS devices are to [1]: decrease cardiac filling pressures [2], reduce myocardial oxygen consumption and cardiac workload [3]; improve end-organ and coronary perfusion, and [4] to limit infarct size in the setting of AMI.
Applying Concept Drift to Understand Hepatitis Evolution in Brazil
Published in Cybernetics and Systems, 2020
Ricardo A. Rios, Tatiane N. Rios, Rosemary Melo, Euler Santos de Santana, Técia Maria Santos Carneiro, Argemiro D.’ Oliveira Junior
There exists 5 types of hepatitis virus – A, B, C, D, and E – that present different transmission routes, need for other virus to reproduce, and form to evolve to its chronic, acute, or fulminant infection. Hepatitis A and E are transmitted by the fecal-oral route, whereas the types B, C, and D are transmitted when a person is exposed to infected blood and body fluids. Hepatitis B is mostly transmitted by sexual contact, in contrast to hepatitis C, in which this route is most common in HIV carrier. It is important to highlight hepatitis D presents the same characteristics of hepatitis B, once this virus needs the hepatitis B antigen to evolve (Gorgos 2013).