Clinical, paraclinical characteristics and real –world treatment of acute heart failure at Hanoi Heart Hospital

Background: At Hanoi Heart Hospital, in recent years, along with the development of science and technology, the development of modern treatment measures such as percutaneous coronary intervention, coronary artery bypass surgery, heart valve replacement ... helped save the lives of many patients. However, these patients still require continued treatment for heart failure as a complication of the primary illness and thus also increase the number of patients with heart failure, both acute and decompensated. Objective: “Describe the clinical and subclinical characteristics of hospitalized patients with acute heart failure and the status of heart failure treatment according to current heart failure treatment guidelines at Hanoi Heart Hospital”. Method: Cross-sectional, prospective, descriptive analysis with convenient sample size. Results: From January 2018 to december 2018, 475 patients were hospitalized due to acute heart failure or decompensation ,63,8% male and 36, 2% female. Mean age 69,1 ± 13,8; 63,6% newly discovered heart failure; 41,4% EF 40 – 50% and 58,6% EF < 40%; number of Hopital days 8.3 ± 6.2 days(( 1- 46 days); there are five (1.1%) patients died in hospital; among them a patient who was treated for one day due to severe illness died; we have used interventions, assisted circulation and respiration such as CRT, CRT-D, CVVH, IABP, atrial septal defect and ECMO. Conclusion: Results of treatment of acute heart failure at Hanoi Heart Hospital is feasible with rate of discharge is 87,7%.

Flow characteristics and hemolytic performance of the new Breethe centrifugal blood pump in comparison with the CentriMag and Rotaflow pumps

Blood pumps have been increasingly used in mechanically assisted circulation for ventricular assistance and extracorporeal membrane oxygenation support or during cardiopulmonary bypass for cardiac surgery. However, there have always been common complications such as thrombosis, hemolysis, bleeding, and infection associated with current blood pumps in patients. The development of more biocompatible blood pumps still prevails during the past decades. As one of those newly developed pumps, the Breethe pump is a novel extracorporeal centrifugal blood pump with a hybrid magnetic and mechanical bearing with attempt to reduce device-induced blood trauma. To characterize the hydrodynamic and hemolytic performances of this novel pump and demonstrate its superior biocompatibility, we use a combined computational and experimental approach to compare the Breethe pump with the CentriMag and Rotaflow pumps in terms of flow features and hemolysis under an operating condition relevant to ECMO support (flow: 5 L/min, pressure head: ~350 mmHg). The computational results showed that the Breethe pump has a smaller area-averaged wall shear stress (WSS), a smaller volume with a scalar shear stress (SSS) level greater than 100 Pa and a lower device-generated hemolysis index compared to the CentriMag and Rotaflow pumps. The comparison of the calculated residence times among the three pumps indicated that the Breethe pump might have better washout. The experimental data from the in vitro hemolysis testing demonstrated that the Breethe pump has the lowest normalized hemolysis index (NIH) than the CentriMag and Rotaflow pumps. It can be concluded based on both the computational and experimental data that the Breethe pump is a viable pump for clinical use and it has better biocompatibility compared to the clinically accepted pumps.

A facile freeze-thaw ultrasonic assisted circulation method of graphite flakes prepared by anode graphite from spent lithium-ion batteries for application in nanofluids

Graphite has been widely used as the anode material in lithium-ion batteries (LIBs) due to its good conductivity, layered crystal structure, high charging-discharge potential, and other characteristics. With the rapid...

Device-Induced Hemostatic Disorders in Mechanically Assisted Circulation

Mechanically assisted circulation (MAC) sustains the blood circulation in the body of a patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) or on ventricular assistance with a ventricular assist device (VAD) or on extracorporeal membrane oxygenation (ECMO) with a pump-oxygenator system. While MAC provides short-term (days to weeks) support and long-term (months to years) for the heart and/or lungs, the blood is inevitably exposed to non-physiological shear stress (NPSS) due to mechanical pumping action and in contact with artificial surfaces. NPSS is well known to cause blood damage and functional alterations of blood cells. In this review, we discussed shear-induced platelet adhesion, platelet aggregation, platelet receptor shedding, and platelet apoptosis, shear-induced acquired von Willebrand syndrome (AVWS), shear-induced hemolysis and microparticle formation during MAC. These alterations are associated with perioperative bleeding and thrombotic events, morbidity and mortality, and quality of life in MCS patients. Understanding the mechanism of shear-induce hemostatic disorders will help us develop low-shear-stress devices and select more effective treatments for better clinical outcomes.

Delayed Sternal Closure after Congenital Heart Surgery in Infants: Postoperative Course

Delayed sternal closure in infants and children of the first months of life after the correction of complex congenital heart defects (CHD) can increase cardiac output. This is a forced measure due to the development of unstable hemodynamics, capillary leak syndrome and myocardial edema, as the sternotomy wound closure in the early postoperative period provides a compression effect on the function of the myocardium. The aim. To evaluate mortality and to detect predictors of adverse outcome as well as the incidence of non-cardiac complications in delayed sternal closure after surgical repair of CHD. Materials and methods. Twenty two children were studied. Six children died. Anesthetic management was provided using propofol (4–6 mg/kg/h) and fentanyl (5–10 μg/kg/h) infusions. Modified ultrafiltration was applied at the end of assisted circulation in all the cases. Sternal closure was performed on average on day 3 ± 2 after surgery. Results. Mortality odds ratio (OR) in patients with the mean arterial pressure (MAP) < 35 mmHg was 3.7; mortality OR in patients with SVO2 < 40 % was 0.94; mortality OR in patients with blood lactate > 10 mmol/L in the first three days of postoperative intensive care was 2.1. Conclusions. Delayed sternal closure is an acceptable method of maintaining cardiac output in young infants with CHD in postoperative period. High blood lactate (> 10 mmol/L) and especially its further growth, as well as MAP < 35 mmHg, can predict adverse outcomes of cardiac surgery with open sternotomy.