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Restricted accessEditorialFirst published March, 2014pp. 101-101
Restricted accessReview articleFirst published March, 2014pp. 102-116Renewed interest in the age-old concept of “bloodletting”, a therapeutic approach practiced until as recently as the 19th century, has been stimulated by the knowledge that blood loss, such as following regular donation, is associated with significant reductions in key hemorheological variables, including whole blood viscosity (WBV), plasma viscosity, hematocrit and fibrinogen. An elevated WBV appears to be both a strong predictor of cardiovascular disease and an important factor in the development of atherosclerosis. Elevated WBV through wall shear stress is the most direct physiological parameter that influences the rupture and erosion of vulnerable plaques. In addition to WBV reduction, phlebotomy may reduce an individual’s cardiovascular risk through reductions in excessive iron, oxidative stress and inflammation. Reflecting these findings, blood donation in males has shown significant drops in the incidence of cardiovascular events, as well as in procedures such as percutaneous transluminal coronary angioplasty and coronary artery bypass grafting. Collectively, the available data on the benefits of therapeutic phlebotomy point to the importance of monitoring WBV as part of a cardiovascular risk factor, along with other risk-modifying measures, whenever an increased cardiovascular risk is detected. The development of a scanning capillary tube viscometer allows the measurement of WBV in a clinical setting, which can prove to be valuable in providing an early warning sign of an increased risk of cardiovascular disease.
Restricted accessResearch articleFirst published March, 2014pp. 117-123Cardioplegic solutions often cause high blood concentrations of potassium. The conventional hemoconcentration circuit was improved to correct electrolyte imbalances through a method involving dilutional ultrafiltration (DUF) and an alternative hemodialysis (ALTHD) method. This study aimed to determine the effectiveness of this ALTHD method.
Bovine blood was used, in conjunction with a hemoconcentrator, in an experimental hemodialysis (HD) circuit to evaluate an ALTHD method. The effectiveness of the method was determined by electrolyte and hematocrit measurements following the procedure.
The ALTHD method corrected electrolyte levels as effectively as DUF and was less affected by dilution than DUF.
The ALTHD method may provide faster electrolyte adjustments than DUF because its efficiency depends on both the blood and dialysate flow rates. In addition, the ALTHD method is expected to provide increased efficiency. Thus, our DUF/ALTHD circuit-switching method may be clinically useful when rapid electrolyte correction is required.
Restricted accessResearch articleFirst published March, 2014pp. 124-129The aim of study was to assess the effects of an intraoperative external head-cooling technique on cognitive dysfunction in the early postoperative period (at the 10th day) in patients after coronary artery bypass graft (CABG) surgery. Patients in Group H (n=25) were cooled with CPB and the intraoperative, external head-cooling technique, patients in Group C (n=25) were cooled only with cardiopulmonary bypass (CPB) to achieve mild hypothermia (33 – 34°C). Cognitive function was analyzed before the operation and after the surgery using the Mini Mental State Examination (MMSE), the Modified Visual Reproduction Test from the Wechsler Memory Scale, Trail Making (A/B), WAIS - Digit Span (WDS) and WAIS Digit Symbol Substitution Test (WDSST). The incidence of cognitive impairment at the 10th day after the surgery was 36% (n=9) in Group H and 64% (n=16) in Group C (p=0.048). The temperature during the aortic cross-clamp period was associated with a lower rate of cognitive dysfunction (p=0.05, r2=0.09). The intraoperative, external head-cooling technique during the aortic cross-clamp period has a neuroprotective effect and leads to less short-term cognitive function impairment after CABG surgery.
Restricted accessResearch articleFirst published March, 2014pp. 130-138Sudden cardiac arrest is one of the leading causes of death. Conventional CPR techniques after cardiac arrest provide circulation with reduced and varying blood flow and pressure. We hypothesize that using pressure- and flow-controlled reperfusion of the whole body improves neurological recovery and survival after 15 min of normothermic cardiac arrest.
Pigs were randomized in two experimental groups and exposed to 15 min of ventricular fibrillation (VF). After this period, the animals in the control group received conventional CPR with open chest compression (n=6), while circulation in the treatment group (n=6) was established with an extracorporeal life support system (ECLS) to control blood pressure and flow. Follow-up included the assessment of neurological recovery and magnetic resonance imaging (MRI) for up to 7 days.
Five of the six animals in the control group died, one animal was resuscitated successfully. In the treatment group, 1/6 could not be separated from ECLS. Five out of the six pigs survived and were transferred to the animal facility. One animal was unable to walk and had to be sacrificed 30 hours after ECLS. The remaining 4 animals of the treatment group and the surviving pig from the control group showed complete neurological recovery. Brain MRI revealed no pathological changes.
We were able to demonstrate a significant improvement in survival after 15 minutes of normothermic cardiac arrest. These results support our hypothesis that using an ECLS for pressure- and flow-controlled circulation after circulatory arrest is superior to conventional CPR.
Restricted accessResearch articleFirst published March, 2014pp. 139-141Extracorporeal membrane oxygenation (ECMO) is increasingly used in ARDS patients with hypoxemia and/or severe hypercapnia refractory to conventional treatment strategies. However, it is associated with severe intracranial complications, e.g. ischemic or hemorrhagic stroke. The arterial carbon dioxide partial pressure (PaCO2) is one of the main determinants influencing cerebral blood flow and oxygenation. Since CO2 removal is highly effective during ECMO, reduction of CO2 may lead to alterations in cerebral perfusion. We report on the variations of cerebral oxygenation during the initiation period of ECMO treatment in a patient with hypercapnic ARDS, which may partly explain the findings of ischemic and/or hemorrhagic complications in conjunction with ECMO.
Restricted accessResearch articleFirst published March, 2014pp. 142-152The following article has been included in a multiple retraction:
Abdi M, Karimi A, Navidbakhsh M, et al. Modeling of cerebral aneurysm using equivalent electrical
circuit (Lumped Model).
In 2015 SAGE became aware of author misconduct concerning the suspected fabrication of identities, as well as the impersonation of legitimate individuals, to manipulate the peer review process across three separate journal publications. SAGE and the journal Editors immediately launched an investigation and have decided to retract the following articles for reasons of author misconduct.
Alireza Karimi was the submitting author on 12 of the articles. SAGE regrets the academic record was compromised by manipulation of the peer review process and apologises to readers.
Karimi A, Navidbakhsh M and Razaghi R. Dynamic finite element simulation of the human head damage mechanics protected by polyvinyl alcohol sponge. Int J Damage Mech, first published on 15 May 2014, DOI: 10.1177/1056789514535945.
Karimi A, Navidbakhsh M and Haghpanahi M. Constitutive model for numerical analysis of polyvinyl alcohol sponge under different strain rates. J Thermoplast Compos Mater, first published on 15 January 2014, DOI: 10.1177/0892705713520176.
Karimi A, Navidbakhsh M, Yousefi H et al. An experimental study on the elastic modulus of gelatin hydrogels using different stress–strain definitions. J Thermoplast Compos Mater, first published on 29 April 2014, DOI: 10.1177/0892705714533377.
Elhamian MM, Alizadeh M, Shokrieh MM, et al. An innovative three-dimensional biphasic-laminated composite model for articular cartilage tissue. J Thermoplast Compos Mater, first published on 1 February 2015, DOI: 10.1177/0892705715569821.
Karimi A, Navidbakhsh M, Yamada H, et al. A comparative study on the quasilinear viscoelastic mechanical properties of the umbilical artery and the umbilical vein. Perfusion, first published on 22 May 2014, DOI: 10.1177/0267659114536761.
Tehrani P, Rahmani S, Karimi A, et al. A novel cardiac assist device (AVICENA): a numerical study to compute the generated power. Perfusion, first published on 19 August 2014, DOI: 10.1177/ 0267659114547943.
Elhamian SMM, Alizadeh M, Shokrieh MM, et al. The effect of collagen fiber volume fraction on the mechanical properties of articular cartilage by micromechanics models. Perfusion, first published on 20 August 2014, DOI: 10.1177/0267659114547942.
Razaghi R, Karimi A, Navidbakhsh M, et al. Determination of the vulnerable plaque in a stenotic human coronary artery – finite element modelling. Perfusion, first published on 28 October 2014, DOI: 10.1177/0267659114557720.
Karimi A, Navidbakhsh M, Beigzadeh B, et al. Hyperelastic mechanical behavior of rat brain infected by Plasmodium berghei ANKA – experimental testing and constitutive modelling. Int J Damage Mech 2014;23:857–871, DOI: 10.1177/1056789513514072.
Karimi A, Navidbakhsh M and Faghihi S. A comparative study on plaque vulnerability using constitutive equations. Perfusion, 2014;29:178–183, DOI: 10.1177/0267659113502835.
Abdi M, Karimi A, Navidbakhsh M, et al. Modeling of cerebral aneurysm using equivalent electrical circuit (Lumped Model). Perfusion 2014;29:142–152, DOI: 10.1177/0267659113498617.
Karimi A, Navidbakhsh M and Faghihi S. Fabrication and mechanical characterization of a polyvinyl alcohol sponge for tissue engineering applications. Perfusion 2014;29:231–237, DOI: 10.1177/ 0267659113513823.
Karimi A, Navidbakhsh M, Yousefi H, et al. Experimental and numerical study on the mechanical behavior of rat brain tissue. Perfusion 2014;29:307–314, DOI: 10.1177/0267659114522088.
Restricted accessResearch articleFirst published March, 2014pp. 153-158Sickle cell anemia and thalassemia are hemoglobinopathies rarely encountered in the United States. Compounded with congenital heart disease, patients with sickle cell disease (SCD) requiring cardiopulmonary bypass and open-heart surgery represent the proverbial “needle in the haystack”. As such, there is some trepidation on the part of clinicians when these patients present for complex cardiac surgery.
SCD is an autosomal, recessive condition that results from a single nucleotide polymorphism in the β-globin gene. Hemoglobin SS molecules (HgbSS) with this point mutation can polymerize under the right conditions, stiffening the erythrocyte membrane and distorting the cellular structure to the characteristic sickle shape. This shape change alters cellular transit through the microvasculature. As a result, circumstances such as hypoxia, hypothermia, acidosis or diminished blood flow can lead to aggregation, vascular occlusion and thrombosis. Chronically, SCD can give rise to multiorgan damage secondary to hemolysis and vascular obstruction.
This review and case study details an 11-year-old African-American male with known SCD who presented to the cardiothoracic surgical service with congenital heart disease consisting of an anomalous, intramural right coronary artery arising from the left coronary sinus for surgical consultation and subsequent surgical correction. This case report will include a review of the pathophysiology and current literature regarding preoperative, intraoperative and postoperative management of SCD patients.
Restricted accessResearch articleFirst published March, 2014pp. 159-162To review our experience of extracorporeal membrane oxygenation in airway management during tracheal surgery.
A retrospective, observational study was conducted to evaluate the effectiveness of extracorporeal membrane oxygenation in tracheal surgery in Shanghai Chest Hospital between 2008 and 2012.
In all 91 tracheal surgeries, 7 high-risk cases used extracorporeal membrane oxygenation. The duration of extracorporeal membrane oxygenation support ranged from 10 min to 31 min. All extracorporeal membrane oxygenation patients underwent surgical procedures safely and there was no hospital mortality.
Although various advanced anesthesia techniques can ensure a safe airway in tracheal surgery in most cases, extracorporeal circulation plays an important role in high-risk cases.
Restricted accessResearch articleFirst published March, 2014pp. 163-170Medically refractory hemorrhage in patients on ECMO (extracorporeal membrane oxygenation) support can have catastrophic complications. Recombinant-Activated Factor VII (rFVIIa; NovoSeven®) may provide lifesaving hemostasis; however, there are reports of catastrophic thrombosis related to its administration.
This review attempts to add safety and efficacy data to existing literature regarding the use of rFVIIa for refractory hemorrhage in pediatric patients on ECMO support.
A retrospective chart review was performed for all pediatric patients on ECMO who received rFVIIa for refractory hemorrhage from 2004 to 2009. Data was extracted for each refractory bleeding event, including patient blood loss and transfused blood products in the 6 hours before the first dose, between rFVIIa doses and in the 6 hours after the final dose. For purposes of data collection, a hemorrhagic event was defined as new onset hemorrhage or a hemorrhage occurring at least 12 hours after the most recent dose of rFVIIa.
In total, seven patients aged 1 month to 15 years received rFVIIa for 14 different hemorrhagic events. There was no significant difference in blood loss or blood product transfusion associated with rFVIIa administration. There was one patient-related and one ECMO-related complication temporally associated with rFVIIa administration: decreased ECMO circuit oxygenator efficiency and the development of an intra-gastric clot requiring surgical evacuation.
These data suggest limited efficacy for rFVIIa use for refractory hemorrhage in pediatric patients on ECMO support. There were two non-catastrophic complications temporally associated with its administration.
Restricted accessResearch articleFirst published March, 2014pp. 171-177Positioning therapy may improve lung recruitment and oxygenation and is part of the standard care in severe acute respiratory distress syndrome (ARDS). Venovenous extracorporeal membrane oxygenation (vvECMO) is a rescue strategy that may ensure sufficient gas exchange in ARDS patients failing conventional therapy. The aim of this case series was to describe the feasibility and pitfalls of combining positioning therapy and vvECMO in patients with severe ARDS.
A retrospective cohort of nine patients is described. The patients received 20 (15–86) hours (median, 25th and 75th percentile) of positioning therapy while being treated with vvECMO. The initial PaO2/FiO2 index was 64 (51–67) mmHg and the arterial carbon dioxide tension was 60 (50–71) mmHg. Positioning therapy included 135 degrees prone, prone positioning and continuous lateral rotational therapy. During the first three days, the oxygenation index improved from 47 (41–47) to 12 (11–14) cmH2O/mmHg. The lung compliance improved from 20 (17–28) to 42 (27–43) ml/cmH2O. Complications related to positioning therapy were facial oedema (n=9); complications related to vvECMO were entrance of air (n=1) and pump failure (n=1). However, investigation of root causes revealed no association with the positioning therapy and had no documented effect on the outcome.
The reported cases suggest that positioning therapy can be performed safely in ARDS patients treated with vvECMO, providing appropriate precautions are in place and a very experienced team is present.
Restricted accessResearch articleFirst published March, 2014pp. 178-183The following article has been included in a multiple retraction:
Karimi A, Navidbakhsh M and Faghihi S. A comparative study on plaque vulnerability using
constitutive equations.
In 2015 SAGE became aware of author misconduct concerning the suspected fabrication of identities, as well as the impersonation of legitimate individuals, to manipulate the peer review process across three separate journal publications. SAGE and the journal Editors immediately launched an investigation and have decided to retract the following articles for reasons of author misconduct.
Alireza Karimi was the submitting author on 12 of the articles. SAGE regrets the academic record was compromised by manipulation of the peer review process and apologises to readers.
Karimi A, Navidbakhsh M and Razaghi R. Dynamic finite element simulation of the human head damage mechanics protected by polyvinyl alcohol sponge. Int J Damage Mech, first published on 15 May 2014, DOI: 10.1177/1056789514535945.
Karimi A, Navidbakhsh M and Haghpanahi M. Constitutive model for numerical analysis of polyvinyl alcohol sponge under different strain rates. J Thermoplast Compos Mater, first published on 15 January 2014, DOI: 10.1177/0892705713520176.
Karimi A, Navidbakhsh M, Yousefi H et al. An experimental study on the elastic modulus of gelatin hydrogels using different stress–strain definitions. J Thermoplast Compos Mater, first published on 29 April 2014, DOI: 10.1177/0892705714533377.
Elhamian MM, Alizadeh M, Shokrieh MM, et al. An innovative three-dimensional biphasic-laminated composite model for articular cartilage tissue. J Thermoplast Compos Mater, first published on 1 February 2015, DOI: 10.1177/0892705715569821.
Karimi A, Navidbakhsh M, Yamada H, et al. A comparative study on the quasilinear viscoelastic mechanical properties of the umbilical artery and the umbilical vein. Perfusion, first published on 22 May 2014, DOI: 10.1177/0267659114536761.
Tehrani P, Rahmani S, Karimi A, et al. A novel cardiac assist device (AVICENA): a numerical study to compute the generated power. Perfusion, first published on 19 August 2014, DOI: 10.1177/ 0267659114547943.
Elhamian SMM, Alizadeh M, Shokrieh MM, et al. The effect of collagen fiber volume fraction on the mechanical properties of articular cartilage by micromechanics models. Perfusion, first published on 20 August 2014, DOI: 10.1177/0267659114547942.
Razaghi R, Karimi A, Navidbakhsh M, et al. Determination of the vulnerable plaque in a stenotic human coronary artery – finite element modelling. Perfusion, first published on 28 October 2014, DOI: 10.1177/0267659114557720.
Karimi A, Navidbakhsh M, Beigzadeh B, et al. Hyperelastic mechanical behavior of rat brain infected by Plasmodium berghei ANKA – experimental testing and constitutive modelling. Int J Damage Mech 2014;23:857–871, DOI: 10.1177/1056789513514072.
Karimi A, Navidbakhsh M and Faghihi S. A comparative study on plaque vulnerability using constitutive equations. Perfusion, 2014;29:178–183, DOI: 10.1177/0267659113502835.
Abdi M, Karimi A, Navidbakhsh M, et al. Modeling of cerebral aneurysm using equivalent electrical circuit (Lumped Model). Perfusion 2014;29:142–152, DOI: 10.1177/0267659113498617.
Karimi A, Navidbakhsh M and Faghihi S. Fabrication and mechanical characterization of a polyvinyl alcohol sponge for tissue engineering applications. Perfusion 2014;29:231–237, DOI: 10.1177/ 0267659113513823.
Karimi A, Navidbakhsh M, Yousefi H, et al. Experimental and numerical study on the mechanical behavior of rat brain tissue. Perfusion 2014;29:307–314, DOI: 10.1177/0267659114522088.
Restricted accessCase reportFirst published March, 2014pp. 184-186We present a case of severe haemolysis post mitral valve repair that presented within the first week of operation. Despite assurance of a good repair, with initial postoperative echocardiographic evidence, the patient subsequently developed haemolysis and required forty units of blood over three months. We emphasize that an unexplained anaemia post mitral valve repair should trigger suspicion for mechanical haemolysis and suggest disease progression or failure of repair.