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Biomedical subjects

Bartley P Griffith

Publications and source records attributed to Bartley P Griffith.

At least 19 recordsLinked to original sources

Heart preservation using continuous ex vivo perfusion improves viability and functional recovery.

BACKGROUND: Cold static storage (CS) is a proven preservation method for heart transplantion, yet early postoperative graft dysfunction remains prevalent, so continuous perfusion (CP) during ex vivo transport may improve viability and function of heart grafts. METHODS AND RESULTS: Canine hearts underwent CP (n=9) or CS (n=9) for 6 h while intramyocardial pH was continuously monitored. Biopsies were assayed for ATP, caspase-3, malondialdehyde (MDA), and endothelin-1 (ET-1) levels at baseline, after preservation (t1), and after 1 h of blood reperfusion on a Langendorff model (t2). Functional recovery was determined at t2 by +dP/dt, -dP/dt, developed pressure, peak pressure and end-diastolic pressure. CP resulted in higher tissue pH and ATP stores and reduced caspase-3, MDA and ET-1 levels compared with CS at both t1 and t2. Post reperfusion recovery was significantly greater in CP vs CS for all myocardial functional parameters except end-diastolic pressure. Weight gain was significantly increased in CP vs CS at t1, but not at t2. CONCLUSIONS: Low-grade tissue acidosis and energy depletion occur during CS and are associated with oxidative injury and apoptosis during reperfusion. CP attenuates these biochemical and pathologic manifestations of tissue injury, together with improved myocardial recovery, despite mild, transient edema.

Adenosine Triphosphate↗

Strain-related regional alterations of calcium-handling proteins in myocardial remodeling.

BACKGROUND: Cardiac remodeling has been shown to have deleterious effects at both the global and local levels. The objective of this study is to investigate the role of strain in the initiation of structural and functional changes of myocardial tissue and its relation to alteration of calcium-handling proteins during cardiac remodeling after myocardial infarction. METHODS: Sixteen sonomicrometry transducers were placed in the left ventricular free wall of 9 sheep to measure the regional strain in the infarct, adjacent, and remote myocardial regions. Hemodynamic, echocardiographic, and sonomicrometry data were collected before myocardial infarction, after infarction, and 2, 6, and 8 weeks after infarction. Regional myocardial tissues were collected for calcium-handling proteins at the end study. RESULTS: At time of termination, end-systolic strains in 3 regionally distinct zones (remote, adjacent, and infarct) of myocardium were measured to be -14.65 +/- 1.13, -5.11 +/- 0.60 (P < or = .05), and 0.92 +/- 0.56 (P < or = .05), respectively. The regional end-systolic strain correlated strongly with the abundance of 2 major calcium-handling proteins: sarcoplasmic reticulum Ca2+ adenosine triphosphatase subtype 2a (r2 = 0.68, P < or = .05) and phospholamban (r2 = 0.50, P < or = .05). A lesser degree of correlation was observed between the systolic strain and the abundance of sodium/calcium exchanger type 1 protein (r2 = 0.17, P < or = .05). CONCLUSIONS: Regional strain differences can be defined in the different myocardial regions during postinfarction cardiac remodeling. These differences in regional strain drive regionally distinct alterations in calcium-handling protein expression.

Animals↗

Aortic valve bypass for aortic stenosis: imaging appearances on multidetector CT.

OBJECT: Aortic valve bypass is a technique used in high-risk patients with critical aortic stenosis that consists of placement of a conduit from the left ventricular apex to descending aorta. We describe the imaging appearances of this apicoaortic conduit on multidetector CT (MDCT). METHODS: Each patient underwent retrospective ECG-gated MDCT using a 16-detector-row scanner several days after placement of an apicoaortic conduit. All images were assessed by two radiologists who reviewed the appearance of the apicoaortic conduit and any post-operative complications. Follow-up studies were available for several patients. RESULTS: Twelve patients (9 men, 3 women, mean age - 78 years) underwent evaluation and the conduit was visible in each. The valve within the conduit was visible in ten (91%) of the 11 patients who received intravenous contrast material. Common findings were periconduit outpouching and hypoperfusion involving the left ventricle. Complications included pericardial hemorrhage, hemothorax and ventricular pseudoaneurysm. Mild to moderate increase in wall thinning was identified in the three patients who underwent follow-up imaging. CONCLUSION: Aortic valve bypass with an apicoaortic conduit appears to be a feasible alternative to aortic valve replacement in high-risk patients. MDCT is an excellent method to assess the imaging features of such conduits.

Aged↗

A randomized trial of inhaled cyclosporine in lung-transplant recipients.

BACKGROUND: Conventional regimens of immunosuppressive drugs often do not prevent chronic rejection after lung transplantation. Topical delivery of cyclosporine in addition to conventional systemic immunosuppression might help prevent acute and chronic rejection events. METHODS: We conducted a single-center, randomized, double-blind, placebo-controlled trial of inhaled cyclosporine initiated within six weeks after transplantation and given in addition to systemic immunosuppression. A total of 58 patients were randomly assigned to inhale either 300 mg of aerosol cyclosporine (28 patients) or aerosol placebo (30 patients) three days a week for the first two years after transplantation. The primary end point was the rate of histologic acute rejection. RESULTS: The rates of acute rejection of grade 2 or higher were similar in the cyclosporine and placebo groups: 0.44 episode (95 percent confidence interval, 0.31 to 0.62) vs. 0.46 episode (95 percent confidence interval, 0.33 to 0.64) per patient per year, respectively (P=0.87 by Poisson regression). Survival was improved with aerosolized cyclosporine, with 3 deaths among patients receiving cyclosporine and 14 deaths among patients receiving placebo (relative risk of death, 0.20; 95 percent confidence interval, 0.06 to 0.70; P=0.01). Chronic rejection-free survival also improved with cyclosporine, as determined by spirometric analysis (10 events in the cyclosporine group and 20 events in the placebo group; relative risk of chronic rejection, 0.38; 95 percent confidence interval, 0.18 to 0.82; P=0.01) and histologic analysis (6 vs. 19 events, respectively; relative risk, 0.27; 95 percent confidence interval, 0.11 to 0.67; P=0.005). The risks of nephrotoxic effects and opportunistic infection were similar for patients in the cyclosporine group and the placebo group. CONCLUSIONS: Inhaled cyclosporine did not improve the rate of acute rejection, but it did improve survival and extend periods of chronic rejection-free survival. (ClinicalTrials.gov number, NCT00268515.).

Acute Disease↗

Aprotinin shows both hemostatic and antithrombotic effects during off-pump coronary artery bypass grafting.

BACKGROUND: Hemostatic drugs are widely thought to be unnecessary and potentially detrimental in off-pump coronary artery bypass graft surgery (OPCABG), despite well-established use in on-pump surgery. In a randomized, prospective OPCABG trial, we assessed efficacy and safety of aprotinin through a comprehensive assessment of graft patency and hematologic function. METHODS: Sixty patients were randomly assigned to full-dose aprotinin or placebo. Heparin was titrated to a kaolin-based activated clotting time of greater than 300 seconds. Exclusionary criteria included creatinine greater than 2 mg/dL, conversion to on-pump CABG, and preoperative GPIIb/IIIa inhibition. Hematologic assessments were obtained preoperatively, at the end of surgery, and on days 1 and 3: mean platelet volume, thrombin generation (prothrombin fragment 1.2 assay), and aspirin resistance using a modified thrombelastography, whole blood aggregometry, 11-dehydro-thromboxane B2 levels, and flow cytometry. Thrombotic events were defined as postoperative myocardial infarction by electrocardiography or elevated troponin I, clinical stroke by examination and head computed tomography, and bypass graft failure by multichannel computed tomography angiography on day 5. RESULTS: Aprotinin was associated with a significant reduction in intraoperative and postoperative blood loss compared with placebo but had no effect on transfusion rates. Patients treated with aprotinin had significantly fewer thrombotic events (3% versus 23%, p < 0.05, Fisher's exact test) and less postoperative aspirin resistance (20% versus 46%, respectively, p < 0.05, Fisher's exact test). Postoperative prothrombin fragment 1.2 level was reduced by aprotinin use. CONCLUSIONS: Aprotinin reduced perioperative bleeding after OPCABG. Preserved aspirin sensitivity in the aprotinin group may explain the observed reduction in thrombotic events and might be related to the suppression of perioperative and transmyocardial thrombin formation.

Aprotinin↗

Off-pump versus on-pump coronary artery bypass grafting in consecutive patients: decision-making algorithm and outcomes.

BACKGROUND: Debate continues between on-pump or off-pump approach for coronary artery bypass grafting (CABG). We used off-pump coronary artery bypass grafting (OPCAB) as a tool within a decision-making algorithm driven by the patient-related factors of coronary anatomy and comorbidity. Our analysis presents this decision algorithm and describes outcomes using this approach. METHODS: From January 2000 to December 2003, 592 consecutive patients undergoing isolated CABG were assigned by one surgeon to a technique: on-pump CABG or OPCAB according to (1) anatomy and (2) predicted risk. Anatomic factors against OPCAB were target vessel size less than 1.25 mm, calcification, poor quality, intramyocardial location, and multiple stenoses. Given that OPCAB could be performed safely, patients in the moderate risk range, ie, those elderly with multiple comorbidities, were preferentially treated using OPCAB. RESULTS: The OPCAB group had higher predicted 30-day mortality compared with the on-pump CABG group, consistent with the protocol's intent. However, morbidity and mortality were similar between on-pump CABG and OPCAB. The OPCAB patients received the same number of internal mammary artery grafts but fewer distal grafts. Mortality and observed to expected ratios were favorable for both groups and below those The Society of Thoracic Surgeons' predicted for OPCAB. CONCLUSIONS: Matching surgical strategy to patient-related factors and needs resulted in excellent outcomes. Our data support the use of a protocol based on patient characteristics to drive the surgeon's choice between an on-pump CABG or OPCAB approach. As such, OPCAB can be viewed as a tool to be used by the surgeon developing a best practice in treating coronary artery disease.

Aged↗

Aortic valve bypass for the high-risk patient with aortic stenosis.

BACKGROUND: Interest in percutaneous therapy of heart valve disease has focused attention on the high-risk patient with aortic stenosis. Aortic valve bypass (apicoaortic conduit) surgery is the construction of a vascular graft containing a bioprosthetic valve from the apex of the left ventricle to the descending thoracic aorta. We have undertaken a programmatic effort to perform aortic valve bypass surgery as an alternative to conventional aortic valve replacement in selected high-risk patients, and now report our recent experience. METHODS: Between April 2003 and May 2005, 14 patients with aortic stenosis underwent aortic valve bypass surgery at two institutions. All patients selected for aortic valve bypass surgery were deemed to be at very high risk for conventional aortic valve replacement. These patients represented 14 (5.8%) of all 243 patients undergoing isolated aortic valve surgery during the same time period. Mean Society of Thoracic Surgeons predicted risk for operative mortality (11%) was between the 90th and 95th percentile. RESULTS: Twelve of 14 patients had previous cardiac surgery with patent bypass grafts. Average age was 78 years. Mean aortic valve area was 0.68 cm2. All operations were performed through a left thoracotomy on the beating heart (cross-clamp time, 0 minutes). Cardiopulmonary bypass was used for 6 patients (median cardiopulmonary bypass time, 15 minutes). There were 2 perioperative deaths. Median postoperative length of stay was 9 days. Two noncardiac late deaths occurred. Nine of 10 surviving patients are functional class I and are living independently. Early postoperative echocardiography confirms excellent aortic valve bypass function with preservation of ventricular ejection performance. CONCLUSIONS: Treatment of high-risk aortic stenosis patients with aortic valve bypass surgery is promising. Avoidance of sternotomy and cardiopulmonary bypass supports broader application to moderate-risk patients with aortic stenosis and as a control arm for studies of novel interventional therapies.

Aged↗

Computational and experimental evaluation of the fluid dynamics and hemocompatibility of the CentriMag blood pump.

The CentriMag centrifugal blood pump is a newly developed ventricular assist device based on magnetically levitated bearingless rotor technology. A combined computational and experimental study was conducted to characterize the hemodynamic and hemocompatibility performances of this novel blood pump. Both the three-dimensional flow features of the CentriMag blood pump and its hemolytic characteristics were analyzed using computational fluid dynamics (CFD)-based modeling. The hydraulic pump performance and hemolysis level were quantified experimentally. The CFD simulation demonstrated a clean and streamlined flow field in the main components of the CentriMag blood pump. The predicted results by hemolysis model indicated no significant high shear stress regions in the pump. A comparison of CFD predictions and experimental results showed good agreements. The relatively large gap passages (1.5 mm) between the outer rotor walls and the lower housing cavity walls provide a very good surface washing through a secondary flow path while the shear stresses in the secondary flow paths are reduced, resulting in a low rate of hemolysis ([Normalized Index of Hemolysis] NIH = 0.0029 +/- 0.006) without a decrease of the pump's hydrodynamic performance (pressure head: 352 mm Hg at a flow rate of 5.0 L/min and a rotational speed of 4,000 rpm).

Biomedical Engineering↗

An unusual cause of pulmonary vein stenosis: a case report and review of the literature.

We describe the case of a patient with the Carney syndrome and several resections for recurrent left atrial myxomas who underwent autotransplantation of the heart with resection of the left and right atria and reconstruction of both atria with bovine pericardium. She subsequently presented with severe shortness of breath, ascites, and peripheral edema. She was found to have stenosis of all four pulmonary veins and severe pulmonary hypertension. We describe the echocardiographic findings and review the literature on assessment of acquired pulmonary vein stenosis.

Cardiac Surgical Procedures↗

Endothelial injury and acquired aspirin resistance as promoters of regional thrombin formation and early vein graft failure after coronary artery bypass grafting.

OBJECTIVE: The predominant mechanism of early graft failure after coronary artery bypass grafting remains in doubt. Aspirin administered in the initial hours after coronary artery bypass grafting improves graft patency, implicating prostanoid synthesis in the pathogenesis. We hypothesized that synergy between endothelial disruption in the venous conduit and aspirin resistance would cause vein graft failure. METHODS: Aspirin resistance, defined by diagnostic findings on at least two of three separate assays, was serially assessed in 225 patients undergoing off-pump coronary artery bypass grafting. Endothelial cell integrity was determined in surplus segments obtained from 408 vein grafts. The deposition of intraluminal thrombin within the vein was determined by comparing serum F1.2 levels between the coronary sinus and the aorta after grafting. Intraoperative blood flow in the grafts was measured with transit-time technology, and patency was assessed with electrocardiographically gated multichannel computed tomographic coronary angiography on day 5. Aspirin was the sole antithrombotic agent used during the study. RESULTS: Thrombosed grafts (16/408) showed more endothelial cell loss at the time of grafting than did those grafts that remained patent (10.8% +/- 21.5% vs 51.4% +/- 39.1% integrity, P < .01). Aspirin resistance occurred in 67 patients (30%). Graft thrombosis was associated with aspirin resistance (P < .04) and reduced endothelial integrity (P < .01). These factors coexisted in 14 of 16 grafts that failed and were associated with elevated coronary sinus F1.2 levels. CONCLUSION: Aspirin resistance and relatively compromised venous endothelial cell integrity together marked patients whose vein grafts failed within days after off-pump coronary artery bypass grafting. These observations form a basis for identifying patients at risk and developing approaches to prevent vein injury or to selectively intervene in high-risk circumstances.

Aged↗

Safety and feasibility of autologous myoblast transplantation in patients with ischemic cardiomyopathy: four-year follow-up.

BACKGROUND: Successful autologous skeletal myoblast transplantation into infarcted myocardium in a variety of animal models has demonstrated improvement in cardiac function. We evaluated the safety and feasibility of transplanting autologous myoblasts into infarcted myocardium of patients undergoing concurrent coronary artery bypass grafting (CABG) or left ventricular assist device (LVAD) implantation. In addition, we sought to gain preliminary information on graft survival and any associated changes in cardiac function. METHODS AND RESULTS: Thirty patients with a history of ischemic cardiomyopathy participated in a phase I, nonrandomized, multicenter pilot study of autologous skeletal myoblast transplantation concurrent with CABG or LVAD implantation. Twenty-four patients with a history of previous myocardial infarction and a left ventricular ejection fraction <40% were enrolled in the CABG arm. In a second arm, 6 patients underwent LVAD implantation as a bridge to heart transplantation, and patients donated their explanted native hearts for testing at the time of heart transplantation. Myoblasts were successfully transplanted in all patients without any acute injection-related complications or significant long-term, unexpected adverse events. Follow-up positron emission tomography scans showed new areas of glucose uptake within the infarct scar in CABG patients. Echocardiography measured an average change in left ventricular ejection fraction from 28% to 35% at 1 year and of 36% at 2 years. Histological evaluation in 4 of 6 patients who underwent heart transplantation documented survival and engraftment of the skeletal myoblasts within the infarcted myocardium. CONCLUSIONS: These results demonstrate the survival, feasibility, and safety of autologous myoblast transplantation and suggest that this modality offers a potential therapeutic treatment for end-stage heart disease.

Adult↗

CT of Uhl's anomaly in an adult.

Uhl's anomaly is an extremely rare condition of unknown cause characterized by complete or partial absence of the right ventricular myocardial layer, which is replaced by nonfunctional fibroelastic tissue. The disease causes progressive right-sided heart failure, increased right-sided cardiac pressure, massive peripheral edema, and ascites. Patients usually present in infancy and rarely survive to adulthood. The disease appears to be congenital in origin. Diagnosis was previously made at autopsy, but advances in imaging now permit diagnosis by echocardiography or cross-sectional imaging (computed tomography or magnetic resonance). We present a case of a 51-year-old patient with Uhl's anomaly who underwent placement of a ventricular assist device as a bridge to cardiac transplantation, and discuss CT findings.

Fatal Outcome↗

A novel approach to tricuspid valve replacement: the upside down stentless aortic bioprosthesis.

BACKGROUND: Tricuspid valve replacement (TVR) is a rarely needed operation. Choices between mechanical and biological prosthesis still generate controversy. We present our initial clinical experience with a stentless aortic root placed inverted in the tricuspid annulus. METHODS: Between August 2000 and September 2003, TVR for severe tricuspid insufficiency was performed in 8 patients. Indications were infective endocarditis (7) and iatrogenic damage (1). Mean age was 42.2 years old (20 to 58 years old). Five patients were male and 3 patients had a concomitant procedure (mitral valvuloplasty, coronary bypass grafting, and aortic valve replacement). A stentless aortic root, size 27 mm (n = 5) or 29 mm (n = 3) was placed inverted in the tricuspid position after the valsalva sinuses were scalloped. Interrupted 4-0 polypropylene sutures were used between the tricuspid valve annulus and the sewing ring. The struts equivalent on the stentless valve were anchored to the septal, anterior and posteroinferior wall of the right ventricle using 5-0 PTFE pledgeted sutures. RESULTS: Hospital survival was 100% and mean hospital stay was 12.5 days (3 to 18 days). Intraoperative and follow-up echocardiograms revealed no stenosis or insufficiency. Mean follow-up was 17.2 months (1-38 months). There were 3 late deaths due to continued IV drug use (n = 2) and end-stage renal failure (n = 1). CONCLUSIONS: This is a novel surgical alternative for a very high risk population. Potential advantages over current options include minimization of blood contact with nonbiological surfaces, preservation of annular motion, freedom from anticoagulation, and a theoretical lower rate of calcification.

Adult↗

A multi-institutional experience with the CryoMaze procedure.

BACKGROUND: The Cox Maze III operation remains the gold standard for the surgical treatment of atrial fibrillation (AF). We report our experience using a flexible argon-powered metal cryoprobe for creation of the complete Cox-Maze III lesion set in patients with AF (the CryoMaze operation). METHODS: Beginning July 2002, 38 patients underwent the CryoMaze operation. Two patients had isolated CryoMaze procedures, whereas 36 patients had the CryoMaze performed in combination with coronary, valvular, or aortic surgery. All patients had electrocardiographic follow-up. Atrial fibrillation was continuous in 79%. Mean duration of AF before operation was 48 months. RESULTS: There were no complications related to the use of cryoenergy. There was 1 hospital death (2.6%) and no late deaths. At a mean follow-up of 12 months, 35 of 37 patients (95%) were in normal sinus rhythm. One patient required pacemaker implantation 3 months after surgery, and 1 patient refused follow-up. There have been no early or late thromboembolic events. CONCLUSIONS: The CryoMaze operation reliably cures atrial fibrillation at medium term follow-up, with rates identical to those reported for the classic Cox-Maze III operation.

Adult↗

Surgical treatment of mitral valve endocarditis in North America.

BACKGROUND: Several single-institution series have suggested the feasibility and effectiveness of mitral valve repair for infective endocarditis (IE). METHODS: We examined 6627 patients with IE undergoing mitral valve surgery at 661 Society of Thoracic Surgeons-participating centers in 1994 to 2003. RESULTS: The diagnosis of IE was assigned to 5.8% (6,627 of 114,934) of patients having mitral valve surgery. The overall frequency of mitral valve repair for IE was 29.7% (1,965 of 6,627). Mitral valve repair was less frequently used for patients with active IE (423 of 2,654; 15.9%) than those with treated IE (1,459 of 3,570; 40.9%). Operative mortality was 3.7% (72 of 1,965) for mitral valve repair and 10.8% (502 of 4,662) for mitral valve replacement. Mortality rates were lower for patients with treated IE compared with active IE. After adjusting for multiple preoperative risk factors, mitral valve repair (odds ratio, 0.67; 95% confidence interval, 0.51 to 0.88) was associated with a significantly lower risk of death. Active (versus treated) IE (odds ratio, 2.12; 95% confidence interval, 1.68 to 2.68) and recent cerebrovascular accident (odds ratio, 1.71; 95% confidence interval, 1.28 to 2.31) were independent predictors of mortality. CONCLUSIONS: Mitral valve repair is less commonly applied for IE compared with other indications for mitral valve surgery. Patients with active IE were less likely to receive repair than those with treated IE. Mitral valve repair was associated with a lower risk of mortality. These results provide support for performing mitral valve repair when technically feasible in the setting of IE.

Aged↗

Platelet function tests predict bleeding and thrombotic events after off-pump coronary bypass grafting.

OBJECTIVE: A balanced coagulation system after cardiac surgery minimizes bleeding and thrombotic events. However, the best method to monitor this balance has not been established. We used a series of tests of coagulation and platelet function to define the risk of bleeding and thrombotic events after OPCAB. METHODS: In 76 patients, routine coagulation tests (i.e. prothrombin time, fibrinogen level, d-dimer, and platelet count), thrombelastography, and whole blood aggregometry were obtained perioperatively and on days 1 and 3 after OPCAB. Intra- and postoperative blood loss was determined. Early patency of venous bypass grafts was determined using CT angiography (Philips Medical, Corp.). RESULTS: Chest tube output and red cell volume loss at 24 h were 952+/-475 and 190+/-115 ml, respectively. Early graft failure developed in eight patients. Perioperative changes in routine coagulation tests showed no correlation with either bleeding or thrombosis. However, perioperative decline in platelet function as assessed by the area under the impedance curve for whole blood aggregometry correlated with intraoperative blood loss (R=0.42, P<0.05). A perioperative decline in the maximum amplitude of the thrombelastography trace showed a significant correlation with 24h hemoglobin loss (R=0.45, P<0.05). Compared to those with all patent grafts, patients with early graft failure demonstrated a reduction in platelet sensitivity to aspirin by both thrombelastography and aggregometry on day 3. CONCLUSIONS: In contrast to standard coagulation testing, platelet function predicted both bleeding and thrombosis after OPCAB. Titration of perioperative platelet function according to these tests may minimize thrombosis without increasing bleeding.

Aged↗

Progress toward an ambulatory pump-lung.

OBJECTIVES: Currently available therapies for acute and chronic lung diseases have not been effective and have various problems associated with the technologies used. We present a novel active mixing pump-lung with the goal of providing total respiratory support to ambulatory patients. METHODS: The pump-lung is based on the concept of active mixing oxygenation within a constrained vortex. The rotation of hollow-fiber membranes disrupts the concentration boundary layer, increasing gas exchange efficiency, and simultaneously pumps the blood. Consequently, the amount of membranes required to achieve gas transfer sufficient for total respiratory support is considerably small. A series of studies, including computational design, experimental bench testing, and in vivo animal experiments, have been performed to implement this concept into a viable artificial pump-lung device. RESULTS: A series of pump-lung prototypes with a membrane surface area of 0.17 to 0.5 m2 were designed and characterized in vitro with bovine blood, demonstrating extremely high gas exchange efficiency. The prototype with a gas exchange surface area of 0.5 m2 was evaluated in calves. The device provided oxygen transfer of approximately 115 mL/min for respiratory support of an animal for up to 5 days. CONCLUSIONS: Progress to date suggests a high likelihood of success for an extracorporeal shorter-term lung that can be switched in and out like dialysis devices. Our device is unique in that it incorporates an integrated pumping and active mixing principle for excellent gas transfer and eliminates the need of the native right ventricle's ability to power blood through the artificial and natural lungs.

Animals↗