Arfifiiciol Orgons 10(3):255-256. Raven Press, New York 0 1986 International Society for Artificial Organs

Abstracts from the Japanese Journal of Artificial Organs (Jinkozoki) Published by the Japanese Society of Artificial Organs and Tissues

Volume 14 Number 6, 1985

TRIAL OF BILIRUBIN REMOVAL FROM THE SERUM: BILI- RUBIN ADSORPTION BY POLYAMINE-TRIGLYCIDYLISO- CYANULATE RESIN. Y. Shimahara, R. Nakura, A. Jikko, K. Yasuda, M. Matsushima, H . Noda, E. Ishikawa, K. Sawanishi, H. Suzuki, K. Hosoda, and T. Kubota. Jinkozoki 14(6):1947-52, 1985.

The bilirubin adsorption capacity of polyamine-triglycidyl~so- cyanulate (PAT) resin was examined, using icteric human serum obtained by plasmapheresis. PAT resin markedly adsorbs direct and indirect bilirubin and uric acid from the serum. Ca2+, creati- nine, and BUN were also adsorbed relatively well. Little change was observed in the levels of serum albumin, globulin, glucose, amino acids cholesterol, free fatty acids, triglycerides, Na+ , K + , and C I - . The amount of bilirubin adsorbed by PAT corre- lates positively with the initial bilirubin concentration of the serum. However, no relation was found between the removal rate and the bilirubin levels of the serum. PAT’S bilirubin ad- sorption ability deteriorates gradually according to time course. It was suggested to apply the PAT resin to clinical use, if the optimal conditions in temperature, flow rate, volume, and shape of the column, etc., are determined and an adequate combina- tion with other hemopurification procedures such as plasma- pheresis is established. Key Words: Hyperbilirubinemia- Plasmapheresis-Protein-bound substance-Ion-exchange resin-Artificial liver.

A NEW STYLE OF CATHETER-MOUNTED AORTIC VALVE FOR RELIEF OF AORTIC REGURGITATION. J. Miya, H. Maeta, and M. Hori. Jinkozoki 14(6):1953-8, 198.5.

For relief of aortic regurgitation (AR), we have developed a new style of umbrella-shaped catheter-mounted aortic valve (CAV). This CAV is composed of a catheter, a main shaft that slides in the catheter, three flexible wires whose distal ends are fixed to the main shaft and proximal ones to the catheter, and a valve sheet sutured to these flexible wires. Following insertion into the aortic annulus, the CAV is opened by means of pulling the main shaft to form an umbrella-like shape, so that the mid- portions of each flexible wire make an arch and are fixed into the Valsalva sinuses (where the flexible wires are designed to form an outwardly protruded arch to fix the CAV satisfactorily and not to obstruct coronary orifices). The efficacy of this CAV was experimentally evaluated using 7 mongrel dogs with destroyed aortic valves. Formation of AR decreased diastolic and mean aortic pressure by 42.0 and 30.3 mm Hg, respectively, increased left atrial pressure by 8.7 mm Hg, and decreased cardiac output by 46.4%. Under these conditions, insertion and application of the CAV increased diastolic and mean aortic pressure by 22.9 and 16.2 mm Hg, respectively, decreased left atrial pressure by 3.1 mm Hg, and increased cardiac output by 50.9%. Compared with CAVs developed previously, the most remarkable advan- tage of this new style of CAV is its stable fixation in the aorta brought about by the three arched wires. This stability ensured the prevention of regurgitation in diastole and decreased the risk of coronary orifice obstruction by the valve sheet. Accompanied with these considerable improvements of hemodynamics for

AR, the advantages would bring a possibility of actual clinical use of this CAV. Key Words: Left heart failure-Catheter- mounted aortic valve- Aortic regurgitation.

COMPARISON OF CARDIAC FUNCTIONS DURING PER- FORMANCE OF PLASMA EXCHANGE AND DOUBLE-FIL- TRATION PLASMAPHERESIS. T. Ogawa, T. Suzuki, M. Ta- guchi, T. Matsubara, Y. Hirofuji, Y. Fujii, T. Murasawa, K. Fuji- moto, Y . Hanyuda, and N. Honda. Jinkozoki 14(6):1959-63, 1985.

We performed plasma exchange (PEx) and double-filtration plasmapheresis (DFPP) on 4 patients, 2 with HB-nephropathy, 1 with amyotrophic lateral sclerosis (ALS), and 1 with progres- sive systemic sclerosis (PSS). We investigated various cardio- vascular parameters via the Swann-Ganz catheter on 4 occasions in each case: before and at 1 and 2 h after initiation of PEx and DFPP and at 30 min after their completion. In the HB-nephro- pathy and ALS cases, all cardiovascular parameters were within normal limits. But in PSS, systemic vascular resistance (SVR) increased significantly before PEx and DFPP. In the patients ex- cept that with PSS, mean pulmonary arterial pressure (PAP), cardiac index (CI), and stroke work index (SWI) decreased sig- nificantly more during DFPP than PEx, but SVR increased sig- nificantly during DFPP. The mean arterial pressure (MAP) did not decrease significantly at 2 h after initiation of DFPP and at 30 min after completion. In PSS, PAP, CI, and SWI decreased sig- nificantly more during DFPP than PEx, but SVR did not in- crease, so that MAP decreased during DFPP significantly. These facts suggest that DFPP has more influence upon hemodynamics than PEx, because of the decreased plasma refilling rate during DFPP. It is important to gain sufficient information on cardiovas- cular dynamic status at the time of DFPP in patients with sys- temic vascular disease. Key Words: Hemodynamics- Plasma exchange- Double-filtration plasmapheresis- Systemic vascular disease.

EXPERIMENTAL AND CLINICAL STUDIES OF CHARCOAL HEMOADSORPTION FOR ACUTE HEPATIC FAILURE. Y. Tabata. Jinkozoki 14(6): 1964-75, 1985.

The present study was undertaken to investigate the efficacy of charcoal hemoadsorption (HA) in the treatment of acute he- patic failure (AHF). The effects of HA on the survival of AHF rats and the reticuloendothelial system (RES) function were studied experimentally. The survival of the HA treatment group was significantly improved compared with the control. EC. AKBR, and RES function were significantly improved among the HA treatment group compared with the control. In clinical study from 1975 to 1983, 28 AHF patients were hemoadsorbed. The study period was divided into 3 terms according to the treatments. During the 3rd term, HA and plasma exchange were performed alternatively in the AHF patients even though they were in grade I1 coma. The survival among patients treated during the 3rd term was significantly improved compared with those treated during the 1st and 2nd terms. Hepatic cellular en-

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ergy metabolism, studied using AKBR, was improved following HA. These data indicate that HA has a beneficial effect on the survival of AHF and that the mechanism of the beneficial effect could be through the improvement of hepatic energy metabo- lism. They also indicate that HA is more effective when it is applied to patients still in an early stage of AHF. Key Words: Acute hepatic failure-Galactosamine-Rat-Hemoadsorp- tion- Energy charge.

A STUDY OF EQUINE UMBILICAL CORD VESSELS AS A VENOUS SUBSTITUTE. Y. Onda. Jinkozoki 14(6): 1976-84, 1985.

Glutaraldehyde-tanned equine umbilical cord vessels (EUCV) were investigated as a venous substitute. After glutaraldehyde treatment, the quality of the EUCV was improved as follows: (a) high tolerance against internal pressure; (b) adequate rigidity with elasticity; (c) high antithrombogenicity; (d) good disinfec- tant effect; (e) marked suppression of antigenicity; (0 high toler- ance in a living body; (g) easy handling and preservation. The glutaraldehyde-tanned EUCV were transplanted in the infra- renal vena cava of mongrel dogs. The patency rate was 83% after 7 days but 60% after 4 weeks. However, no further obstruction was observed after 4 weeks up to 1 year. The main cause of the obstruction was constriction at the anastomotic region. The pa- tency rate could be improved with some adjuvant treatments in this period. In conclusion, the glutaraldehyde-tanned EUCV could b e r ega rded a s a usefu l venous s u b s t i t u t e fo r humans. Key Words: Glutaraldehyde-Equine umbilical cord vessels-Venous transplantation.

HEPARINLESS TEMPORARY SHUNT TUBE COATED WITH TM3: AN EXPERIMENTAL STUDY. C. Nojiri. Jinkozoki

Use of temporary shunt tube has been a very useful and easy

14(6):1985-97, 1985.

method in descending thoracic aneurysmectomy. 1 developed an original heparinless shunt tube coated with TM3, which is a new antithrombogenic polymer. The purpose of this study was to evaluate antithrombogenicity as well as hemodynamic perfor- mance in dogs. All underwent a 5-h period of aortofemoral by- pass without systemic heparinization. After bypa.ss all tubes were clear without detectable thrombi, and an SEMI study dem- onstrated no platelet aggregation or fibrin strands. Hemodynam- ically this tube showed excellent results. Because the shape of TM3-coated shunt tube can afford excellent antithrombogenicity and performance without systemic heparinization, this shunt tube is worthy of clinical trials. Key Words: Heparinless shunt tube-Antithrombogenicity-Scanning electron micro- scope study - Platelet aggregation.

SEPARATION AND STORAGE OF PYRIDOXYLATED HEMO- GLOBIN AS ARTIFICIAL RED CELLS. S. Sekiguchi, K. Ito, N. Ototake, H. Ikeda, S. Sasakawa. Jinkozoki 14(6): 1998-9, 1985.

Stroma-free hemoglobin (SFH) solutions are potential oxygen carriers as red blood cell substitutes, but they have two major defects: high oxygen binding and short life span. To improve these defects, we modified the SFH solutions with pyridoxal5'- phosphate. But the modified SFH solutions contain' nonreactive SFH and pyridoxylated hemoglobin (PLP-Hb). Then we sepa- rated completely nonreactive SFH from PLP-Hb wilth an ion ex- changer, DEAE Sephadex A-50. Moreover, separated PLP-Hb solutions have two different derivatives, and the P,, values are, respectively, 17.5 and 24.5 mm Hg (Ps0 values of SFH and red blood cells are 10.5 and 25-26 mm Hg, respectively). When those two PLP-Hb derivatives are stored at 4"C, they are very stable, at least until 4 weeks. Therefore, it is evident that PLP- Hb separated from SFH using DEAE Sephadex 14-50 is a valu- able material as a red blood cell substitute. Key Words: Ox- ygen carriers-Red blood cell substitutes-Pyridoxylated he- moglobin-P,, value.

Artif Organs, Vol. 10, No. 3. 1986