ASAIO Conference

Final-Program-MMD-2014.prog_

June 19

Random Notes

•    Blood Stasis is the main cause of thrombosis
•    23 French can access the venous system
•    3 French per mm
•    Extracorporal Membrane Oxygenator used in the treatment of Cardiogenic Shock
◦    Use ECMO as a short term mechanical assist device
◦    Peripheral vs. Central venus access – choice
◦    3L/min is the rate through ECMO

 June 20

Left ventricular End-diastolic Pressure-dependent Passive And Active Flow Adjustment Scheme In Continuous-flow Left ventricular Assist Devices

Vakhtang Tchantchaleishvili, MD, University of Rochester, Rochester, NY

Panel

The Cordex SmartcuffTM: A Direct, Calibrated Measurement Of Endothelial Dysfunction
Kathy Magliato, MD, MBA, St. John’s Health Center, Santa Monica, CA

Posters

Development of an Ultra-compact Membrane Oxygenator for New Born Infant
Shohei Nukii, BS, Tokyo Denki University, Tokyo, Japan

•    PRIMING  volume of conventional devices is 45 ml
•    Dropped to 20 ml in this device
•    Flow rates ~400 ml/ min. With CO2 transfer and O2 transfer at 20 ml/min
•    Use hollow fiber membrane

Utility Operating Method to Achieve Effective veno-venous Extracorporeal Membrane Oxygenation
Konomi Togo, MA, National Cerebral CV Center Research Institute, Osaka, Japan

•    Flow rates are 2.5 l/min. Transfer rates are 150 ml/min
•    Use PMP membrane

An in vitro System to Replicate Thrombosis in ECMO
Susan Hastings, BS, Georgia Institute of Technology, Atlanta, GA – ASAIOfyi Member

•    ECMO has very high rate of complications
•    Clotting and hemorrhage
•    Clots form at connector step size changes. Clots found mostly on the downstream side of the connectors

Hastings Lecture

The father of rotary heart pumps

11:00-11:30am – ASAIO Hastings Lecture – Serene Stupidity
Richard Wampler, MD,  Associate Prof Surgery, Oregon Health Sciences University, Loomis, CA

• Thomas Edison – there are no rules around here we are trying to get things done
• Trust your crazy idea
• Be prepared for soul crushing failures
• Never, never, never give up – Churchill
• Whatever you can do or dream you can. Begin it. Boldness has genius power and magic in it. – Goethe.

My thought: Impeller rotors could be used in our device.

RENAL 3 | VASCULAR ACCESS: INNOVATIvE DEvICES

1:30-3:00pm – Fairchild Room Co-Chairs:
Lalathaksha Kumbar, MD, Henry Ford Hospital, Detroit, MI
Jeffrey Lawson, MD, PhD, Duke University Medical Center, Durham, NC
1:30-1:45pm

Arteriovenous Fistula Eligibility System
Nicholas Franano, MD, Flow Forward Medical Inc, Olathe, KS
1:45-2:00pm

•    6 mm in diameter and 600 ml/min for maturity
•    12 to maturity wall shear stress is the key
•    40-50% fail to mature and are abandoned
•    A large group are not eligible because their veins are too small
•    Why is AV fistula maturation rate so low
•    Nobody knows but these guys have a theory
◦    pulsatile cyclic stretching of the vein wall when attached to the artery
◦    vein wall thickening, smooth muscle response to pulsatile flow – this is called hyperplasia
◦    Poor wall shear stress control –
▸    too low no dilation
▸    too high strip endothelium
•    How do we get better flow? Can`t do it with a fistula.
•    AFE system dilates veins prior to AVF surgery using controlled, non-pulsatile flow
•    Did 2 non-clinical studies (pigs)
•    Gets great results
•    Providing non-pulsitile flow, in vivo priming to dilate veins before surgery.
•    Use pump to prime veins with non-pulsatile flow much faster maturation
•    Can use mall veins.
•    Not sure what will happen when connection is made, but early fistula loss should be avoided

TvA-FLEx Percutaneous Autogenous Arteriovenous Fistula
William Cohn, MD, Texas Heart Institute, Houston, TX
2:00-2:15pm

•    Successful AV fistulas need 2-3 additional procedures DDS
•    Non-surgical
•    Injects a system to push a couple of catheters into neighboring vein and artery.
•    Uses an electrical pulse to fuse the two. Unclear exactly how this works.
•    Fistula development and
•    Some complications triggering neuromuscular response. Arm moves!
•    28 successful patients and 27 that had useable fistulas at 3 months.  A couple of problems. These patients were on dialysis at 3 months and at 6 months.
•    Does procedure on brachial vein

Optiflow vascular Anastomosis
Adam Dakin, MBA, Bioconnect Systems Inc, Ambler, PA
2:15-2:30pm
•    A connector between the artery and vein
•    made of siliconized polyerothene
•    fistula first catheter last
•    catheters are the second leading cost of death
•    failure to mature is the leading problem with fistulas
•    50% probability that you are going to have to do another fistula after 6 months
•    Idea is to create a controlled flow conduit
•    Adverse remodeling happens around the device. Does not constrict flow. Lumen stays the same size.
•    20% will thrombos during first 6 weeks
•    Anastemosis is the name of the junction between artery and vein
•    Optiflow Anastemosis
•    Published in the journal of vascular access
•    Doc says there are similar devices for small vessels. Used in coronary grafts with much smaller flow rates. 60 cc/min. These might be the right thing for us.
▸    Doc says 20% of patients have arteries that are not usable.

NexSite Catheter
Chris Davey, MBA, Marvao Medical Devices Ltd, Galway, Ireland
2:30-2:45pm

•    Their are innovations left in the catheter markets
•    Known as the `white hose of death`
•    infection rates are unacceptably high
•    CMS is shifting cost to providers
•    CRBSI is the acronym for infection
•    Still a population that requires catheters
•    What is out there that has worked to reduce CRBSI?
•    Rabindrath 2009 meta analysis
◦    Concluded that the antimicrobial coatings don`t work
◦    Management of catheter does help
•    Modified catheter cuff

Practical Lifelong vascular Access For Forearm Wearable Artificial Organs
Arnold Lande, MD, Northport Navigable Waters Institution, Northport, MI
2:45-3:00pm

•    huge effort on closed loop artificial pancreas
•    Since the 1983 whole group has believed cannot access blood over a life time
•    Tried to go to subcultaneous tissue.  All kinds of problem
•    Biostator is a bedside system that has worked since the 80s. Controls glucose levels
•    AVF fistula causes the artery going down the arm and larger arteries migrating into the lower arm.
•    Vein Fistula Graft is created by a failed AVF that is very stable
•    Shows an arm band and futurama character
•    aland718@gmail.com from Travers City, MI

Later told me … Blood flow must be above 15 ml/min

Novel Use Of Existing Technology For Better Patient Outcome In Outpatient Hemodialysis Unit
Roshan Patel, MD, Elmhurst Hospital, Elmhurst, NY

RENAL 4 | vASCULAR ACCESS: INNOvATIvE
THERAPEUTICS & MATERIALS
3:45-5:00pm – Fairchild Room Co-Chairs:
Stephen Ash, MD, HemoCleanse, Lafayette, IN
Nicholas Franano, Flow Forward Medical Inc, Olathe, KS
3:45-4:05pm
Immunosuppressive Therapies to Prevent Intimal Hyperplasia
Timmy Lee, MD, University of Alabama, Birmingham, AL
4:05-4:25pm
•    Focused on the cell biology and therapies to treat neointimal hyperplasia
•    endothelial injury from angioplasty may induce
◦    vascular inflammation
◦    vein is more aggressive response than artery
•    looking at drugs that prevent proliferation. paclitaxil. Deliverd at the site where endothelial injury occurs
•    studies on treating stenosis have showed poor results
•    preventing stenosis
◦    adventitial cells myofibroblasts migrate into the intima
◦    drugs applied directly to adventitia to block activation of fibroblasts and targets downstream

Ension Infection Resistant Surface
Patrick Cahalan, BS, Ension Inc, Cape Coral, FL
4:25-4:45pm

•    Best surface is endo/glycocaylx
•    Collagen interface to promote tissue integration
•    Uses XPS to establish that outer surface is exclusively collagen

Tissue-Engineered vascular Grafts
Jeffrey Lawson, MD, PhD, Duke University Medical Center, Durham, NC
4:45-5:00pm
A Nanofibrous Bioactive Hemodialysis Access Graft
Mauricio Contreras, MD, BIDMC, Boston, MA

June 21

Hemocompatibility Enhancement Of Silicon Nanopore Membranes (SNM) Using Optimized Deposition Of Thin-Film Poly (Sulfobetaine Methacrylate) (pSBMA)
Steven Kim, MD, University of California, San Francisco, CA – ASAIOfyi Member

•    200-600 ml/hr/hG/mm^2 vs 30 for conventional devices
•    Zhang et al polymerization to control thickness
•    CD62 platelet marker
•    PolySMBA

RENAL 6 | ENABLING TECHNOLOGIES FOR WEARABLE
DIALYSIS AND ARTIFICIAL KIDNEY
10:45am-12:00pm – Georgetown West – Concourse Level Co-Chairs:
Stephen Ash, MD, HemoCleanse, Lafayette, IN
William Fissell, MD, Vanderbilt University Medical Center, Nashville, TN
10:45-11:00am

Automated Wearable Artificial Kidney: A Peritoneal Dialysis Approach
Martin Roberts, PhD, University of California, Los Angeles, CA
11:00-11:15am

•    Inventor of the REDY sorbant system
•    Peritoneal is better because you cannot continuously anticoagulate a patient. Good for about a week (and then it stops being effective?)
•    Peritoneal – avoids pumps, anticoatulants, accidental disconnection
•    Continuous ambulatory wearable
•    Downside – patient intensive, drain peritoneal every 4 hours 7 ml/min flow rates
•    Need at least 33 ml/min target 40 ml/min
•    Blood tidal PD

Ultrathin Silicon Membranes For Wearable Dialysis
James McGrath, PhD, University of Rochester, Rochester, NY
11:15-11:30am

Nanomaterials To Prevent Membrane Fouling
Baoxia Mi, PhD, University of Maryland, College Park, MD
11:30-11:45am
To reduce fouling

•    electrically neutral, smooth,
•    polyzwitterion nanobrush
◦    Overall neutral charge
◦    XPS claims to get 100% surface coverage
◦    Doing contact angles, etc.
◦    CBET grant NSF

Dialysate Regeneration With Sorbent Technology
Stephen Ash, MD, HemoCleanse Inc, Lafayette, IN
11:45-12:00pm

•    Sorbance has been modeled by Dr. Linda Wine at Perdue University
•    Sorbant regeneratino of dialysate for remote, home, acute center, a few liters is all that is needed
•    Charcol binds to almost every organic compound Stephen Ash
•    Redy column
•    Nephology 15 (2010) 406-411
•    2 Kg column
•    Redy is uncontrolled dialysis
•    2014 paper in artificial organs on urea clerance
•    expers res med devies 4(6) Moving sorbent closer to
•    Albumin as a sorbant. Artificial Orgns
•    Falkenhagen 2013 plama regeneration

Bioartificial Kidney
William Fissell, MD, Vanderbilt University Medical Center, Nashville, TN

•    Medical moonshot. Total implantable. Body doing 100 ml/min
•    Elongated slit structures.
•    Biomimetic looking at glumerulus structure.
•    Double down on elongated slit structure.
•    Roy, Fissel Zydney paper JMS makes the case for enhanced permeability at given selection
•    100 nm pore spacing, 7 nm pores, 60 um x 120 um windows