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Is time for a national multi-institutional mechanical circulatory assistance program?
¿Es momento para un programa de asistencia mecánica circulatoria multi-institucional?
Gustavo Sánchez-Mirandaa
a Subjefe de la Unidad Coronaria, Centro Médico ABC Observatorio
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    "textoCompleto" => "<p class="elsevierStylePara">The treatment of terminal heart failure is currently one of the greatest challenges in clinical practice&#46; There is limited pharmacological arsenal and there are few inter-ventionist or surgical options&#46; During the last two decades&#44; heart transplant has been the most viable option to treat terminal heart failure&#46; However&#44; in Latin American countries there are ideological&#44; economical and even political restrictions that have seriously limited transplant programs&#46; As a bridge to transplant or recovery or as destination therapy&#44; ventricular assist devices &#40;VAD&#41; have become a well acknowledged and established therapeutic modality to treat patients with terminal heart failure&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">Various ventricular assist devices have been successfully developed and tested in different countries&#44; mainly in the United States&#44; Europe and Japan&#46; Some developing countries have also been working on the design and testing of VADs&#44; strengthening local mechanical assistance and heart transplant programs&#46; Such is the case of several research centers in Brazil&#44; where the development of certain assist devices has only reached in vitro experimental phases&#44; others have been tested in animal models in vivo&#44; and others have been tested in clinical assays&#46;<span class="elsevierStyleSup">2 </span>The University General Hospital Gregorio Mara&#241;&#243;n in Madrid has proposed a low cost ventricular assistance system&#44;<span class="elsevierStyleSup">3</span> while Spain has proven the achievements of an aggressive national heart transplant program&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">In Mexico&#44; the development of innovative ventricular assist systems has been very limited&#44; not having reached clinical testing and much less marketing phases&#46; The article entitled &#34;In vivo assessment of hemocompatibility of a ventricular assist device in healthy swine - measurement of inflammatory parameters&#34; published in this issue of <span class="elsevierStyleItalic">Archivos de Cardiolog&#237;a</span> by Catarina Sacrist&#225;n and a multidisciplinary group of professionals including biomedical engineers&#44; anesthesiologists&#44; cardiovascular surgeons&#44; hematologists&#44; chemistries&#44; immunologists&#44; and anatomical and molecular pathologists&#44; demonstrates the hemo-compatibility of three different silicone rubber surfaces of the VAD device&#58; heparin-coated surfaces &#40;Hep-Coat&#41;&#44; uncoated substances &#40;Pass-Coat&#41; and passivated coating&#44; in combination with different types of systemic anticoagulation&#58; No anticoagulation&#44; systemic heparin treatment and antiaggregant treatment&#46;</p><p class="elsevierStylePara">The authors chose inflammation parameters that revealed well-known acute responses upon VAD implantation&#46; Apparently&#44; the surface showing the least inflammatory reaction when in contact with blood was the Pass-Coat&#44; which would be expected&#46; Perhaps a greater time of exposure to these surfaces might reveal greater differences after chronic use of the device&#46; In addition&#44; the similar response to coagulation activation and thrombin generation complex &#40;plasma thrombin-anti-thrombin III complex&#41; observed in both groups could also be expected&#44; with a tendency to lesser coagulation activation in heparin and Hep-Coat models&#46; Macroscopic and microscopic analyses revealed no significant coaguli in disposable parts of the VAD&#46; In this model&#44; assistance is venous-venous &#40;right to left jugular veins&#41; and thus the mechanical capacity was not assessed&#46; Only the behavior of the different non-biological surfaces of the system were assessed when making contact with blood&#46; This paper concludes that this innovative and multipurpose ventricular assist device&#44; which is the result of the conjunct efforts of several national institutions&#44; did not induce a major inflammatory response and did not activate the coagulation cascade at least in the short term &#40;6 hours&#41;&#44; although it needs to be tested in subacute and chronic models&#46;</p><p class="elsevierStylePara">This report describes only a small part of a great effort which has produced several publications&#44; the first in 2003&#44;<span class="elsevierStyleSup">5</span> and the patent of the device which began in December of 2004 and was updated in 2007 &#40;Air-pressure powered driver for pneumatic ventricular assist devices US7217236&#41;&#46; As a result of various in vitro studies and theoretical analyses&#44; this device has been improved several times&#46; It is my understanding that this is the first national report of a ventricular assist device tested in animals with serious and reliable histocompatibility analyses&#46; This is very relevant&#44; particularly because although ventricular assist devices are used in several medical centers in Mexico&#44; they are almost always imported from other countries where VADs are already commercialized&#46; A very high price is payed to use this technology&#44; which is particularly relevant because economical resources are limited in Mexico&#46; The development of this type of technology in Mexico should be applauded&#46;</p><p class="elsevierStylePara">The available resources must be divided between several specialized institutions that have slowly acquired experience in treating heart failure patients with mechanical assistance&#46; In order to develop and implement this and other types of specialized and expensive technology&#44; it is necessary to unite economical resources and several types of human talent&#44; which will eventually improve our ability to develop this type of biotechnology&#46; </p><p class="elsevierStylePara">The effort and participation of several institutions from different states in Mexico are necessary to develop a national mechanical support assistance program&#46; Some institutions can work on technology development&#44; while others will perform histocompatibility and acute response tests or medium to long-term studies in animals&#44; and several other institutions will be required to perform clinical assays&#46; This effort requires trained personnel &#40;biomedical engineers&#44; histopathologists&#44; nurses&#44; cardiologists&#44; cardiovascular surgeons&#44; intensive care specialists&#44; psychologists&#44; cardiovascular rehabilitation specialists&#44; etc&#46;&#41;&#44; specialized hospital facilities to offer intensive care for patients with VAD&#44; adequate channels to transfer patients between hospitals with different levels of specialization&#44; and outpatient care programs for VAD patients and their families or caretakers&#46; Bringing together the resources&#44; talents and experience of specialized personnel could lead to the development of specialized technology generated in our country&#44; which could eventually lead to improved care for patients with severe heart failure&#44; improved quality of life and increased survival&#46; </p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleItalic">Corresponding author&#58;</span> Gustavo S&#225;nchez Miranda&#44;<br></br> Sur 136 No&#46; 116 - 519&#44; Col&#46; Las Am&#233;ricas&#46; Delegaci&#243;n &#193;lvaro Obreg&#243;n&#46; CP 01120&#44; M&#233;xico City&#46; Phone&#58; &#43;52 &#40;55&#41; 5230 8000&#44; ext&#46;&#58; 8597 &#43;52 &#40;55&#41; 5272 2582&#46; <span class="elsevierStyleItalic"><br></br> E-mail&#58;</span><a href="mailto&#58;gsanchezm&#64;abchospital&#46;com" class="elsevierStyleCrossRefs">gsanchezm&#64;abchospital&#46;com</a></p><p class="elsevierStylePara">Received in March 24&#44; 2010&#59; <br></br> accepted in March 24&#44; 2010&#46; </p>"
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Article information
ISSN: 14059940
Original language: English
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2022 December 17 5 22
2022 November 12 10 22
2022 October 17 6 23
2022 September 11 20 31
2022 August 21 15 36
2022 July 8 6 14
2022 June 11 7 18
2022 May 36 11 47
2022 April 18 13 31
2022 March 19 9 28
2022 February 20 10 30
2022 January 9 3 12
2021 December 7 9 16
2021 November 16 9 25
2021 October 11 11 22
2021 September 6 9 15
2021 August 8 12 20
2021 July 7 7 14
2021 June 9 7 16
2021 May 12 7 19
2021 April 35 14 49
2021 March 5 7 12
2021 February 13 7 20
2021 January 13 7 20
2020 December 6 8 14
2020 November 8 3 11
2020 October 8 4 12
2020 September 12 7 19
2020 August 9 8 17
2020 July 3 9 12
2020 June 7 9 16
2020 May 7 6 13
2020 April 7 6 13
2020 March 4 3 7
2020 February 7 6 13
2020 January 4 3 7
2019 December 16 6 22
2019 November 8 7 15
2019 October 4 6 10
2019 September 7 1 8
2019 August 8 3 11
2019 July 7 6 13
2019 June 7 16 23
2019 May 19 28 47
2019 April 9 9 18
2019 March 7 2 9
2019 February 6 6 12
2019 January 3 4 7
2018 December 4 2 6
2018 November 2 4 6
2018 October 3 12 15
2018 September 4 0 4
2018 August 3 1 4
2018 July 6 2 8
2018 June 1 0 1
2018 May 2 2 4
2018 April 1 0 1
2018 March 5 1 6
2018 February 3 2 5
2018 January 1 1 2
2017 December 6 0 6
2017 November 0 1 1
2017 October 3 2 5
2017 September 5 0 5
2017 August 9 1 10
2017 July 3 1 4
2017 June 3 0 3
2017 May 11 1 12
2017 April 18 3 21
2017 March 13 1 14
2017 February 2 1 3
2017 January 3 1 4
2016 December 7 4 11
2016 November 11 3 14
2016 October 23 3 26
2016 September 11 3 14
2016 August 13 2 15
2016 July 9 2 11
2016 June 31 5 36
2016 May 24 17 41
2016 April 17 6 23
2016 March 23 7 30
2016 February 20 14 34
2016 January 18 19 37
2015 December 18 15 33
2015 November 11 13 24
2015 October 15 13 28
2015 September 10 6 16
2015 August 5 5 10
2015 July 10 5 15
2015 June 1 0 1
2015 May 7 4 11
2015 April 11 8 19
2015 March 17 9 26
2015 February 11 1 12
2015 January 17 10 27
2014 December 34 9 43
2014 November 19 4 23
2014 October 36 6 42
2014 September 30 4 34
2014 August 19 3 22
2014 July 20 2 22
2014 June 27 3 30
2014 May 16 3 19
2014 April 30 1 31
2014 March 31 10 41
2014 February 32 8 40
2014 January 25 5 30
2013 December 43 4 47
2013 November 34 6 40
2013 October 43 6 49
2013 September 39 7 46
2013 August 47 4 51
2013 July 48 8 56
2013 June 13 5 18
2013 May 16 5 21
2013 April 10 15 25
2013 March 12 8 20
2013 February 8 5 13
2013 January 6 2 8
2012 December 4 3 7
2012 November 1 3 4
2012 October 3 2 5
2012 September 0 1 1
2010 March 554 0 554
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos