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ASAIO Journal Farewell

Zwischenberger, Joseph B.

doi: 10.1097/MAT.0b013e3182923b11
Editorial
Free

From the Department of Surgery, University of Kentucky, College of Medicine, Lexington, Kentucky.

Submitted for consideration March 2013; accepted for publication March 2013.

Disclosure: The author has no conflicts of interest to report.

Reprint Requests: Joseph B. Zwischenberger, Department of Surgery, University of Kentucky, College of Medicine, 138 Leader Ave., Lexington, KY 40506-9983. Email: joseph.zwischenberger@uky.edu; j.zwische@uky.edu.

It has now been 10 years since I was appointed editor-in-chief of ASAIO Journal, and I was asked to give a brief overview of how the journal has evolved over that time. For those of you interested in a complete history of the journal, I refer you to the “ASAIO Gold: Fifty Years of Artificial Organs from Discovery to Clinical Use,”1 which was published by ASAIO in June 2004 at the time of the Society’s Golden Anniversary.

I became involved with the ASAIO Journal with my first, first-author publication under Bob Bartlett’s mentorship in 1984! I soon befriended Monica Beyer who was the associate editor when Eli Freidman was editor-in-chief. For experience, she would have me proofread the ASAIO Transactions. As you will recall, before 1992, ASAIO Journal was a transactions journal where people would submit their manuscripts for publication after presenting them as posters or oral presentations at the annual ASAIO meeting. As such, they were not peer reviewed. Monica quickly discovered that some would be print ready and others only in rough draft form. During this time, I learned from Monica editorial skills and ASAIO standards. Eli and Monica were instrumental in moving the journal from an unjuried transactions journal to a peer-reviewed journal.

Unfortunately, there was little support in those days, and Monica worked tirelessly out of a small office in New York to distribute manuscripts for peer review and compile and edit all manuscripts for publication. Of course everything was paper, and mail review was cumbersome. When Tom Depner, the president of ASAIO at the time, visited UTMB at Galveston in 2002, I had established manuscript support, which I think helped him make the decision for me to be editor. Similarly, the society supported the hiring of Betty Littleton to be the managing editor. UTMB generously supported Betty with an office, supplies, and computer support and helped pay for postage. On Betty’s first day on the job, we received a 6-foot-tall collection of boxes, full of manuscripts that had yet to be reviewed. Over the next 6 months, Betty and I expanded the Editorial Board and began the onerous task of distributing all of those manuscripts for review. Initially, we encountered page limitations imposed by the contracted publisher. Much to my surprise, we were never actually able to fill the pages once the peer review process matured.

To hone my skills, I spent 2 days with the publisher Lippincott Williams & Wilkins (LWW) going to “editor school” and learning about their publishing capabilities. They recommended that a 30% rejection rate should be our target. Over the next 2 years, Betty and I reviewed every manuscript alongside the Editorial Board. We quickly learned that a major portion of the articles were written in the author’s second language, so we began a rewriting service for those submissions. Despite the many professional editing services and language coaches available, Betty, who spent years as a high school English teacher, proved to be best at this service. Her skill set allowed us to expand our penetration into the Asian countries where Betty’s rewriting skills were frequently applied and greatly appreciated. In 2004, we organized the 50th Anniversary edition of the journal’s publication. In 2005, Betty had a car accident injuring her back. She subsequently had trouble driving and sitting at a desk all day. UTMB agreed to outfit her home with an office, and ASAIO supplied her with a home computer. At this point, ASAIO Journal became fully electronic, and we elected to have the section editors assume more responsibility. The plan was to have Betty be a clearing house for all juried manuscripts, electronically.

In 2007, I was recruited to be Chairman of the Department of Surgery at the University of Kentucky (UK), my alma mater for both my undergraduate degree and medical school. I moved to Lexington, Kentucky, to assume my new job, and we continued to manage the journal with Betty working at home in Texas. Fortunately, we had already gone totally electronic while in Galveston, so our workflow was unaffected. During this transition, I met Linda Combs, who was relatively new at UK but had extensive editing experience while working at the Mayo Clinic. She began to assume some of the managing editor duties, and UK generously assumed some of her salary support. She continues to assist me to this day.

During those years, we had our share of situations that did not play out well. The pediatric circulatory support group became more independent over the years. There was an issue regarding whether papers presented at their meeting should be given priority for publication. The Editorial Board decided all manuscripts would be subject to the same peer review process. The number of pediatric submissions dropped precipitously and was slow to rebound. To save on publication costs, we collectively decided to stop publishing reviews and nonoriginal editorials. Unfortunately, this also decreased our self-citation rate and influenced the impact factor. Consequently, we have one of the lowest self-citation rates in the field.

With the stock crash of 2008, ASAIO began to look at ways to further gain efficiencies. At this time, Betty was at retirement age and after an extensive review and bidding process, the Editorial Board decided we would contract with a professional organization for day-to-day operations. This required a reorganization of the journal because we were hiring a company that was much more savvy with the journal publishing business but less knowledgeable of our subject content. Similarly, they did not provide hands-on assistance with writing and editing. During this reorganization, we made the final leap to organize the Editorial Board as it is configured now. We further expanded the number and diversity of the section editors and made sure each of the different sections had Editorial Board members and multiple volunteer reviewers for support. This reorganization created each section into a semiautonomous portion of the journal so that each section editor was responsible for his/her content. Secondary gain was immediately realized because the expertise of that subject area was concentrated into that section. For instance, nephrologists and dialysis was concentrated in the Kidney Support/Dialysis/Vascular Section; physiologists, pulmonologists, and bioengineers interested in gas exchange were concentrated in the Respiratory Support Section. This concentration of expertise significantly improved the quality of the reviews and final product. Marjory Spraycar from KWF Editorial Services was assigned to our journal by the publisher LWW, and she has now become knowledgeable of the management and conduct of the ASAIO Journal, both business and content. She is assisted by Michelle Gaffney.

For the past 10 years, we have held a breakfast at the ASAIO Annual Meeting for the Editorial Board members. To my surprise, attendance has been greater than 90% for each of the 10 years. During the meeting, we would learn of the Journal’s progress, impact factor, market share, and financial status of the journal. I am pleased to report that we now have a 30% rejection rate, an impact factor of 1.39, and a cited half-life of 6.8 years. We have the lowest self-citation rate and the highest first-time publication rate in the field. Our publisher tells us this is the healthiest profile of all of the artificial organ publications.

Over the past 10 years, we have seen huge strides made in terms of translational research, and the theme “From Discovery to Clinical Use to Commercialization” is prominently featured on the home page of the ASAIO Web site with the word commercialization in large font. The Tissue Engineering and Biomaterials Section, managed by Dr. Jan Simoni, has published clinical applications of novel biomaterials, dramatic developments in tissue engineering, and introduced stem cell publications. Many were related to scaffolds that support and direct the growth of stem cells into differentiated cells to replace damaged organs or tissues.2–5 The reported tissue-engineered heart valves are already in clinical trials,6–8 whereas successfully grown liver, skin, esophagus, cartilage, blood vessels, and so on, on polymers are in late stages of preclinical development.

Cardiopulmonary bypass and mechanical circulatory support devices have undergone major innovation during the last decade. Importantly, these innovations have had a major influence on the treatment of cardiac disease in both adults and children. Under the direction of Mark Slaughter (Adult Circulatory Support Section) and Bill Holman (Clinical Cardiovascular/Cardiopulmonary Bypass Section), the journal has published many key clinical articles. Early testing and pump performance for new devices were routinely published first in the ASAIO Journal, along with subsequent publications describing their continued improvements, clinical use, and outcomes. These publications, to mention only a few, have included reports on development of a mock circulation model for testing cardiac support devices,9 the principles of the intra-aortic balloon pump and mechanisms affecting its performance,10,11 the impact and effects of hemofiltration and pulsatile flow,12–14 the investigational and clinical use of continuous flow ventricular assistance devices and systems15–17 and their potential complications,18,19 development of devices for bridge to heart transplantation,20–22 a device made of artificial muscle for the treatment of end-stage heart failure that is currently under development,23 and reports on the Extracorporeal Life Support Registry, including the 2004 Report, which over the past 10 years has been our most often cited publication.24

In recent years, the Pediatric Circulatory Support Section, under the previous direction of Chuck Cox and now Mark Plunkett, has seen a marked increase in submission and publications, and the scope and depth of the articles have expanded. Some of the major advances published in ASAIO Journal have covered the topics of the development of the Berlin Heart EXCOR device and its clinical and investigational use,25,26 management and outcomes of pediatric patients on extracorporeal membrane oxygenation (ECMO) and extracorporeal life support,27–29 and ventricular assist devices.30,31 Reports have also been published of experimental animal and mock loop models of congenital heart defects,32 and recently, the application of right heart assist in animal models33 and the testing in a rabbit model of a miniaturized heart-lung machine34 for future clinical translation to the pediatric population. The expansion of this area is further evidenced by the first ASAIO Pediatric Mechanical Circulatory Support Program which was held in 2012 before the annual ASAIO meeting. The inaugural meeting addressed pediatric mechanical support issues and was so well received that the second annual meeting will be held this year.

Respiratory support technology has changed the standard of care, and many articles reporting those changes have been published in the Respiratory Support Section under the direction of Keith Cook. Ten years ago, we were still practicing first-generation venoarterial and venovenous (VV) ECMO with patients sedated, on ventilators, in the intensive care unit. In 2006, a typical ECMO was complex, expensive, labor-intensive, time-limited, and thrombogenic; system failures were common. In addition, VV ECMO had from 20% plus mixing so the patients were usually desaturated and “blue.” The development of the Novalung extracorporeal membrane ventilator used in the VV mode showed promise.35 By 2011, we saw the commercialization of low-resistance gas exchangers and polymethylpentene oxygenators,36,37 low-pressure/low-trauma blood pumps with self-regulating circuits, and continuing improvements,38–40 image-guided vascular access,41 less thrombogenic coatings,42 and development of the single-access dual lumen catheter for VV ECMO.43 The result is the capability of ambulatory ECMO as treatment or bridge to lung transplant. Walking, talking patients who can exercise while on total respiratory support seem to have improved outcomes after lung transplant.44

The current Kidney Support/Dialysis/Vascular Access Section, managed by Daniel Schneditz, was merged from the Nephrology Section managed by Robert L. Lindsay until the end of 2006 and the Dialysis and Kinetics Section managed by John K. Leypoldt until the end of 2004. During these years, approximately 130 articles covering all topics of renal replacement therapy, clinical studies, and technical developments were published in the ASAIO Journal. The journal has provided a significant fraction of its content to the readership of the renal community with almost 20% of articles related to renal replacement therapy. Some of the most cited articles from this section have dealt with complications associated with dialysis such as central vein stenosis,45 cardiac calcification,46 and solutions such as quotidian nocturnal hemodialysis,47 the Molecular Adsorbent Recirculating System,48 and substitution-free hemodiafiltration.49 Other important reports appearing in this section focused on hemorrhagic shock resuscitation with an artificial oxygen carrier,50 the use of modified ultrafiltration to reverse hemodilution and improve cardiac function,51 the treatment of intractable pruritus with albumin dialysis,52 an assessment of the clinical experience with hemodialysis using the heparin-coated AN69 ST membrane,53 and results in animal studies that indicate potential for transplantation across species barriers.54

The relatively new Biomedical Engineering Section, managed by Bill Federspiel, provided an important avenue for our investigators. Modeling, bench work, and animal studies related to developing novel artificial organ devices preclinically and improving device function or better understanding of the device once in clinical use received a venue. As the clinical use of ventricular assist devices increased, the Biomedical Engineering Section highlighted many studies relating to how these blood pumps interact with the cardiovascular system and how to best use them to reduce ventricular load.55–57 The section captured the intensive bioengineering efforts to develop control strategies and algorithms for blood pumps.11,58,59 Important articles were also published on the biomechanics of the heart and aortic valve during continuous flow VAD assist.7,60 This section of the journal published studies on alternate forms of ventilation (including total liquid ventilation) as a treatment for severe acute respiratory distress syndrome,61 design features of novel artificial lungs, including intravascular gas exchange catheters and total artificial lungs,36,62 and how these devices interact with the cardiopulmonary system. The Biomedical Engineering Section also addressed technologies not fitting directly within the other journal sections, including different approaches to develop an artificial blood product.

But even with all the advances in the field of artificial organs, we have not forgotten our heritage. We have recently resurrected the “Moment in History” articles, with Mark Kurusz as the section editor. Journal readers, society members, and others interested in medical history receive compelling perspectives on the genesis of artificial organs. As the saying goes, all things were once new, and each Moment in History has the potential to offer readers a better understanding of what is often taken for granted in our rush to promote contemporary artificial organ technology. Moments in History have included a history of extracorporeal life support,63 the “untold” story of cardiopulmonary bypass64 and a look back at the important lessons learned from the meetings of the Columbia University Biomaterials Seminars held in the 1970s and 1980s.65

It is now time for a new editor. I am pleased to be handing over the editorial duties to a good friend and colleague and an experienced section editor and board member—Mark Slaughter. He has been on the Editorial Board since 2006 and the section editor since 2009. He has faithfully served in that role and has always accomplished his assignments in a timely fashion. The timing for this editor transition is perfect because we are now healthy as a journal and as a society. A solid relationship has been established with LWW, and we have recently recontracted with them to continue to publish our journal. Like many of my era, I am geared toward hardcopy or at least an electronic copy of a full journal. The younger set, as you know, are much more attuned to social media, sound bytes, video bytes, and interactive publications.

As I look back over the past 30 years, I feel especially driven to assist undergraduates, medical students, interns, residents, and fellows to begin their scientific careers of innovation and investigation. To that end, we have focused on our youth with the highest percentage of first-time publications of any journal in the industry. I look forward to entering emeritus status with the journal so that I can help the society, the journal, and Mark so that we can improve upon what we have built. As I mentioned in my first introduction editorial 10 years ago, the Zwischenberger family coat of arms has as its motto: “Respect the old, but make way for the new.” Hopefully, at this point, I can do both.

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References

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7. May-Newman K, Enriquez-Almaguer L, Posuwattanakul P, Dembitsky W. Biomechanics of the aortic valve in the continuous flow VAD-assisted heart. ASAIO J. 2010;56:301–308
8. Claiborne TE, Girdhar G, Gallocher-Lowe S, et al. Thrombogenic potential and Innovia polymer valves versus Carpentier-Edwards Perimount Magna aortic bioprosthetic valves. ASAIO J. 2011;57:26–31
9. Pantalos GM, Koenig SC, Gillars KJ, Giridharan GA, Ewert DL. Characterization of an adult mock circulation for testing cardiac support devices. ASAIO J. 2004;50:37–46
10. Papaioannou TG, Stefanadis C. Basic principles of the intraaortic balloon pump and mechanisms affecting its performance. ASAIO J. 2005;51:296–300
11. Schampaert S, Rutten MC, van T Veer M, et al. Modeling the interaction between the intra-aortic balloon pump and the cardiovascular system: The effect of timing. ASAIO J. 2013;59:30–36
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19. Magliato KE, Kleisli T, Soukiasian HJ, et al. Biventricular support in patients with profound cardiogenic shock: A single center experience. ASAIO J. 2003;49:475–479
20. Morgan JA, Stewart AS, Lee BJ, Oz MC, Naka Y. Role of the Abiomed BVS 5000 device for short-term support and bridge to transplantation. ASAIO J. 2004;50:360–363
21. Hochareon P, Manning KB, Fontaine AA, Tarbell JM, Deutsch S. Correlation of in vivo clot deposition with the flow characteristics in the 50 cc penn state artificial heart: A preliminary study. ASAIO J. 2004;50:537–542
22. Loforte A, Montalto A, Ranocchi F, et al. Levitronix CentriMag third generation magnetically levitated continuous flow pump as bridge to solution. ASAIO J. 2011;57:247–253
23. Tozzi P, Michalis A, Hayoz D, Locca D, von Segesser LK. Artificial muscle for end-stage heart failure. ASAIO J. 2012;58:103–108
24. Conrad SA, Rycus PT, Dalton H. Extracorporeal Life Support Registry Report 2004. ASAIO J. 2005;50:204–210
25. Rockett SR, Bryant JC, Morrow WR, et al. Preliminary single center North American experience with the Berlin Heart pediatric EXCOR device. ASAIO J. 2008;54:479–482
26. Stiller B, Lemmer J, Schubert S, et al. Management of pediatric patients after implantation of the Berlin Heart EXCOR ventricular assist device. ASAIO J. 2006;52:497–500
27. Shah SA, Shankar V, Churchwell KB, et al. Clinical outcomes of 84 children with congenital heart disease managed with extracorporeal membrane oxygenation after cardiac surgery. ASAIO J. 2005;51:504–507
28. Huang SC, Wu ET, Chen YS, et al. Experience with extracorporeal life support in pediatric patients after cardiac surgery. ASAIO J. 2005;51:517–521
29. Ghez O, Feier H, Ughetto F, Fraisse A, Kreitmann B, Metras D. Postoperative extracorporeal life support in pediatric cardiac surgery: Recent results. ASAIO J. 2005;51:513–516
30. Reinhartz O, Hill JD, Al-Khaldi A, Pelletier MP, Robbins RC, Farrar DJ. Thoratec ventricular assist devices in pediatric patients: Update on clinical results. ASAIO J. 2005;51:501–503
31. Ricci M, Gaughan CB, Rossi M, et al. Initial experience with the TandemHeart circulatory support system in children. ASAIO J. 2008;54:542–545
32. Lukic B, Zapanta CM, Khalapyan T, et al. The effect of left ventricular function and drive pressures on the filling and ejection of a pulsatile pediatric ventricular assist device in an acute animal model. ASAIO J. 2007;53:379–384
33. Wei X, Li T, Sanchez P, et al. Initial experience with a juvenile sheep model for evaluation of the pediatric intracorporeal ventricular assist services. ASAIO J. 2013;9:75–80
34. Schnoering H, Arens J, Detering SM, et al. Development of a rabbit animal model for miniaturized heart–lung machines. ASAIO J. 2013;59:152–156
35. Fischer S, Hoeper MM, Tomaszek S, et al. Bridge to lung transplantation with the extracorporeal membrane ventilator Novalung in the veno-venous mode: The initial Hannover experience. ASAIO J. 2007;53:168–170
36. Cook KE, Perlman CE, Seipelt R, Backer CL, Mavroudis C, Mockrost LF. Hemodynamic and gas transfer properties of a compliant thoracic artificial lung. ASAIO J. 2005;51:404–411
37. Khoshbin E, Roberts N, Harvey C, et al. Poly-methyl pentene oxygenators have improved gas exchange capability and reduced transfusion requirements in adult extracorporeal. ASAIO J. 2005;51:281–287
38. Asama J, Shinshi T, Hoshi H, Takatani S, Shimokohbe A. A new design for a compact centrifugal blood pump with a magnetically levitated rotor. ASAIO J. 2004;50:550–556
39. Nobili M, Sheriff J, Morbiducci U, Redaelli A, Bluestein D. Platelet activation due to hemodynamic shear stresses: Damage accumulation model and comparison to in vitro measurements. ASAIO J. 2008;54:64–72
40. Spurlock DJ, Raney DN, Fracz EM, Mazur DE, Bartlet RH, Haft JW. In vitro testing of a novel blood pump designed for temporary extracorporeal support. ASAIO J. 2012;58:109–114
41. Javidfar J, Wang D, Zwischenberger J, et al. Insertion of dual lumen extracorporeal membrane oxygenation catheter with image guidance. ASAIO J. 2011;57:203–205
42. Burkhart HM, Joyner N, Niles S, et al. Presence of plasticizer di-2(ethylhexyl)phthalate in primed extracorporeal circulation circuits. ASAIO J. 2007;53:365–367
43. Wang D, Zhou X, Liu X, Sidor B, Lynch J, Zwischenberger JB. Wang-Zwische double lumen cannula-toward a percutaneous and ambulatory paracorporeal artificial lung. ASAIO J. 2008;54:606–611
44. Diaz-Guzman E, Hoopes CW, Zwischenberger JB. The evolution of extracorporeal life support as a bridge to lung transplantation. ASAIO J. 2013;59:3–10
45. MacRae JM, Ahmed A, Johnson N, Levin A, Kiaii M. Central vein stenosis: A common problem in patients on hemodialysis. ASAIO J. 2005;51:77–81
46. Coen G, Manni M, Agnoli A, et al. Cardiac calcifications: Fetuin-A and other risk factors in hemodialysis patients. ASAIO J. 2006;52:150–156
47. Yuen D, Richardson RM, Fenton SS, McGrath-Chong ME, Chan CT. Quotidian nocturnal hemodialysis improves cytokine profile and enhances erythropoietin responsiveness. ASAIO J. 2005;51:236–241
48. El Banayosy A, Kizner L, Schueler V, Bergmeier S, Cobaugh D, Koerfer R. First use of the Molecular Adsorbent Recirculating System technique on patients with hypoxic liver failure after cardiogenic shock. ASAIO J. 2004;50:332–337
49. Lee K, Pino CJ, Humes HD. Substitution-free hemodiafiltration. ASAIO J. 2012;58:514–521
50. Yoshizu A, Izumi Y, Park S, et al. Hemorrhagic shock resuscitation with an artificial oxygen carrier, hemoglobin vesicle, maintains intestinal perfusion and suppresses the increase in plasma tumor necrosis factor-alpha. ASAIO J. 2004;50:458–463
51. Wang W, Zhu DM, Huang HM, et al. Effect of flow rate, negative pressure, and duration of modified ultrafiltration on hemodynamics and inflammatory mediators. ASAIO J. 2007;53:41–45
52. Bellmann R, Feistritzer C, Zoller H, et al. Treatment of intractable pruritus in drug induced cholestasis with albumin dialysis: A report of two cases. ASAIO J. 2004;50:387–391
53. Lavaud S, Paris B, Maheut H, et al. Assessment of the heparin-binding AN69 ST hemodialysis membrane: II. Clinical studies without heparin administration. ASAIO J. 2005;51:348–351
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60. Zamamipa Garcia MA, Enriquez LA, Dembitsky W, May-Newman K. The effect of aortic valve incompetence on the hemodynamics of a continuous flow ventricular assist device in a mock circulation. ASAIO J. 2008;54:237–244
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62. Amoako KA, Archangeli C, Handa H, et al. Thromboresistance characterization of extruded nitric oxide-releasing silivone catheters. ASAIO J. 2012;58:238–246
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