Antepartum Temporary Heart Pump Placement to Support Delivery and Bridge to Transplant.

Background: With advances in technology, temporary mechanical circulatory support (tMCS) devices have increasingly been used to treat patients in cardiogenic shock.

Case Summary: A 25-year-old G1P0 woman with known idiopathic dilated cardiomyopathy since infancy was hospitalized with acute on chronic decompensated heart failure (HF) at 30 weeks of gestation and bridged to delivery and heart transplantation with an Impella CP heart pump.

Discussion: There is a dearth of experience in use of tMCS for patients experiencing peripartum HF reported in the literature and significant uncertainty over the use of anticoagulation antepartum.

Giant Coronary Artery Aneurysms With Coronary Sinus Fistula: Forget the Distal Bypass.

We describe the surgical approach for 2 symptomatic patients with coronary artery aneurysms with coronary sinus fistulas. One patient presented as an elective procedure secondary to concerns for aneurysmal growth and rupture; the second patient presented in cardiogenic shock from excessive shunting and right heart failure. Historically, coronary aneurysms have mandated ligation with distal bypass.

Single cell multiomics and 3D genome architecture reveal novel pathways of human heart failure.

Heart failure is a leading cause of morbidity and mortality; yet gene regulatory mechanisms driving cell type-specific pathologic responses remain undefined. Here, we present the cell type-resolved transcriptomes, chromatin accessibility, histone modifications and chromatin organization of 36 non-failing and failing human hearts profiled from 776,479 cells spanning all cardiac chambers. Integrative analyses revealed dynamic changes in cell type composition, gene regulatory programs and chromatin organization, which expanded the annotation of cardiac -regulatory sequences by ten-fold and mapped cell type-specific enhancer-gene interactions.

Left Atrial Reverse Remodeling in Patients Supported With Durable Left Ventricular Assist Devices and Clinical Implications.

Background: The left atrium (LA) maintains a dynamic interaction with the left ventricle (LV). LA forward and reverse remodeling affect prognosis in patients with chronic heart failure. We examined LA reverse remodeling in patients supported with LV assist devices (LVADs) and investigated a potential impact on clinical outcomes.

Reduced left atrial compliance exacerbates primary graft dysfunction after lung transplantation.

Objective: Primary graft dysfunction (PGD) after lung transplantation (LTx) heralds significantly worse short- and long-term outcomes. The preoperative presence of recipient left ventricular diastolic dysfunction elevates postcapillary hydrostatic pressures and increases the risk for PGD. In this study, we investigated the role of the left atrial strain (LAS), a recently established sensitive marker of left atrial compliance, as a predictor of PGD.

Application of the Updated Cardiogenic Shock Working Group SCAI Classification for Cardiogenic Shock: A Single-Centre Analysis.

Background: In 2019, the Society for Cardiovascular Angiography and Interventions (SCAI) proposed an algorithm to assess cardiogenic shock (CS) severity, known as SCAI classification. In 2022, the Cardiogenic Shock Working Group (CSWG) modified the original classification using specific parameters to better define hypotension and hypoperfusion with the goal to further refine stratification.

Methods: Consecutive patients with CS who were managed at a quaternary academic medical centre from May 2015 to December 2021 were evaluated (N = 1162).

Hospital costs associated with mechanical left ventricular mechanical unloading devices during VA ECMO for adult cardiogenic shock.

Importance: No works to-date have described the financial burden and behaviors of left ventricular mechanical unloading (LVMU) for patients on veno-arterial extracorporeal membrane oxygenation (VA ECMO). Given the uptrending use of VA ECMO, describing its associated cost is essential for its continued uptake.

Objective: We describe the inpatient costs of patients who were managed with ECMO for cardiogenic shock (CS) with and without LVMU.

Aortic shape and diameter variations are predictive of short-term complications in transcatheter aortic valve replacement.

Introduction: Anatomic and geometric considerations are critical components for transcatheter aortic valve replacement (TAVR) procedural planning. Aortic root geometry and 3-dimensional orientation have been previously associated with short-term complications but with mixed and inconsistent results. The purpose of this study was to investigate aortic 3-dimensional anatomical shape variants identified by principal component analysis (PCA) and whether these variants are associated with short-term complications.

AAV9-cBIN1 gene therapy rescues chronic heart failure due to ischemic cardiomyopathy in a canine model.

Background: Ischemic cardiomyopathy and resultant heart failure (HF) is a significant cause of morbidity and mortality worldwide. Downregulation of cardiac bridging integrator 1 (cBIN1), a membrane scaffolding protein responsible for organizing t-tubules and organizing the calcium handing apparatus, occurs in progressive HF. Therefore, gene therapy upregulating cBIN1 production may rescue failing muscle and clinical HF.

Proteomic Characterization of Cardioprotective Human Acellular Amniotic Fluid.

Amniotic fluid-derived products are a promising resource for cell therapy and tissue engineering due to their anti-inflammatory, angiogenic, and antifibrotic properties. Human amniotic fluid (hAF) has been used in medical applications such as wound healing, skin disorders, and ophthalmic conditions. Recently, we demonstrated that hAF is an effective treatment for myocardial ischemia-reperfusion injury in adult rats.

Informing Management of Patients Developing Cardiogenic Shock at a Spoke and Being Transferred to a Hub.

Background: Multidisciplinary teams and regionalized care systems have been suggested to improve cardiogenic shock (CS) outcomes. We sought to identify clinical factors associated with successful outcomes for patients developing CS at an outside healthcare facility (spoke) and being transferred to a quaternary medical center (hub).

Methods And Results: Consecutive patients with CS were evaluated (N=1162).

Aspirin and Hemocompatibility After LVAD Implantation in Patients With Atherosclerotic Vascular Disease: A Secondary Analysis From the ARIES-HM3 Randomized Clinical Trial.

Importance: The Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure (ARIES-HM3) study demonstrated that aspirin may be safely eliminated from the antithrombotic regimen after HeartMate 3 (HM3 [Abbott Cardiovascular]) left ventricular assist device (LVAD) implantation. This prespecified analysis explored whether conditions requiring aspirin (prior percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], stroke, or peripheral vascular disease [PVD]) would influence outcomes differentially with aspirin avoidance.

Objective: To analyze aspirin avoidance on hemocompatibility-related adverse events (HRAEs) at 1 year after implant in patients with a history of CABG, PCI, stroke, or PVD.

Cardiac bridging integrator 1 gene therapy rescues chronic non-ischemic heart failure in minipigs.

Heart failure (HF) is a major cause of mortality and morbidity worldwide, yet with limited therapeutic options. Cardiac bridging integrator 1 (cBIN1), a cardiomyocyte transverse-tubule (t-tubule) scaffolding protein which organizes the calcium handling machinery, is transcriptionally reduced in HF and can be recovered for functional rescue in mice. Here we report that in human patients with HF with reduced ejection fraction (HFrEF), left ventricular cBIN1 levels linearly correlate with organ-level ventricular remodeling such as diastolic diameter.

Direct procurement with machine perfusion and normothermic regional perfusion in donation after circulatory death heart transplantation.

Background: Donation after circulatory death (DCD) heart transplants have increased in the United States with direct procurement with machine perfusion (DPP) and thoracoabdominal normothermic regional perfusion (TA-NRP) techniques. There remains a paucity of data examining DPP and TA-NRP outcomes. The purpose of this study was to investigate the impact of the DCD technique on post-transplant outcomes compared to donation after brain death (DBD) donors.

Cost-Effectiveness of a Shock Team Approach in Refractory Cardiogenic Shock.

Background: Multidisciplinary Shock Teams have improved clinical outcomes for cardiogenic shock, but their implementation costs have not been studied. This study's objective was to compare costs between patients treated with and without a Shock Team and determine if the team's implementation is cost-effective compared with standard of care.

Methods: We examined patients with refractory cardiogenic shock treated with or without a Shock Team at a tertiary academic hospital from 2009 to 2018.

Clinical Characteristics and Outcomes of Patients Suffering Acute Decompensated Heart Failure Complicated by Cardiogenic Shock.

Background: Cardiogenic shock (CS) can stem from multiple causes and portends poor prognosis. Prior studies have focused on acute myocardial infarction-CS; however, acute decompensated heart failure (ADHF)-CS accounts for most cases. We studied patients suffering ADHF-CS to identify clinical factors, early in their trajectory, associated with a higher probability of successful outcomes.

Pathophysiologic Vasodilation in Cardiogenic Shock and Its Impact on Mortality.

Background: Cardiogenic shock (CS) mortality remains near 40%. In addition to inadequate cardiac output, patients with severe CS may exhibit vasodilation. We aimed to examine the prevalence and consequences of vasodilation in CS.

Impact of Diabetes and Glycemia on Cardiac Improvement and Adverse Events Following Mechanical Circulatory Support.

Background: Type 2 diabetes is prevalent in cardiovascular disease and contributes to excess morbidity and mortality. We sought to investigate the effect of glycemia on functional cardiac improvement, morbidity, and mortality in durable left ventricular assist device (LVAD) recipients.

Methods And Results: Consecutive patients with an LVAD were prospectively evaluated (n=531).