Successful combined liver-kidney transplant with intraoperative VA-ECMO and Impella 5.5 support.

Cardiogenic shock during liver transplantation (LT) is a significant challenge, particularly in patients with comorbidities like end-stage renal disease (ESRD). Mechanical circulatory support (MCS), including veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to manage refractory shock in these complex cases. This case report discusses the management of a 69-year-old patient who developed intraoperative refractory cardiogenic shock while undergoing combined liver-kidney transplantation and was supported with VA-ECMO and Impella 5.

Risk Factors for Development of Stroke in Patients With Continuous-Flow Left Ventricular Assist Device Support as Destination Therapy.

Background: Continuous-flow left ventricular assist devices (LVADs) are increasingly used as destination therapy. Although postimplantation stroke rates have been described in the context of bridge-to-transplant or mixed cohorts, stroke development is not well evaluated in patients who receive continuous-flow LVAD with a destination therapy indication. This report characterizes the stroke profile of a modern institutional cohort of patients undergoing destination therapy and evaluates their risk factors for stroke onset.

Mechanical Circulatory Support Strategies for Cardiogenic Shock Secondary to Peripartum Cardiomyopathy.

Background: Peripartum cardiomyopathy (PPCM) is a severe complication of pregnancy hallmarked by nonischemic reduction in left ventricular ejection fraction to <45% late in gestation or shortly postpartum. This study evaluated outcomes among women who required mechanical circulatory support (MCS) for end-stage heart failure in the setting of PPCM.

Methods: Thirty female patients 18-46 years of age underwent advanced heart failure surgical procedures for PPCM between 2012 and 2020.

Multidisciplinary Management and Staged Surgical Treatment for Chronic Thromboembolic Pulmonary Hypertension and Subclavian Vein Thrombosis Caused by Venous Thoracic Outlet Syndrome.

Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of deep vein thrombosis (DVT) and pulmonary embolism (PE), occurring in 3-5% of patients despite therapeutic anticoagulation. Venous thoracic outlet syndrome (VTOS) causing subclavian vein (SCV) thrombosis is also an uncommon condition, not frequently associated with clinically significant PE. In this report, we present two patients with CTEPH and SCV thrombosis caused by VTOS who had successful multidisciplinary management and staged surgical treatment for both conditions.

Outcomes in peripheral right ventricular device support: Comparing the dual lumen, single canula and femoral vein cannulation strategies for right ventricular support.

IntroductionThe Protek Duo (PtD) dual lumen, single cannula was developed as a percutaneous system for temporary mechanical support, inserted through the internal jugular vein (IJ) for both atrial inflow and pulmonary artery outflow. Outcomes of PtD compared to alternative Peripheral Right Ventricular Assist Device (pRVAD) methods are limited.MethodsA retrospective analysis was conducted of pRVAD recipients from January 2017 - February 2022 ( = 111).

Escalating Surgical Treatment for Left Ventricular Assist Device Infection and Expected Mortality: Clinical Risk Prediction Score.

Background: Left ventricular assist devices (LVAD) improve survival for patients with cardiac failure, but LVAD-specific infection (VSI) remains a challenge with poorly understood predictive risk factors. The indications and use of escalating medical treatment to surgical debridement and potential flap reconstruction are not well characterized.

Study Design: A retrospective review of consecutive patients undergoing primary LVAD implantation at a tertiary academic center was performed.

Physiologic benefits of veno-pulmonary extracorporeal membrane oxygenation for COVID-19 ARDS: A single center experience.

Background: A subset of patients with COVID-19 acute respiratory distress syndrome (ARDS) require extracorporeal membrane oxygenation (ECMO). Veno-pulmonary (VP) ECMO provides support to the right ventricle and decreased risk of recirculation.

Methods: A retrospective analysis of patients with COVID-19 ARDS and VP ECMO was performed.

Surgically implanted endovascular, microaxial left ventricular assist device: A single institution study.

Objective: The Impella 5.5 (Abiomed, Inc), a surgically implanted endovascular microaxial left ventricular assist device, is increasingly used worldwide and there have been more than 10,000 implants. The purpose of this study is to describe a large-volume, single-center experience with the use of the Impella 5.

Advanced Respiratory Support Days as a Novel Marker of Mortality in COVID-19 Acute Respiratory Distress Syndrome Requiring Extracorporeal Membrane Oxygenation.

Emerging evidence suggests prolonged use of noninvasive respiratory support may increase mortality of patients with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome who require extracorporeal membrane oxygenation (ECMO). Using a database of adults receiving ECMO for COVID-19, we calculated survival curves and multivariable Cox regression to determine the risk of death associated with pre-ECMO use of high-flow nasal oxygen (HFNO), noninvasive ventilation (NIV), and invasive mechanical ventilation (IMV) days. We investigated the performance of a novel variable, advanced respiratory support days (composite of HFNO, NIV, and IMV days), on Respiratory ECMO Survival Prediction (RESP) score.

Management of severe tricuspid valve regurgitation due to ruptured papillary muscle in a patient with mediastinitis early after heart transplant.

Objective: Even though severe tricuspid regurgitation is not uncommon after cardiac transplantation, primary severe tricuspid regurgitation is rare. We present such a case with additional complexities.

Methods: The patient was 44-year-old man with a HeartWare durable left ventricular assist device (Heartware Inc) who received a temporary right ventricular assist device (RVAD) with a ProtekDuo cannula (LivaNova Inc USA) for refractory ventricular fibrillation and underwent a heart transplant as United Network for Organ Sharing Status 1, in the presence of partially compensated cardiogenic shock, renal failure.

Characterization of de novo malignancy after orthotopic heart transplantation: single-centre outcomes over 20 years.

Objectives: Malignancy is the leading cause of late mortality after orthotopic heart transplantation (OHT), and the burden of post-transplantation cancer is expected to rise in proportion to increased case volume following the 2018 heart allocation score change. In this report, we evaluated factors associated with de novo malignancy after OHT with a focus on skin and solid organ cancers.

Methods: Patients who underwent OHT at our institution between 1999 and 2018 were retrospectively reviewed (n = 488).

Circulatory Arrest for Traumatic Brachiocephalic Artery Pseudoaneurysm Repair.

Blunt traumatic injuries to the brachiocephalic artery require surgical management. The operative technique used depends on the location of the injury, the patient's hemodynamic stability, and the surgeon's experience. Perfusion strategy can facilitate vascular control of the aortic arch and branch vessels.

Competing Risks to Transplant in Bridging With Continuous-flow Left Ventricular Assist Devices.

Background: Continuous-flow left ventricular assist device (CF-LVAD) support is a mainstay in the hemodynamic management of patients with end-stage heart failure refractory to optimal medical therapy. In this report we evaluated waitlist complications and competing outcomes for CF-LVAD patients compared with primary transplant candidates listed for orthotopic heart transplantation at a single center.

Methods: All patients listed for orthotopic heart transplantation between 2006 and 2020 at our institution were retrospectively reviewed (CF-LVAD, 300; primary transplant, 244).

30 Years of Heart Transplant: Outcomes After Mechanical Circulatory Support From a Single Center.

Background: Survival after bridge to transplantation with mechanical circulatory support (MCS) has yielded varying outcomes on the basis of device type and baseline characteristics. Continuous-flow left ventricular assist devices (CF-LVADs) have significantly improved waitlist mortality, but recent changes to the transplantation listing criteria have dramatically altered the use of MCS for bridge to transplantation.

Methods: Orthotopic heart transplantations from 1988 to 2019 at our institution (Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO) were retrospectively reviewed and stratified by pretransplantation MCS status into CF-LVAD (n = 224), pulsatile LVAD (n = 49), temporary MCS (n = 71), and primary transplantation (n = 463) groups.

Cannulation Strategy for Extracorporeal Membrane Oxygenation Does Not Influence Total Hospital Cost.

Background: The Center for Medicare and Medicaid Services decreased reimbursement rates for peripheral venoarterial (VA) extracorporeal membrane oxygenation (ECMO) and venovenous (VV) ECMO procedures in October 2018. Limited data are available describing hospital costs and clinical resources required to support ECMO patients.

Methods: All patients supported on ECMO at our institution between March 2017 and October 2018 were identified.

Cardiac allograft rejection in the current era of continuous flow left ventricular assist devices.

Objective: Left ventricular assist device (LVAD) implantation has been shown to increase allosensitization before orthotopic heart transplantation, but the influence of LVAD support on posttransplant rejection is controversial. This study examines the postoperative incidence of acute cellular rejection (ACR) in patients bridged with continuous flow LVAD (CF-LVAD) relative to primary transplant (Primary Tx).

Methods: All patients who underwent orthotopic heart transplantation at our institution between July 2006 and March 2019 were retrospectively reviewed (n = 395).

Hypertrophic obstructive cardiomyopathy: the Mayo Clinic experience.

Background: Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease characterized by left ventricular hypertrophy in the absence of other etiologies. Clinical presentation may vary from asymptomatic to sudden cardiac death. Medical treatment is the first-line therapy for symptomatic patients.

Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve-in-Ring Implantation: A Word of Caution.

Left ventricular outflow tract obstruction is a well-known, albeit rare, adverse event that can occur after mitral valve replacement. With the current increase in transcatheter valve interventions, new and unique adverse events may be expected to occur. We present a case of severe left ventricular outflow tract obstruction that developed after transcatheter mitral valve implantation.

Right Coronary Artery Septic Embolization Secondary to Aerococcus urinae Native Mitral Valve Endocarditis.

Septic embolization to the coronary arteries from infective endocarditis is a rare occurrence. Appropriate treatment is not yet fully determined. We report a case of mitral valve endocarditis due to Aerococcus urinae presenting as acute inferior myocardial infarction.

Libman-Sacks Endocarditis in a Patient With Antiphospholipid Syndrome.

Antiphospholipid syndrome is a systemic autoimmune syndrome with cardiac manifestations such as nonbacterial thrombotic endocarditis, also known as Libman-Sacks endocarditis. A 61-year-old female with history of antiphospholipid syndrome presented in acute pulmonary edema. Echocardiography demonstrated mobile vegetations on the free margins of both the anterior and the posterior mitral valve leaflets.

Reduced left internal mammary artery blood flow on normal sternal retraction.

The left internal mammary artery is the conduit of choice for bypassing the left anterior descending artery. A 72-year-old man underwent off-pump triple-vessel coronary artery bypass. The left internal mammary artery was harvested with brisk blood flow from the distal artery on completion of harvesting, but normal sternal retraction with a Medtronic OctoBase retractor led to cessation of flow.