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.

Recurrent Heart Failure From Fulminant Giant Cell Myocarditis Following COVID-19 Infection Requiring Heart Transplantation.

Background: Giant cell myocarditis (GCM) is a rare, rapidly progressive inflammatory cardiomyopathy marked by T cell-mediated myocardial destruction. Early diagnosis is difficult, and outcomes are poor without aggressive treatment.

Case Summary: A 46-year-old woman with recent COVID-19 presented with flulike symptoms and dyspnea.

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.

Robotic Lung Transplantation: Feasibility, Initial Experience, and 3-Year Outcomes.

Background: Lung transplantation is performed through clamshell or sternotomy incisions, which may contribute to morbidity and limit patient eligibility. Robotic lung transplantation offers a less-invasive alternative, but data informing treatment choice are limited. This study was therefore designed to evaluate midterm outcomes of robotic and minimally invasive lung transplantation.

Hyperbaric Oxygen Therapy for Necrotizing Soft Tissue Infections: A Retrospective Cohort Analysis of Clinical Outcomes.

Hyperbaric oxygen therapy (HBOT) is an adjunctive therapy for necrotizing soft tissue infections (NSTIs) that remains controversial due to lack of quality clinical evidence. This retrospective cohort examines the impact of HBOT on clinical outcomes from NSTI at a single center where evaluation for HBOT is standard of care. The COVID-19 pandemic disrupted HBOT service and NSTI cases went without HBOT treatment, allowing for a comparison of treatment groups.

Improvement in radiologic findings over time is associated with increased survival in patients with viral ARDS requiring extracorporeal membrane oxygenation.

Introduction: Acute respiratory distress syndrome (ARDS) requiring venovenous extracorporeal membrane oxygenation (VV ECMO) support is associated with chest radiograph changes commonly referred to as "drowning ECMO lung" ECMO lung presents as white-out of both lung fields, involving all lobes of the bilateral lungs. While the clinical significance of chest radiograph findings over time has been described in the general ARDS population, it has not been evaluated specifically in VV ECMO patients. This subpopulation suffers the most severe disease as well as the confounding effects of ECMO support.

Minimally Invasive Direct Aortic Implantation of Impella 5.5 As Bridge to Transplant: A Case Report.

The use of temporary mechanical circulatory support in cardiogenic shock (CS) is increasing. The Impella (Abiomed) is a percutaneous, microaxial ventricular assist device approved for short-term use in CS that can be implanted peripherally. Direct aortic placement is an alternative commonly performed when the sternum is open, for example, in post-cardiotomy shock or when the peripheral vasculature is of insufficient size or quality for implantation.

Persistent Expectoration of Pulmonary Artery Embolization Coils Requiring Lobectomy.

Transcatheter embolization is an important tool in the treatment of pulmonary artery and bronchial artery pseudoaneurysms, malformations, and hemorrhage. Migration of coils, particularly through erosion into the associated bronchus, is a rare but known potential complication after the use of intravascular embolization coils in the pulmonary vasculature. Here we present a case of migration of segmental pulmonary artery coils through the right lower lobe bronchus and proximally through the vocal cords, causing significant symptoms of discomfort, hemoptysis, and ongoing expectoration of coils necessitating thoracoscopic right lower lobectomy.

Task Sharing in Global Cardiac Surgery: A Scoping Review.

Background: Access to cardiac surgical services is limited in low- and middle-income countries. The shortage of cardiac surgical care providers is a major contributor to this limited access to lifesaving care. Task shifting and task sharing allow nonspecialists to perform roles typically reserved for specialists such as cardiothoracic surgeons, cardiac anesthesiologists, and other health care workers with specific training in cardiac surgical care.

Extracorporeal life support as a bridge to lung transplantation: Where are we now?

The number of lung transplant procedures performed internationally is increasing but the donor organ pool is insufficient to meet demand and waiting list mortality is unacceptably high. As survival rates for patients with acute respiratory distress syndrome managed on extracorporeal life support (ECLS) have steadily improved, a potential role for ECLS to support critically ill patients awaiting a donor organ match has emerged. We explore the rapidly evolving landscape of ECLS as a bridge to lung transplantation with review of the patient selection criteria, predictors of survival, modes of pre and peri-transplant support, and the importance of a holistic multidisciplinary approach to care.

Ischemia-reperfusion Injury in the Transplanted Lung: A Literature Review.

Lung ischemia-reperfusion injury (LIRI) and primary graft dysfunction are leading causes of morbidity and mortality among lung transplant recipients. Although extensive research endeavors have been undertaken, few preventative and therapeutic treatments have emerged for clinical use. Novel strategies are still needed to improve outcomes after lung transplantation.

Postoperative small bowel obstruction secondary to single malformed staple following laparoscopic total abdominal colectomy.

Surgical staplers are ubiquitous in gastrointestinal surgery, especially laparoscopy. Intraperitoneal staples are designed to be inert and are generally regarded as benign; however, complications from primarily malformed staples can rarely occur. Here, we present a case of early mechanical postoperative small bowel obstruction due to a surgical staple following laparoscopic total abdominal colectomy and end ileostomy creation performed for medically refractory ulcerative colitis.

Small bowel necrosis and perforation due to sodium polystyrene sulfonate in the setting of graft versus host disease and fulminant infection.

Gastrointestinal injury is a common adverse event associated with use of sodium polystyrene sulfonate (SPS), tradename Kayexalate. Risk factors for SPS-mediated gastrointestinal necrosis include chronic kidney disease, solid organ transplant recipiency and recent surgery. This report presents a patient with past medical history significant for acute myeloid leukemia (AML) complicated by graft versus host disease (GvHD) and colitis who initially presented with small bowel obstruction.

Heterotopic Porcine Cardiac Xenotransplantation in the Intra-Abdominal Position in a Non-Human Primate Model.

Heterotopic cardiac transplantation in the intra-abdominal position in a large animal model has been essential in the progression of the field of cardiac transplantation. Our group has over 10 years of experience in cardiac xenotransplantation with pig to baboon models, the longest xenograft of which survived over 900 days, with rejection only after reducing immunosuppression. This article aims to clarify our approach to this model in order to allow others to share success in long-term survival.