Single-center experience of LVAD implantation in patients with sickle-cell trait: A retrospective analysis.

BACKGROUND: The most worrisome complications in patients supported by left ventricular assist device (LVAD) are pump thrombosis, embolism, and bleeding. The actual rate of these events in patients with sickle-cell disease (SCD) has not well investigated. The aim of our study is to evaluate the outcomes of LVAD implantation in patients with sickle-cell hemoglobinopathy at our institution. METHODS: This retrospective, observational, single-center study was conducted on patients with sickle-cell trait (SCT), who underwent LVAD implantation using the HeartMate3 LVAD. RESULTS: LVAD devices were implanted in four patients with SCT. All procedures were performed successfully. All patients had uneventful post-implant course. Overall, the mean follow-up time was 25 months (range 21-28 months) and showed an unremarkable post-implant course. There was a significant improvement in hematological markers over the follow-up period. CONCLUSIONS: Despite the limited numbers of patients enrolled in this study, our findings indicate that LVAD surgery is safe in SCD patients and offers remarkable clinical improvement. Further studies are needed to provide more evidence regarding this type of patients undergoing LVAD implantation.

Outcome of percutaneous HeartMate3 decommissioning: A single-centre experience.

OBJECTIVES: To highlight the role of percutaneous left ventricular assist device (LVAD) decommissioning as a safe procedure after myocardial recovery in patients with advanced heart failure. BACKGROUND: The HeartMate3 LVAD (Abbott, Chicago, IL, USA) is designed to provide circulatory support with enhanced hemocompatibility for patients with advanced heart failure. Most VADs are used as a bridge to heart transplantation; however, in certain cases, myocardial function recovers, and VADs can be explanted after the patient is weaned. Although surgical explantation remains the gold standard, minimally invasive percutaneous decommissioning has been described as a successful alternative. In this study, we present our experience, one-year outcomes, and adverse events associated with percutaneous LVAD decommissioning. METHODS: We conducted a retrospective review of data from six consecutive patients who underwent percutaneous LVAD decommissioning. RESULTS: Six patients were enrolled in the study. For all six patients, HM3 decommissioning was completed at least 6 months ago. No technical complications were documented. No strokes were observed within the study period, and the ejection fraction improved. The mean follow-up duration was 18 ± 8.5 months, and the survival rate was 100%. CONCLUSION: Percutaneous HeartMate3 decommissioning appears to be safe. In particular, the survival after the procedure was 100%, and no events, especially thromboembolic ones, occurred.

Aortic Coarctation Effect on Atherosclerosis of the Left Internal Mammary Artery: A Case Presentation and Literature Review.

Atherosclerosis of the internal mammary artery (IMA) is an uncommon disease. We present a case report of a patient with stable angina who had a history of coarctation repair. After meticulous investigation and discussion, a coronary artery bypass graft (CABG) was planned. During the surgery, we found that the left internal mammary artery (LIMA) was severely atherosclerotic without any blood flow, and a fragment of LIMA was taken for histopathological examination for further insight into pathogenesis. Vein grafts were alternatively used. Furthermore, relevant literature review and management were discussed for the use of LIMA in patients with a history of aortic coarctation.

Uncommon Location of a Papillary Fbroelastoma: Case Report.

An elderly man, with a history of diabetes and hypertension presented to our hospital complaining of attack of syncope and palpitations. Echocardiogram revealed the presence of a pedunculated mass attached to the interventricular septum. Sternotomy was performed and ascending aorta was opened transversely, aortic valve leafets were retracted, and a tumour was resected. The postoperative course was uneventful; the patient was discharged after 1 week from the operation. This case demonstrates atypical location for fibroelastoma on the interventricular septum, thus underpinning the need for proper assessment of all patients with a history of systemic embolization to rule out any unusual intracardiac causes.

Un homme âgé ayant des antécédents de diabète et d'hypertension s'est présenté à notre hôpital pour des épisodes de syncope et des palpitations. L'échocardiographie a mis en évidence une masse pédiculée fixée au septum interventriculaire. Une sternotomie a été pratiquée; l'aorte ascendante a été ouverte transversalement, les feuillets de la valve aortique ont été rétractés, et une tumeur a été retirée. La période postopératoire s'est déroulée sans incident; le patient a obtenu son congé une semaine après l'intervention chirurgicale. Ce cas montre l'emplacement atypique d'un fibroélastome sur le septum interventriculaire, confirmant qu'il faut procéder à une évaluation appropriée de tous les patients ayant des antécédents d'embolisation générale afin d'exclure toutes les causes intracardiaques inhabituelles.

Fracture of an Edwards Duromedics Mitral Prosthesis Leaflet.

We report the case of a 54-year-old patient who underwent a repeated mitral replacement after a nontraumatic fracture of a leaflet of an Edwards Duromedics (Baxter) mechanical prosthesis that was performed 33 years after implantation. This paper discusses the different options for surgical management of such a complication. (Level of Difficulty: Intermediate.).

The effect of pannus and weight gain in mitral stenosis after mitral ring annuloplasty.

Pannus formation is a known complication of valve replacement surgery. However, few cases describe pannus formation in the mitral position, and they are mostly associated with prosthetic valves rather than only annuloplasty. We describe the case of a 62-year-old woman who first underwent reductive annuloplasty using a Carpentier-Edwards 28 mm ring prosthesis in 2009 that performed well on regular follow-up for 5 years. In 2014, the patient presented with significant weight gain, shortness of breath (New York Heart Association functional class III) and signs of severe mitral stenosis. Echocardiography demonstrated the formation of a pannus and increased pressure gradients. Removal of the ring prosthesis and pannus-like fibrotic tissue was performed. The native valve was left in place as it had supple leaflets and performed well once properly debrided. The patient remained well throughout a 24-month follow-up. .

Fistula formation following repair of a pseudoaneurysm of the mitral-aortic intervalvular fibrosa - A rare complication.

The mitral-aortic intervalvular fibrosa is an avascular fibrous structure connecting the mitral and aortic annuli that is prone to pseudoaneurysm formation. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a known complication of many conditions such as infective endocarditis and valvular surgery. It requires surgical correction. Its long-term consequences are little known. We present in this report the case of a 62-year-old male with history of pseudoaneurysm of the mitral-aortic intervalvular fibrosa repair and redo mitral and aortic prosthetic valve replacements. After five years of asymptomatic follow-up, the patient presented with sudden-onset heart failure. Echocardiographic investigation demonstrated two aorto-atrial fistulae at the site of his previous repair and adequate function of both prosthetic valves. The fistulae were repaired and the prosthetic valves were left in place. This represents a potential late surgical complication of pseudoaneurysm of the mitral-aortic intervalvular fibrosa. .

Surgical Treatment of an Anomalous Left Coronary Artery From the Pulmonary Artery in a Sexagenarian Woman.

Late presentation of an anomalous left coronary artery from the pulmonary artery (ALCAPA) is uncommon because patients rarely survive past infancy. We present a case of symptomatic ALCAPA associated with decreased myocardial contractility in a 68-year-old woman. The patient underwent reimplantation of the left coronary artery in the aortic root.