Blood type O heart transplant candidates have longer waitlist time and higher delisting under the new allocation system.

OBJECTIVE: Prior studies have examined the effect of blood type on heart transplantation (HTx) waitlist outcomes in cohorts through 2015. We aim to analyze the effect of blood type on contemporary waitlist outcomes with a new allocation system focus. METHODS: Adults listed for HTx between April 2015 and December 2020 were included. Survival to HTx and waitlist death/deterioration was compared between type O and non-type O candidates using competing risks regression. Donor/recipient ABO compatibility trends were further investigated. RESULTS: Candidates with blood type O (n = 7509) underwent HTx less frequently than candidates with blood type other than type O (n = 9699) (subhazard ratio [sHR], 0.56; 95% CI, 0.53-0.58) with higher rates of waitlist death/deterioration (sHR, 1.18; 95% CI, 1.04-1.34). Subgroup analyses demonstrated persistence of this trend under the new donor heart allocation system (HTx: sHR, 0.58; 95% CI, 0.54-0.62; death/clinical deterioration: sHR, 1.27; 95% CI, 1.02-1.60), especially among those listed at high status (1, 2, or 3) (HTx: sHR, 0.69; 95% CI, 0.63-0.75; death/deterioration: sHR, 1.61; 95% CI, 1.16-2.22). Among those listed at status 3, waitlist death/deterioration was modified by presence of a durable left ventricular assist device (left ventricular assist device: sHR, 1.57; 95% CI, 0.58-4.29; no left ventricular assist device: sHR, 3.79; 95% CI, 1.28-11.2). Type O donor heart allocation to secondary ABO candidates increased in the new system (14.5% vs 12.0%; P < .01); post-HTx survival remained comparable between recipients with blood type O and non-type O (log-rank P = .07). CONCLUSIONS: Further logistical considerations are warranted to minimize allocation inequity regarding blood type under the new allocation system.

Mechanical Circulatory Support Options in Patients With Aortic Valve Pathology.

Mechanical circulatory support (MCS) is used in cardiogenic shock for periprocedural hemodynamic stability in high-risk patients and to support patients with symptomatic coronary artery disease. Depending on the MCS type, oxygenation and ventilation, in addition to increasing blood pressure by augmenting blood flow, can be achieved. MCS typically follows a failure of less invasive maneuvers or intolerance to them, such as significant ventricular arrhythmia burden from inotropic support. MCS options include intra-aortic balloon pump, transvalvular percutaneous left ventricular assist devices, venoarterial extracorporeal membrane oxygenation, and surgically implanted left ventricular assist devices. The number of MCS options has increased, and this has made the decision-making process complicated. MCS decision-making is complex, even in patients without valvular pathology. The presence of aortic valve (AV) abnormalities, such as aortic stenosis, aortic insufficiency, replaced AVs, or AV masses, adds even further to the challenge of selecting the appropriate support strategy. In this narrative review, a concise review of MCS options and the special considerations for various AV pathologies are presented.

A Thrombus in Transit Complicating Acute Pulmonary Embolism.

A 51-year-old man presented with acute pulmonary embolism. He was found to have a large intracardiac thrombus in transit across a patent foramen ovale. He underwent anticoagulation and urgent surgical thrombectomy with good outcome. (Level of Difficulty: Beginner.).

Single-port Laparoscopic Appendectomy: Beyond the Learning Curve: A Retrospective Comparison With Multi-port Laparoscopic Appendectomy.

OBJECTIVES: Previous comparisons between single-port laparoscopic appendectomy (SPLA) and multi-port laparoscopic appendectomy have been conflicting and limited. We compare our single-surgeon, SPLA experience with multi-port cases performed during the same time. METHODS: A retrospective chart review of 128 single-surgeon single-port and 941 multi-port laparoscopic appendectomy cases from April 2009 to December 2014 was conducted. RESULTS: Patient demographics and preoperative laboratory values were comparable. SPLA was associated with shorter operative time (P=0.0001). There was no statistically significant difference in length of hospitalization, postoperative pain medication use, cost, postoperative complication rates (ileus, urinary retention, deep space infection), or readmission between the 2 groups. There were no postoperative incisional hernias in the single-port group. The single-port group had more postoperative oxycodone use (P=0.0110). CONCLUSIONS: Our study supports recently published metaanalyses that fail to support older studies demonstrating longer operative times, and higher hernia rates with SPLA.

Torsades de Pointes in Intravenous Drug Abuse-Associated Infective Endocarditis.

Intravenous drug abuse rates in the United States have increased exponentially in recent years. Ohio is one of 5 states with the highest age-adjusted drug overdose death rates, with drug overdose causing 39.1 of every 100,000 deaths. In patients who survive, the associated morbidity poses a significant public health burden. Infective endocarditis, defined as an infection of the endocardium of the heart, is a potentially lethal consequence of bacteremia related to intravenous drug abuse. Methicillin-sensitive Staphylococcus aureus (MSSA) is the most commonly implicated organism and may affect the tricuspid valve. Indications for surgery include failure of medical management, worsening embolization, heart failure, and arrhythmias-typically bradyarrhythmias from infectious extension into the conduction system. Vegetation size and type of infection, such as drug-resistance pattern, fungal infection, and presence of prosthetic material, are becoming known risk factors for complications. Studies have demonstrated that early surgery tends to have a better prognosis than delayed intervention. Established guidelines for right-sided surgery are slowly evolving. Tricuspid valve surgery is becoming more common in these cases, but there is known risk for heart block owing to proximity of the conduction system to the tricuspid valve annulus. If patients develop complete heart block postoperatively, pacemaker placement may be indicated. There may be reluctance to implantation because of the risk of device infection with infective endocarditis. In addition, many may recover conduction as infection and edema resolve. Generally, bradyarrhythmias are well tolerated. However, we present 2 cases of torsades de pointes related to post-tricuspid-valve-replacement bradyarrhythmia. Torsades de pointes is a potentially lethal form of polymorphic ventricular arrhythmia associated with QT interval prolongation. Post-tricuspid-valve- replacement mortality may be secondary to induced lethal ventricular arrhythmias.