Impella 5.5: A Systematic Review of the Current Literature.

OBJECTIVE: Impella 5.5 (Abiomed, Danvers, MA, USA) is a temporary mechanical circulatory support device used for patients in cardiogenic shock. This review provides a comprehensive overview of the device's clinical effectiveness, safety profile, patient outcomes, and relevant procedural considerations. METHODS: We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed/MEDLINE database. The search query included articles available from October 6, 2022, through January 13, 2023. Our initial search identified 75 studies. All records were screened by 2 independent reviewers using the Covidence software for adherence to our inclusion criteria, and 8 retrospective cohort studies were identified as appropriate for inclusion. RESULTS: Across the included studies, the sample size ranged from 4 to 275, with predominantly male cohorts. Indications for Impella support varied, and the duration of support ranged from 9.8 to 70 days. Overall, Impella support appeared to be associated with favorable survival rates and manageable complications in various patient populations. Complications associated with Impella use included bleeding, stroke, and device malfunctions. Two studies compared prolonged and Food and Drug Administration-approved Impella support, showing similar outcomes and adverse events. CONCLUSIONS: Impella 5.5 continues to be an attractive option for bridging patients to definitive therapy. Survival during and after Impella 5.5 was favorable for patients regardless of initial indication. However, device use was associated with several important complications, which calls for judicious use and a precontemplated exit strategy. Limitations of this literature review include biases inherent to the retrospective studies included, such as selection and publication bias.

Rare confounder: benign multicystic peritoneal mesothelioma in a patient with mucinous colon adenocarcinoma.

Benign multicystic peritoneal mesothelioma (BMPM) is a rare condition, in which patients have multiple cystic lesions of the peritoneum. BMPM can mimic mucinous carcinomatosis and can thus create a diagnostic dilemma. We present the case of a 76-year-old woman who was referred for management of ascending colon adenocarcinoma and was noted to have several nonspecific cystic lesions in the abdomen and pelvis on preoperative computed tomography and diagnostic laparoscopy. Frozen section analysis suggested the lesions contained 'mucin'. Due to concern for metastases, right colectomy was aborted. Final histologic analysis of the laparoscopic biopsies revealed mesothelial cysts, consistent with BMPM, unrelated to her colon adenocarcinoma. Laparoscopic right colectomy was performed 2 weeks later. BMPM can create diagnostic and therapeutic uncertainty in patients with known visceral malignancies when discovered incidentally. Frozen section analysis may not be accurate in differentiating the two, and final histologic confirmation should be sought prior to definitive treatment.

Fate of Abstracts Presented at Annual Meetings of The Society of Thoracic Surgeons from 2015 to 2019.

BACKGROUND: Society of Thoracic Surgeons (STS) annual meetings provide opportunities to disseminate cardiothoracic research. We assessed rates of publication of STS abstracts as manuscripts in peer-reviewed journals over five years and determined factors associated with successful publication. METHODS: The STS "Annual Meeting Archive" was searched online for abstract books from STS annual meetings from 2015-2019. Abstract books were reviewed for information about presented abstracts. A PubMed and Google search was then performed to identify corresponding peer-reviewed journal publications. RESULTS: A total of 1451 abstracts were presented at STS annual meetings from 2015-2019. Overall publication rate of accepted abstracts as manuscripts in peer-reviewed journals was 1097/1451=75.60%. Most published manuscripts were published in The Annals of Thoracic Surgery (750/1097=68.37%). Median duration between abstract presentation and peer-reviewed journal publication was 313[IQR=212.5-458] days. Only 29/1451=2.00% of abstracts won an award, and all 29 of these award-winning abstracts were published as a manuscript. Oral presentation was associated with increased odds of publication compared to poster presentation (OR=1.28[95% CI=1.04-1.71], p=0.021). Median 5-year impact factor of peer-reviewed journals containing these manuscripts was 5.04[IQR=5.04-5.04], and corresponding manuscripts were cited a median of 4[IQR=1-9] times. Overall, 836/1097=76.20% of manuscripts published in peer-reviewed scientific journals had a corresponding North American author. CONCLUSIONS: Annual STS meetings are a forum for the presentation of high-quality research. The rate of publication of accepted STS abstracts as manuscripts in peer-reviewed journals is >75%, comparing favorably with national meetings of other surgical societies, and >2/3 of published manuscripts are published in STS's official journal.

Volumetric analysis of acute uncomplicated type B aortic dissection using an automated deep learning aortic zone segmentation model.

BACKGROUND: Machine learning techniques have shown excellent performance in three-dimensional medical image analysis, but have not been applied to acute uncomplicated type B aortic dissection (auTBAD) using Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS)-defined aortic zones. The purpose of this study was to establish a trained, automatic machine learning aortic zone segmentation model to facilitate performance of an aortic zone volumetric comparison between patients with auTBAD based on the rate of aortic growth. METHODS: Patients with auTBAD and serial imaging were identified. For each patient, imaging characteristics from two computed tomography (CT) scans were analyzed: (1) the baseline CT angiography (CTA) at the index admission and (2) either the most recent surveillance CTA or the most recent CTA before an aortic intervention. Patients were stratified into two comparative groups based on aortic growth: rapid growth (diameter increase of ≥5 mm/year) and no or slow growth (diameter increase of <5 mm/year). Deidentified images were imported into an open source software package for medical image analysis and images were annotated based on SVS/STS criteria for aortic zones. Our model was trained using four-fold cross-validation. The segmentation output was used to calculate aortic zone volumes from each imaging study. RESULTS: Of 59 patients identified for inclusion, rapid growth was observed in 33 patients (56%) and no or slow growth was observed in 26 patients (44%). There were no differences in baseline demographics, comorbidities, admission mean arterial pressure, number of discharge antihypertensives, or high-risk imaging characteristics between groups (P > .05 for all). Median duration between baseline and interval CT was 1.07 years (interquartile range [IQR], 0.38-2.57). Postdischarge aortic intervention was performed in 13 patients (22%) at a mean of 1.5 ± 1.2 years, with no difference between the groups (P > .05). Among all patients, the largest relative percent increases in zone volumes over time were found in zone 4 (13.9%; IQR, -6.82 to 35.1) and zone 5 (13.4%; IQR, -7.78 to 37.9). There were no differences in baseline zone volumes between groups (P > .05 for all). The average Dice coefficient, a performance measure of the model output, was 0.73. Performance was best in zone 5 (0.84) and zone 9 (0.91). CONCLUSIONS: We describe an automatic deep learning segmentation model incorporating SVS-defined aortic zones. The open source, trained model demonstrates concordance to the manually segmented aortas with the strongest performance in zones 5 and 9, providing a framework for further clinical applications. In our limited sample, there were no differences in baseline aortic zone volumes between patients with rapid growth and patients with no or slow growth.

The biological role and future therapeutic uses of nitric oxide in extracorporeal membrane oxygenation, a narrative review.

BACKGROUND: Nitric oxide (NO) is a gas naturally produced by the human body that plays an important physiological role. Specifically, it binds guanylyl cyclase to induce smooth muscle relaxation. NO's other protective functions have been well documented, particularly its protective endothelial functions, effects on decreasing pulmonary vascular resistance, antiplatelet, and anticoagulation properties. The use of nitric oxide donors as vasodilators has been known since 1876. Inhaled nitric oxide has been used as a pulmonary vasodilator and to improve ventilation perfusion matching since the 1990s. It is currently approved by the United States Food and Drug Administration for neonates with hypoxic respiratory failure, however, it is used off-label for acute respiratory distress syndrome, acute bronchiolitis, and COVID-19. PURPOSE: In this article we review the currently understood biological action and therapeutic uses of NO through nitric oxide donors such as inhaled nitric oxide. We will then explore recent studies describing use of NO in cardiopulmonary bypass and extracorporeal membrane oxygenation and speculate on NO's future uses.

Reconsidering FDA Guidelines: A Single-Center Experience of Prolonged Impella 5.5 Support.

OBJECTIVE: Impella 5.5 (Abiomed, Danvers, MA, USA) is approved by the US Food and Drug Administration (FDA) for mechanical circulatory support for ≤14 days. It is unknown whether prolonged support is associated with worse outcomes. We sought to review our single-center experience with Impella 5.5 and compare outcomes based on support duration. METHODS: We retrospectively reviewed adult patients (≥18 years old) supported with Impella 5.5 at our institution (May 2020 to April 2023). Patients on prolonged support (>14 days) were compared with those supported for ≤14 days. RESULTS: There were 31 patients supported with Impella 5.5 including 14 (45.2%) supported >14 days. Median support duration for those on prolonged support was 43.5 (interquartile range [IQR] 25 to 63.5) days versus 8 (IQR 6, 13) days for those who were not (P < 0.001). Overall, the device-related complication rate was 9.7% and did not differ between groups (P = 0.08). Overall, 30-day postimplant survival was 71% and did not differ by support duration (P = 0.2). In-hospital mortality was 32% and did not differ between cohorts (P > 0.99). Among those surviving to explant (n = 22), long-term strategy included bridge to durable ventricular assist device (18%, n = 4), cardiac transplant (55%, n = 12), and cardiac recovery (27%, n = 6). CONCLUSIONS: High-risk patients with cardiogenic shock may be supported with Impella 5.5 beyond the FDA-approved duration without increased risk of complications or mortality.