Prospective Phenotyping of Right Ventricle Function Following Intra-Aortic Balloon Pump Counterpulsation in Left Ventricular Assist Device Candidates: Outcomes and Predictors of Response.

Intra-aortic balloon pump (IABP) may be applied to optimize advanced heart failure (AHF) patients and improve right ventricular (RV) function before left ventricular assist device (LVAD) implantation. We aimed to evaluate the outcome of this intervention and define RV response predictors. Decompensated AHF patients, not eligible for LVAD because of poor RV function, who required IABP for stabilization were enrolled. Echocardiography and invasive hemodynamics were serially applied to determine fulfillment of prespecified "LVAD eligibility RV function" criteria (right atrium pressure [RA] <12 mm Hg, pulmonary artery pulsatility index [PAPi] >2.00, RA/pulmonary capillary wedge pressure [PCWP] <0.67, RV strain <-14.0%). Right ventricular-free wall tissue was harvested to assess interstitial fibrosis. Eighteen patients (12 male), aged 38 ± 14 years were supported with IABP for 55 ± 51 (3-180) days. In 11 (61.1%), RV improved and fulfilled the prespecified criteria, while seven (38.9%) showed no substantial improvement. Histopathology revealed an inverse correlation between RV interstitial fibrosis and functional benefit following IABP: interstitial fibrosis correlated with post-IABP RA ( r = 0.63, p = 0.037), RA/PCWP ( r = 0.87, p = 0.001), PAPi ( r = -0.83, p = 0.003). Conclusively, IABP improves RV function in certain AHF patients facilitating successful LVAD implantation. Right ventricular interstitial fibrosis quantification may be applied to predict response and guide preoperative patient selection and optimization. http://links.lww.com/ASAIO/A995.

The effect of paracorporeal pulsatile biventricular assist devices on allosensitization in adults: A comparison with left ventricular assist devices.

Ventricular assist devices (VADs) have been associated with the development of anti-HLA antibodies ('allosensitization'), but data on devices providing biventricular support in adults are limited. We sought to characterize differences in anti-HLA antibody formation in adult patients receiving left- (LVAD) versus biventricular- (BiVAD) assist devices as bridge to transplantation (BTT) by retrospectively reviewing the records of adult patients who have undergone VAD implantation at our institution. We assessed 82 patients supported with a pulsatile-flow paracorporeal BiVAD and compared them with 40 patients receiving LVAD till 2018. Forty-eight (58.5%) of the BiVAD and 23 (57.5%) of the LVAD patients were eventually transplanted (p = 0.91) with an average time to transplantation 559 and 598 days, respectively (p = 0.73). Evidence of sensitization pre-VAD was found in 11.0% of the BiVAD patients and 15.0% of the LVAD ones (p = 0.53); these percentages rose to 43.9% (p < 0.001) and 40.0% (p = 0.01), respectively. The post-VAD sensitization status was not significantly different between the BiVAD and the LVAD group (p = 0.68). De novo sensitization was comparable between the two groups (p = 0.55). Post-transplantation outcomes regarding rejections and cardiac allograft vasculopathy were also similar. Conclusively, BiVAD- and LVAD- induced allosensitization do not appear to differ significantly.

Reversible right heart failure after redo operation of a post-traumatic Gerbode defect.

INTRODUCTION: Gerbode defect is a rare entity and represents a small percent of all congenital defects. If left untreated, right heart failure may occur. CASE REPORT: We describe a redo case of a 47-year-old patient complaining about the signs and symptoms of decompensating right heart failure after a surgically treated post-traumatic Gerbode defect 8 years prior. DISCUSSION: Although it is described as a congenital defect, in clinical practice, results mostly as an iatrogenic complication after heart valve surgery, endocarditis, nodal ablation, or post-traumatic defect. Surgical correction is the treatment of choice independently of the provided cause. Dimensions, the position of the defect, are very important factors for the interventional approach. At 12 months post-operatively, the patient remained completely asymptomatic. He has an active life and presents all the echocardiographic metrics within normal values. CONCLUSION: We strongly recommend that in cardiac areas where high wall tension is applied, durable materials such as Dacron should be used. We also believe that a well-documented discussion with the patient, about his medical condition and his therapeutic alternatives, is imperative.

What is the role of sutureless aortic valves in today's armamentarium?

INTRODUCTION: Sutureless and rapid-deployment aortic bioprostheses represent an emerging and promising technology for the treatment of aortic valve stenosis. Unlike traditional aortic bioprostheses, these devices are not hand-sewn, thus allowing a significant reduction in operative times, while facilitating minimally invasive surgery and complex cardiac interventions. Sutureless aortic valve replacement represents a less invasive treatment option and an excellent alternative to conventional aortic valve replacement in elderly and higher risk patients. Areas covered: This review summarizes the current literature on sutureless and rapid-deployment aortic bioprostheses, focusing on their hemodynamic and clinical performance. Moreover, we highlight clinical caveats associated with these devices and report the current recommendations for their use, as advocated by experts in the field. Expert commentary: Finally, we summarize our group's technical modification with regards to positioning of these bioprostheses and propose some technical aspects which could decrease post-procedural permanent pacemaker requirement.

Treatment of a pseudoaneurysm of the ascending aorta in association with aortopulmonary fistula following acute Type A dissection.

This report describes a rare case of aortic pseudoaneurysm with an aortopulmonary fistula in a 69-year-old woman two years following repair of a Type A aortic dissection. The patient presented with NYHA Class IV symptoms having deteriorated rapidly over a course of six weeks. We describe our successful surgical repair following a failed attempt of percutaneous closure with an atrial septal occlusion device.