Berlin heart ventricular assist device as a long-term bridge to transplantation in a Fontan patient with failing single ventricle.

The use of VADs as a BTT in children with heart failure has increased due to enhanced device design and reliability, leading to improved survival, functional capacity, and quality of life. However, the use of VADs in patients with Fontan physiology as a BTT is rare with few case reports. Here, we describe a case of implantation of the Berlin VAD as a BTT for 179 days, one of the longest reported periods of mechanical support, in a child with failing single ventricle.

Biologic mesh use practice patterns in abdominal wall reconstruction: a lack of consensus among surgeons.

BACKGROUND: Despite the prevalence of ventral hernias, there is little agreement as to the most appropriate technique or prosthetic to repair these defects. Our objective was to determine biologic mesh practice patterns of reconstructive surgeons with regard to indications, most appropriate technique, choice of prosthetic, and experience with complications. METHODS: A survey was mailed to 2,000 practicing surgeons. Main outcome measures included surgeon experience with biologic mesh and associated complications. RESULTS: Two hundred and forty (12 %) surgeons responded to the survey. Ten were excluded, as surgeons completing the survey indicated they did not perform ventral hernia repairs or left multiple questions unanswered. Of the 230 included, 93.5 % (n = 215) of responders had experience using biologic mesh. Frequency of biologic graft use in the last year was as follows: low-volume users (<5 times in the last year) 50.7 %; medium-volume users (5-20 times in the last year) 37.3 %; high-volume users (>20 times in the last year) 11.9 %. Indications for biologic mesh use based on wound classifications (clean, clean contaminated, contaminated or dirty) were quite varied and lacked consensus among surgeons (p value < 0.05). The most commonly reported influences for use included personal experience (45 %), literature (28.3 %), and availability (17.2 %). CONCLUSIONS: Despite a lack of level 1 evidence, biologic meshes are being used under various wound classifications. Importantly, use in clean and dirty-infected settings may reflect an inappropriate overuse of these expensive materials. To better guide surgeons, prospective, randomized trials should be undertaken to evaluate the short- and long-term outcomes associated with these materials under the various surgical wound classifications.