Pediatric ventricular assist device registries: update and perspectives in the era of miniaturized continuous-flow pumps.

The success of ventricular assist devices (VADs) in the treatment of end-stage heart failure in the adult population has led to industrial innovation in VAD design, focusing on miniaturization and the reduction of complications. A byproduct of these innovations was that newer generation devices could have clinical applications in the pediatric population. Over the last decade, VAD usage in the pediatric population has increased dramatically, and the newer generation continuous flow (CF) devices have begun to supplant the older, pulsatile flow (PF) devices, formerly the sole option for ventricular assist in the pediatric population. However, despite the increase in VAD implants in the pediatric population, patient numbers remain low, and the need to share data between pediatric VAD centers has become that much more important for the continued growth of VAD programs worldwide. The creation of pediatric VAD registries, such as the Pediatric Registry for Mechanical Circulatory Support (PediMACS), the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) and the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) has enabled the collection of aggregate data from VAD centers worldwide, and provides a valuable resource for clinicians and programs, as more and more pediatric heart failure patients are considered candidates for VAD therapy.

A date pit induced aorto-oesophageal fistula: a case report and concise literature review.

Aorto-oesophageal fistula (AEF) is rare and fatal without intervention. Having consumed a date pit 2 weeks prior, the patient in this case presented with the 'Chiari' triad of chest pain, sentinel arterial upper gastro-intestinal haemorrhage and exsanguination after an asymptomatic interval. Following resuscitation, the patient was managed with a Blakemore tube with both oesophageal and gastric balloons inflated to systemic pressures. An aortic stent graft was planned but the patient died on the operating table. AEFs can be treated surgically with either open or endovascular repair. Open repair is highly risky and involves combined replacement/bypass of the thoracic aorta along with resection/repair of the involved oesophagus. Endovascular repair can prevent fatal exsanguination and increase the likelihood of survival but is associated with a significant rate of secondary infection, recurrence of fistula, mediastinitis and sepsis. Further studies are required to inform on management.

Surgical risk algorithm as a measure of successful adoption of transapical transcatheter aortic valve implantation.

OBJECTIVE: This study was performed to assess the Society of Thoracic Surgeons (STS) score as a measure of successful adoption of transapical transcatheter aortic valve implantation (TAVI). METHODS: The STS score for estimated surgical mortality was calculated and used to select the first 140 consecutive patients undergoing transapical TAVI. The STS score also was used to estimate postoperative morbidity. The comparisons were made between the observed and estimated mortality and morbidity in the entire group, as well as in the first 35, second 35, and last 70 consecutive patients. RESULTS: The differences in outcomes between the first 35, second 35, and last 70 patients were statistically significant for surgical mortality (20.0% vs 14.3% vs 2.9%; P = .045), composite morbidity/mortality (34.3% vs 40.1% vs 15.7%; P = .020), and long length of stay (34.3% vs 45.7% vs 18.6%; P = .027). There were trends of marked decreases in prolonged ventilation (11.4% vs 20.0% vs 4.3%; P = .061), and acute renal failure (14.3% vs 20.0% vs 4.3%; P = .059). In the first 70 patients there were no significant differences between observed and STS estimated incidences in mortality and composite mortality/major morbidity. In the latter 70 patients the observed incidences were lower than STS predicted values in mortality (2.9% vs 9.6%; P = .056), composite major morbidity/mortality (15.7% vs 33.8%; P = .001), and prolonged ventilation (4.3% vs 25.1%; P < .0001). CONCLUSIONS: Only after a protracted learning curve did the anticipated benefits of transapical TAVI materialize for patients at high risk for surgery as predicted by the STS risk algorithms.

The Bentall procedure without the use of a prepared valved-conduit: a step backwards?

A repeat Bentall procedure or a Bentall procedure in an immobile aortic root such as a prior homograft that has calcified can be problematic. Separating the valve from the conduit and with a modified elephant trunk concept we have simplified the proximal graft anastomosis using a running suture technique. This is followed by coronary ostia implantation and then by lowering the aortic valve onto the aortic annulus using a running suture technique.