HeartMate 3 implantation for dextro-transposition of the great arteries after Mustard procedure: A technique of papillary muscle repositioning.

Systemic right ventricular failure after physiologic repair for dextro-transposition of the great arteries can be managed with durable mechanical circulatory support; however, the right ventricular morphology, such as intervening papillary muscles, presents challenges to inflow cannula positioning. Papillary muscle repositioning is an innovative technique to circumvent obstructive anatomy.

Concomitant aortic valve repair for aortic insufficiency and implantation of left ventricle mechanical support.

Background: Moderate to severe aortic valve insufficiency (AI) in patients undergoing left ventricular assist device (LVAD) implantation is a significant complication which occurs in up to 10.7% of patients in the INTERMACS database and has profound consequences for survival. Preoperative Impella use is associaed with greater post-LVAD AI.

Prognostic Implications of Ambulatory N-Terminal Pro-B-Type Natriuretic Peptide Changes in Patients with Continuous-Flow Left Ventricular Assist Devices.

Data regarding the role of N-terminal Pro-B-type natriuretic peptide (NT-pro BNP) in patients with a continuous-flow left ventricular assist device (CFLVAD) is scarce. To evaluate the prognostic implications of measuring both absolute values and changes in NT-pro BNP concentrations in ambulatory patients with a CFLVAD, we performed a retrospective study of 168 consecutive patients who had an LVAD implantation at our institution and survived beyond their index hospitalization. Of these, 127 patients (56.

Heparin-Sparing Anticoagulation Strategies Are Viable Options for Patients on Veno-Venous ECMO.

Background: Extracorporeal membrane oxygenation (ECMO), a rescue therapy for pulmonary failure, has traditionally been limited by anticoagulation requirements. Recent practice has challenged the absolute need for anticoagulation, expanding the role of ECMO to patients with higher bleeding risk. We hypothesize that mortality, bleeding, thrombotic events, and transfusions do not differ between heparin-sparing and full therapeutic anticoagulation strategies in veno-venous (VV) ECMO management.

The Effect of Cardiac Preservation Solutions on Heart Transplant Survival.

Background: Limited data exist that compare the predominant cardiac preservation solutions (CPSs).

Materials And Methods: The United Network for Organ Sharing database was retrospectively reviewed from January 1, 2004 to March 31, 2018, for donor hearts. Of 34,614 potential donors, 21,908 remained after applying the exclusion criteria.

Intravenous thrombolytic therapy for patients with ventricular assist device thrombosis: An attempt to avoid reoperation.

A growing number of patients are undergoing prolonged management of advanced heart failure with the use of continuous flow left ventricular assist devices (LVADs). Subsequently, an increasing number of patients are presenting with complications associated with these devices. Based on an analysis of three major LVAD institutions, the number of patients developing LVAD pump thrombosis may be much higher than originally projected.

Assessing Anticoagulation Practice Patterns in Patients on Durable Mechanical Circulatory Support Devices: An International Survey.

Anticoagulation in mechanical circulatory support (MCS) patients dictated by local practice, and therefore uniform standards for management are lacking. To characterize the worldwide variance in anticoagulation and antiplatelet therapy in patients with MCS devices, a 42 item survey was created and distributed electronically in August 2014. The survey assessed the center-perceived thromboembolic risk (minimal, low, moderate, or high) and characterized the antiplatelet and anticoagulant strategies for the Thoratec HeartMate II (HMII) and HeartWare HVAD (HVAD).

Epicardial adipose tissue has a unique transcriptome modified in severe coronary artery disease.

Objective: To explore the transcriptome of epicardial adipose tissue (EAT) as compared to subcutaneous adipose tissue (SAT) and its modifications in a small number of patients with coronary artery disease (CAD) versus valvulopathy.

Methods: SAT and EAT samples were obtained during elective cardiothoracic surgeries. The transcriptome of EAT was evaluated, as compared to SAT, using an unbiased, whole-genome approach in subjects with CAD (n = 6) and without CAD (n = 5), where the patients without CAD had cardiac valvulopathy.

Presurgical levels of circulating cell-derived microparticles discriminate between patients with and without transfusion in coronary artery bypass graft surgery.

Objectives: Improved understanding of presurgical risk factors for transfusions will lead to reduction in their number and related complications. The goal of this study is to identify these factors in coronary artery bypass graft (CABG) surgery.

Methods: Presented herein are results of analyses of data from an ongoing study of transfusion in CABG surgery.

Lung perfusion and ventilation during implantation of left ventricular assist device as a strategy to avoid postoperative pulmonary complications and right ventricular failure.

Right ventricular failure is a major contributor to increased morbidity and mortality in patients undergoing left ventricular assist device implantation. Cardiopulmonary bypass is associated with increased pulmonary ischaemia and pulmonary vascular resistance. Continuous pulmonary perfusion and ventilation represents an emerging strategy for pulmonary protection during cardiac surgery.

Brachial plexus paralysis of a dominant arm due to hematoma associated with internal jugular vein cannulation.

Paralysis and sensory loss of a dominant right arm developed as complications of cannulation of the right internal jugular vein (IJV) in a patient undergoing cardiac surgery. This sequela of IJV cannulation has not been previously reported at the time of this writing.

Left main coronary artery fistula to the right atrium and superior vena cava: case report and review of the literature.

A unique arteriovenous fistula, originating from the left main coronary artery and branching to drain into the right atrium and superior vena cava is presented with review of the literature.

Pulmonary embolectomy: recommendation for early surgical intervention.

Background: Acute pulmonary embolism (PE) is a life-threatening disease which often results in death if not diagnosed early and treated aggressively. Despite all efforts at improving outcomes, there is no consensus on the management of acute severe PE.

Methods: From May 2000 to June 2009, 16 consecutive patients underwent surgical pulmonary embolectomy at our institution.

Control of troublesome bleeding during repair of acute type A dissection with use of modified rapid deployment hemostat (MRDH).

Troublesome bleeding occurred in the posterior portion of the proximal anastomosis in an ascending aorta graft, being performed on a patient with acute type A dissection. The suture line was close to the left coronary ostium, and attempts at suturing and other maneuvers failed to control hemorrhage. Modified rapid deployment hemostat (MRDH) was successful in achieving hemostasis.

Complex lead extraction via subclavian approach using laser technique.

Removal of fully intravascular pacing leads may be cumbersome. Herein, we report a technique that may be used to remove intravascular leads using laser technology through a subclavian approach, and discuss the process of lead removal as well as management of potential bleeding from the surgical site. We also address the advantages and pitfalls of this technique as compared to other surgical options.

Complete vacuum-assisted sternal closure following neonatal cardiac surgery.

Vacuum-assisted closure (VAC) has been used with success in the management of adults and children with sternal infections. However, this technique has not been applied previously to neonates requiring delayed sternal closure as the sole modality of therapy. In this article, we describe the management of two newborns with hypoplastic left heart syndrome in whom complete sternal wound healing was accomplished solely by using the VAC system.

Modified "sutureless" anastomosis for primary repair of supracardiac total anomalous pulmonary venous connection.

Repair of total anomalous pulmonary venous connection (TAPVC) is associated with a risk of recurrent pulmonary venous obstruction. In this article we describe a technique of primary repair using a posterior approach in which a modified sutureless anastomosis is constructed by suturing the left atrium to the posterior pericardium that surrounds the pulmonary venous confluence. This technique avoids trauma to the pulmonary venous wall and minimizes the risk of distortion of the anastomosis, factors that have been implicated in the occurrence of subsequent pulmonary venous obstruction.

Efficacy, feasibility, and pitfalls of transseptal approach in beating-heart mitral valve surgery.

Background: Mitral valve surgery can be performed through the trans-atrial or the trans-septal approach. Although the trans-atrial is the preferred method, the trans-septal approach has also been used recently and has a particular value in beating-heart mitral valve surgery. Herein we report our experience with beating-heart mitral valve surgery via trans-septal approach, and discuss its advantages and pitfalls.

Unusual modification of the cabrol shunt for control of hemorrhage in acute type a aortic dissection.

A patient with acute Type A dissection required complex root repair with composite graft. She developed life-threatening hemorrhage at the root of the aorta, which could not be controlled with usual measures. A modification of the original Cabrol shunt allowed for successful control of bleeding.

Successful use of a custom-made paracorporeal total artificial heart as a bridge to retransplantation in adult and adolescent patients.

Because the currently available total artificial hearts are rather bulky, the use of a custom-made paracorporeal total artificial heart constructed with 2 ventricular assist devices is an alternative for children and adults with small stature. This article reports our experience using this system in an adult and a pediatric patient. The advantages and disadvantages of this technique are discussed.

Insertion of right ventricular assist device and its removal under local anesthesia.

A patient with acute right ventricular infarction was treated with coronary artery bypass grafting. A few days later developed right ventricular failure and required insertion of a right ventricular assist device through a sternotomy approach (TandemHeart, CardiacAssist, Inc., Pittsburgh, PA, USA).