Bupropion Toxicity Causing Refractory Cardiogenic Shock Successfully Treated With Mechanical Circulatory Support: A Case Report.

Bupropion is a norepinephrine-dopamine reuptake inhibitor that is commonly used as an antidepressant and for smoking cessation. Bupropion overdose can lead to serious side effects which include seizures, status epilepticus, and fatal arrhythmias. Managing bupropion toxicity is challenging as there is no effective antidote and treatment is largely supportive.

Cardio-Obstetric Shock: Mechanical Circulatory Support as a Bridge to Pregnancy Viability.

Cardiogenic shock in pregnancy is rare but is associated with significant morbidity and mortality. Timely recognition with multidisciplinary management is necessary for optimal maternal and fetal outcomes. Here we present a case of cardiogenic shock in the antepartum period managed with mechanical circulatory support as a bridge to pregnancy viability.

Changing Strategy Between Bridge to Transplant and Destination LVAD Therapy After the First 3 Months: Analysis of the STS-INTERMACS Database.

Background: Left ventricular assist devices (LVADs) have been implanted as bridge to transplantation (BTT), bridge to candidacy (BTC) or destination therapy (DT) on the basis of relative and absolute contraindications to transplantation. Multiple factors may lead to changes in the strategy of support after LVAD implantation.

Methods: Based on INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) 2012-2020 data, 11,262 patients survived to 3 months on continuous-flow LVADs with intent of BTT or DT.

Right Ventricular Contractility and Pulmonary Arterial Coupling After Less Invasive Left Ventricular Assist Device Implantation.

Right ventricular failure contributes significantly to morbidity and mortality after left ventricular assist device implantation. Recent data suggest a less invasive strategy (LIS) via thoracotomy may be associated with less right ventricular failure than conventional median sternotomy (CMS). However, the impact of these approaches on load-independent right ventricular (RV) contractility and RV-pulmonary arterial (RV-PA) coupling remains uncertain.

Outcomes of Combined Heart-Kidney Transplantation in Older Recipients.

Objectives: The upper limit of recipient age for combined heart-kidney transplantation (HKT) remains controversial. This study evaluated the outcomes of HKT in patients aged ≥65 years.

Methods: The United Network of Organ Sharing (UNOS) was used to identify patients undergoing HKT from 2005 to 2021.

Impact of Donor Hemodynamics on Recipient Survival in Heart Transplantation.

Background: Heart transplantation is the gold-standard therapy for end-stage heart failure, but rates of donor-heart use remain low due to various factors that are often not evidence based. The impact of donor hemodynamics obtained via right-heart catheterization on recipient survival remains unclear.

Methods: The United Network for Organ Sharing registry was used to identify donors and recipients from September 1999-December 2019.

The HeartMate 3 left ventricular assist device as a strategy to bridge to transplant.

Purpose: Recent changes in the market for left ventricular assist devices have resulted in the HeartMate 3 (HM3) being the only commercially-available device. This study evaluates the outcomes of patients with a HM3 waitlisted for and undergoing orthotopic heart transplantation (OHT).

Methods: Patients waitlisted for isolated OHT with a HM3 or undergoing OHT after bridge-to-transplant (BTT) with a HM3 between 2015 and 2021 were identified from the UNOS registry and included in this study.

Sex mismatch following heart transplantation in the United States: Characteristics and impact on outcomes.

Background: Available literature indicates the possible detrimental effect of sex mismatching on mortality in patients undergoing heart transplantation. Our objective was to examine the role of sex and heart mass (predicted heart mass [PHM]) mismatch on mortality and graft rejection in patients undergoing heart transplantation in the US.

Methods: Data on adult patients who underwent heart transplantation between January 2015 and October 2021 were queried from the United Network of Organ Sharing (UNOS) registry.

Hemodynamic reserve predicts early right heart failure after LVAD implantation.

Background: Early right heart failure (RHF) remains a major source of morbidity and mortality after left ventricular assist device (LVAD) implantation, yet efforts to predict early RHF have proven only modestly successful. Pharmacologic unloading of the left ventricle may be a risk stratification approach allowing for assessment of right ventricular and hemodynamic reserve.

Methods: We performed a multicenter, retrospective analysis of patients who had undergone continuous-flow LVAD implantation from October 2011 to April 2020.

Characteristics and outcomes of left ventricular assist device recipients transplanted before and after the new donor heart allocation system.

Background: Concerns about the impact of the new donor heart allocation system on posttransplant outcomes have emerged after its implementation. We sought to evaluate the characteristics and outcomes of left ventricular assist device (LVAD) recipients transplanted before and after the implantation of the new policy on October 18, 2018.

Methods: Data on bridge to transplantation of adult patients with LVAD between January 2015 and October 2021, with durable LVAD as a (BTT), was queried from the United Network of Organ Sharing (UNOS) registry.

Outcomes in Patients With LVADs Undergoing Simultaneous Heart-Kidney Transplantation.

Background: Multiple studies have shown better outcomes for simultaneous heart-kidney transplant (sHKT) than for isolated orthotopic heart transplant (iOHT) in recipients with chronic kidney disease (CKD). However, outcomes in patients supported by durable left ventricular assist devices (LVADs) have not been well studied.

Methods: Patients with durable LVADs and stage 3 or higher CKD (eGFR < 60 mL/min/1.

Hemodynamic and Clinical Determinants of Left Atrial Enlargement in Liver Transplant Candidates.

New-onset heart failure is a frequent complication after orthotopic liver transplantation (OLT). Left atrial enlargement (LAE) may be a sign of occult left heart disease. Our primary objective was to determine invasive hemodynamic and clinical predictors of LAE and then investigate its effect on post-transplant outcomes.

The impact of changes in renal function during waitlist time on outcomes after heart transplantation.

Background And Aim: This study evaluated the impact of changes in renal function during the waitlist period on posttransplant outcomes of orthotopic heart transplantation (OHT).

Methods: The United Network for Organ Sharing registry was used to identify adult patients undergoing isolated OHT from 2010 to 2020. Patients were stratified by whether their National Kidney Foundation chronic kidney disease (CKD) stage improved, worsened, or remained unchanged between listing and transplantation.

Pulmonary Hypertension in the Context of Heart Failure With Preserved Ejection Fraction.

Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure and frequently is associated with pulmonary hypertension (PH). HFpEF associated with PH may be difficult to distinguish from precapillary forms of PH, although this distinction is crucial because therapeutic pathways are divergent for the two conditions. A comprehensive and systematic approach using history, clinical examination, and noninvasive and invasive evaluation with and without provocative testing may be necessary for accurate diagnosis and phenotyping.

Treatment of right ventricular dysfunction and heart failure in pulmonary arterial hypertension.

Right heart dysfunction and failure is the principal determinant of adverse outcomes in patients with pulmonary arterial hypertension (PAH). In addition to right ventricular (RV) dysfunction, systemic congestion, increased afterload and impaired myocardial contractility play an important role in the pathophysiology of RV failure. The behavior of the RV in response to the hemodynamic overload is primarily modulated by the ventricular interaction and its coupling to the pulmonary circulation.

The impact of insurance type on listing status and wait-list mortality of patients with left ventricular assist devices as bridge to transplantation.

Aims: Adequate health insurance coverage is necessary for heart transplantation (HT) candidates. Prior studies have suggested inferior outcomes post HT with public health insurance. We sought to evaluate the effects of insurance type on transplantation rates, listing status and mortality prior to HT.

Characteristics and outcomes in patients with atrial fibrillation receiving direct oral anticoagulants in off-label doses.

Background: We evaluated adherence to dosing criteria for patients with atrial fibrillation (AF) taking dabigatran or rivaroxaban and the impact of off-label dosing on thromboembolic and bleeding risk.

Methods: We used data for a retrospective cohort from a large U.S.

Gender Differences in Outcomes After Implantation of Left Ventricular Assist Devices.

Background: Left ventricular assist device (LVAD) implantation has historically been underutilized in women compared with men. It was hypothesized that the introduction of continuous-flow LVADs would lead to more LVAD implantations in women and possibly narrow the gender gap.

Methods: Patients who underwent LVAD implantation between 2009 and 2014 were identified using the national inpatient sample.

Approach to a patient with pulmonary hypertension.

Pulmonary hypertension is a common clinical condition that can complicate various cardiac and respiratory abnormalities. Interest in pulmonary hypertension has grown remarkably among the scientific community in the last decade. It is now clear based on the scientific advances have paved the way in understanding the effects of abnormal pulmonary hemodynamics development and its antecedent consequences on the right heart in reducing the quality of life and survival of the patient.

Trends, Outcomes, and Readmissions Among Left Ventricular Assist Device Recipients with Acute Kidney Injury Requiring Hemodialysis.

Although renal function may improve after left ventricular assist devices (LVAD) implantation, acute kidney injury (AKI) requiring hemodialysis (HD) therapy can occur postoperatively. We used data from the National Readmissions Database to calculate annual rates of in-hospital outcomes and readmissions among patients who underwent implantation and developed acute kidney injury (AKI) requiring hemodialysis (HD) for years 2012-2015. We identified 178 (weighted 469) patients with AKI requiring HD after LVAD implantation.

Management of Patients with Heart Failure: Focus on New Pharmaceutical and Device Options.

Hospitalization rates and survival of patients with Heart Failure (HF) have improved. However, 5-year mortality rates remain high and the prevalence of the disease is rising likely due to aging of the population and advances in diagnosis and treatment of other acute and chronic cardiovascular diseases. Over the past three decades the therapeutic armamentarium of heart failure has improved substantially with development of medications targeting neuro-hormonal activation and devices preventing sudden cardiac death and improving cardiac synchrony.

Characteristics and Outcomes of Patients With Cardiogenic Shock Utilizing Hemodialysis for Acute Kidney Injury.

In the setting of cardiogenic shock (CS), impaired biventricular function can cause acute decrease in renal function via reduced renal perfusion and increased renal venous pressure. We sought to analyze the characteristics and outcomes of patients hospitalized with CS who utilized renal replacement therapy (hemodialysis) for acute kidney injury (AKI-HD). We utilized data from the National Inpatient Sample to calculate national rates of in-hospital mortality, use of temporary mechanical support, vascular injury requiring surgery, length of stay (LOS) and hospitalization cost from 2010 to September 2015.

Procedural Outcomes of Patients With Heart Failure Undergoing Catheter Ablation of Atrial Fibrillation.

Background: Catheter ablation is being increasingly performed for rhythm control of atrial fibrillation (AF). Heart failure (HF) frequently coexists with AF because they share common risk factors.

Study Question: This study aims at identifying the characteristics and procedural outcomes of patients with HF undergoing catheter ablation of AF.

Trends in In-Hospital Mortality, Length of Stay, Nonroutine Discharge, and Cost Among End-Stage Renal Disease Patients on Dialysis Hospitalized With Heart Failure (2001-2014).

Background: Heart failure (HF) is a common cause of morbidity and mortality among end-stage renal disease (ESRD) patients on dialysis. We aimed to assess the trends and outcomes in primary and secondary HF hospitalizations among ESRD patients with the use of a nationally representative database.

Methods And Results: We analyzed data from the National Inpatient Sample and the US Census Bureau to calculate annual national rates of in-hospital mortality, length of stay, disposition with a focus on nonroutine discharge (discharge to a health care facility rather than to home), and adjusted median cost among patients with ESRD on dialysis with primary or secondary HF admissions from 2001 to 2014.