Machine Perfusion for Recovery of Brain Death Donor Hearts from Extended Distances.

The emerging ex vivo machine perfusion (MP) enables the extension of ex situ intervals, potentially expanding the heart transplant (OHT) donor pool. From October 18, 2018, to June 30, 2023, isolated OHT using donation after brain death (DBD) from extended distances (>500 miles) were identified in the United Network for Organ Sharing database, and categorized into cold storage (non-MP, N = 1,212) and MP group (N = 152). The MP utilization rate for DBD hearts from extended distances surged from 0% in 2018 to 27.

Impact of Left Ventricular Unloading on Outcome of Heart Transplant Bridging With Extracorporeal Membrane Oxygenation Support in New Allocation Policy.

Background: The new heart allocation policy places veno-arterial extracorporeal membrane oxygenation (VA-ECMO)-supported heart transplant (HT) candidates at the highest priority status. Despite increasing evidence supporting left ventricular (LV) unloading during VA-ECMO, the effect of LV unloading on transplant outcomes following bridging to HT with VA-ECMO remains unknown.

Methods And Results: From October 18, 2018 to March 21, 2023, 624 patients on VA-ECMO at the time of HT were identified in the United Network for Organ Sharing database and were divided into 2 groups: VA-ECMO alone (N=384) versus VA-ECMO with LV unloading (N=240).

Stroke After Acute Type A Dissection Repair Using Right Axillary Cannulation First Approach.

Background: This study sought to analyze the details of strokes after acute type A dissection repair (ATAD) using a right axillary artery (RAX) first approach.

Methods: A total of 356 consecutive ATAD repairs from 2005 to 2022 were analyzed on the basis of arterial cannulation site. Strokes were evaluated by head computed tomography.

Zone 2 arch repair for acute type A dissection: Evolution from arch-first to proximal-first repair.

Objective: With growing experience of acute type A aortic dissection repair, Zone 2 arch repair has been advocated. The aim of this study is to compare the outcome between "proximal-first" and "arch-first" Zone 2 repair.

Methods: From January 2015 to March 2023, 45 patients underwent Zone 2 arch repair out of 208 acute type A aortic dissection repairs: arch-first, N = 19, and proximal-first technique, N = 26, since January 2021.

Use of Donor Hearts ≥50 Years Old for Septuagenarians in Heart Transplantation.

Background: The impact of using donors ≥50 years old on heart transplantation outcomes of septuagenarians is unknown, which may have a potential to expand the donor pool.

Methods: From January 2011 to December 2021, 817 septuagenarians received donor hearts <50 years old (DON<50) and 172 septuagenarians received donor hearts ≥50 years old (DON≥50) in the United Network for Organ Sharing database. Propensity score matching was performed using recipient characteristics (167 pairs).

Rapid-Deployment Aortic Valve Replacement: Patient Selection and Special Considerations.

Sutureless or rapid deployment valves in the setting of aortic valve replacement (AVR) is an emerging surgical technique using the transcatheter valve technology, which may lead to reduction in cross-clamp time and potentially better hemodynamics compared to a stented bioprosthetic valve. The absence of subannular pledgets results to excellent hemodynamic performance with reduced turbulent flow and larger effective orifice area. However, complications from both surgical and transcatheter AVR may still occur and impact survival.

Outcomes of Combined Heart and Kidney Transplantation Under the New Heart Allocation Policy: A United Organ Network for Organ Sharing Database Analysis.

Background: The impact of the new heart allocation policy, which prioritizes acutely ill patients on temporary mechanical circulatory support and provides broader sharing of donor organs, on patient and graft survival in combined heart and kidney transplantation (HKT) is unknown.

Methods: In the United Network for Organ Sharing data, patients were divided in groups before and after the policy change (OLD, January 1, 2015 to October 17, 2018, N=533; and NEW, October 18, 2018 to December 31, 2020, N=370). Propensity score matching was performed utilizing recipient characteristics (283 pairs).

Aortic Reoperation After Prior Acute Type A Aortic Dissection Repair: Don't Despair the Repair.

Background: There is paucity of data regarding reoperation after acute type A aortic dissection (ATAD) repair.

Methods: From October 2006 to March 2022, 75 patients received 123 reoperations after ATAD (proximal, n = 17; distal, n = 103; and both, n = 3) utilizing redo sternotomy (RS, n = 68), left thoracotomy (LT, n = 44), and endovascular approach (TEVAR, n = 11). The axillary artery cannulation was utilized in 97.

Escalation from intra-aortic balloon pump to axillary impella 5.5 support: Staged removal of the femoral access.

With the growing population of advanced heart failure, the use of Impella 5.5 has been increasing. Here, we report an effective strategy of removing the intra-aortic balloon pump (IABP) in the setting of escalation of support to Impella 5.

"Bowing Technique" for Using a HeartMate 3 Mini-Apical Cuff.

A HeartMate 3 mini-apical cuff is designed to facilitate minimally invasive left ventricular assist implantation. A possible problem of using a mini-apical cuff is that multiple buttress braided sutures can interfere with a HeartMate 3 pump when locking the pump. If this happens in a minimally invasive approach, multiple manipulations to engage the pump can cause catastrophic myocardial injury and uncontrollable bleeding, especially in patients with a fragile myocardium.

Insertion of durable left ventricular assist device with repair of ischemic ventricular septal rupture.

Background: A 63-year-old male who presented with acute anterior wall myocardial infarction with ischemic ventricular septal defect (VSD) required veno-arterial extracorporeal membrane oxygenation support due to a profoundly reduced left ventricular function.

Method And Resuls: The VSD was closed with a large bovine pericardial patches. Another Dacron patch was used to close the defect on the anterior wall.

Repair of fungal pseudoaneurysm of the common brachiocephalic trunk.

Background And Aim: To date, little is known about the aneurysms of the bovine aortic arch, known as a "common brachiocephalic trunk (CBT)" from where the left carotid and innominate arteries bifurcate.

Patient And Results: Here we report a case of a fungal pseudoaneurysm of the bovine aortic arch in a patient who had prior history of multiple aortic valve replacement, hepatitis C infection, and human immunodeficiency virus infection. A re-operative replacement of the aortic arch repair utilizing a bifurcated graft was successfully performed under deep hypothermia and selective antegrade cerebral perfusion.

High flow from Impella 5.5 with partial veno-arterial extracorporeal membrane oxygenation support: Case series.

Optimal flow balance between Impella 5.5 and veno-arterial extracorporeal membrane oxygenation (ECMO) support in the setting of EC-PELLA (ECMO+Impella) is unknown. Outcomes of high Impella 5.

Increased mental slowing associated with the APOE epsilon4 allele after trihexyphenidyl oral anticholinergic challenge in healthy elderly.

Objectives: The objectives of this study were to examine the relationship between APOE epsilon4 and subjective effects of trihexyphenidyl on measures reflecting sedation and confusion and to investigate the relationship between trihexyphenidyl-induced subjective effects and objective memory performance.

Methods: This study comprised 24 cognitively intact, health elderly adults (12 APOE epsilon4 carriers) at an outpatient geriatric psychiatry research clinic. This was a randomized, double blind, placebo-controlled, three-way, crossover experimental design.

The effect of mifepristone (RU 486) on plasma cortisol in Alzheimer's disease.

The glucocorticoid receptor (GR) antagonist mifepristone (RU-486) has been reported to increase early morning plasma ACTH/cortisol in diverse non-demented populations. This pilot study examined the cortisol response to RU 486 in patients with Alzheimer's disease (AD), a condition associated with abnormalities in various aspects of the hypothalamic-pituitary-adrenal (HPA) axis. Nine AD subjects were randomized in a placebo-controlled parallel study: 4 in the placebo group and 5 in the RU 486 group.