A novel combination technique of cold crystalloid perfusion but not cold storage facilitates transplantation of canine hearts donated after circulatory death.

Background: Donation after circulatory death (DCD) represents a potential new source of hearts to increase the donor pool. We showed previously that DCD hearts in Greyhound dogs could be resuscitated and preserved by continuous cold crystalloid perfusion but not by cold static storage and could demonstrate excellent contractile and metabolic function on an in vitro system. In the current study, we demonstrate that resuscitated DCD hearts are transplantable.

Low-flow hypothermic crystalloid perfusion is superior to cold storage during prolonged heart preservation.

Background: Preservation of donor hearts for transplantation has traditionally been performed with the use of static cold storage. We have developed and tested a novel gravity-powered system of cold crystalloid perfusion for prolonged donor heart preservation.

Methods: Greyhounds were anesthetized; their hearts were arrested with cold cardioplegic solution and excised.

Bacteraemia in ventricular assist devices: a common complication that need not affect clinical outcomes.

Background: Ventricular assist device (VAD) implantation has become an effective option for patients with severe heart failure. However, device-related infections remain a significant problem. The aim of this study was to describe the incidence and microbiological aetiology of bacteraemia in patients with VADs, and to assess the impact of bacteraemia on clinical outcomes.

Twelve-hour reanimation of a human heart following donation after circulatory death.

Despite increasing use of donation after cardiac death (DCD) and encouraging results for non-cardiac transplants, DCD cardiac transplantation has not been widely adopted because, (1) the DCD heart sustains warm ischaemic injury during the death process and (2) conventional static cold storage significantly adds to the ischaemic injury. We have developed a simple system for perfusion of the DCD heart with cold crystalloid solution using gravity-feed that can reduce ischaemic injury and potentially render the heart suitable for transplantation. This report describes the first application of this technique to a human DCD heart with good functional metabolic recovery over 12h on an ex vivo rig.

Heterotopic heart transplant: is there an indication in the continuous flow ventricular assist device era?

Objectives: Heterotopic heart transplantation (HHTx) is a therapeutic option in heart failure patients with fixed elevated pulmonary hypertension. However, survival is poorer in HHTx recipients, and with improving results in continuous flow ventricular assist devices (VADs), many patients can be bridged to allow normalization of pulmonary artery pressures, making them orthotopic heart transplant (OHTx) candidates. Thus, the aim of this study was to analyse the survival of our HHTx cohort and compare them with our VAD bridge patients.

Carbon dioxide insufflation in open-chamber cardiac surgery: a double-blind, randomized clinical trial of neurocognitive effects.

Objective: The aims of this study were first to analyze neurocognitive outcomes of patients after open-chamber cardiac surgery to determine whether carbon dioxide pericardial insufflation reduces incidence of neurocognitive decline (primary end point) as measured 6 weeks postoperatively and second to assess the utility of carbon dioxide insufflation in cardiac chamber deairing as assessed by transesophageal echocardiography.

Methods: A multicenter, prospective, double-blind, randomized, controlled trial compared neurocognitive outcomes in patients undergoing open-chamber (left-sided) cardiac surgery who were assigned carbon dioxide insufflation or placebo (control group) in addition to standardized mechanical deairing maneuvers.

Results: One hundred twenty-five patients underwent surgery and were randomly allocated.

Ventricular assist device infections.

Ventricular Assist Devices(VAD) are the commonest form of cardiac mechanical support, used as bridge to transplantation but also as destination therapy in non-transplant-eligible patients in whom transplantation is considered unsuitable based on age criteria. Infections are common and can significantly impact on patient outcome. Strategies to prevent and treat infections have not been assessed by randomised controlled trials, a difficult task due to the multiplicity of devices and their ongoing evolution.

Physical conditioning and mental stress reduction--a randomised trial in patients undergoing cardiac surgery.

Background: Preoperative anxiety and physical unfitness have been shown to have adverse effects on recovery from cardiac surgery. This study involving cardiac surgery patients was primarily aimed at assessing the feasibility of delivering physical conditioning and stress reduction programs within the public hospital setting. Secondary aims were to evaluate the effect of these programs on quality of life (QOL), rates of postoperative atrial fibrillation (AF) and length of stay (LOS) in hospital.

Extracorporeal membrane oxygenation in primary graft failure after heart transplantation.

Background: The aim of this review was to analyze our results with extracorporeal membrane oxygenation (ECMO) support for primary graft failure (PGF) in heart transplant recipients.

Methods: A retrospective review of 239 consecutive patients who underwent heart transplantation between January 2000 and August 2009 was performed. Orthotopic, heterotopic, and heart lung transplants were included in this analysis.

Perioperative metabolic therapy improves redox status and outcomes in cardiac surgery patients: a randomised trial.

Objective: Perioperative therapy with antioxidants and metabolic substrates has the potential to reduce oxidative stress and improve recovery from cardiac surgery, particularly in elderly and high risk cases. The aim of this study was to assess the effect of perioperative metabolic therapy at a biochemical, clinical and economic level in cardiac surgical patients.

Methods: Patients (n=117, mean age 65 ± 1.

Atrial fibrillation following lung transplantation: double but not single lung transplant is associated with long-term freedom from paroxysmal atrial fibrillation.

Introduction: The cornerstone of catheter ablation for atrial fibrillation (AF) is pulmonary vein electrical isolation (PVI). Recurrent AF post-PVI is a major limitation of the procedure with PV reconnection present in most patients. Single (SLT) and double (DLT) lung transplant surgery involves a 'cut and sew' PV antral isolation analogous to a catheter-based approach providing an opportunity to assess the efficacy of durable PVI.

Long-term outcomes of cadaveric lobar lung transplantation: helping to maximize resources.

Background: Cadaveric lobar lung transplantation (CLLTx) represents a potential opportunity to address the bias against smaller recipients, especially children, on transplant waiting lists. The widespread use of CLLTx is hindered by the paucity of outcome data with respect to early complications and long-term lung function and survival.

Methods: We looked at the long-term outcomes in 9 patients undergoing CLLTx since May 2003, including early surgical complications, pulmonary function tests, and survival.

Changes in right ventricular function during continuous-flow left ventricular assist device support [corrected].

Background: Studies in explanted hearts from patients supported with a left ventricular assist device (LVAD) suggest that no or a less pronounced reverse remodeling process occurs in the right ventricle (RV) during LVAD support. The intermediate-term functional changes in RV function in patients with refractory heart failure (HF) supported with a continuous LVAD are not well characterized.

Methods: Serial transthoracic echocardiograms and simultaneous measurements of biochemical surrogates of disease severity and organ perfusion were obtained in 20 patients (aged 57 +/- 17 years) with refractory HF before and after implantation of a continuous-flow LVAD (VentrAssist, Ventracor Ltd, Chatswood, Australia).

Large left ventricular metastasis causing left ventricular outflow tract obstruction and haemolysis.

Although post-mortem studies would suggest that cardiac metastases occur frequently, many of these metastases remain clinically silent. However, symptomatic lesions may also remain unrecognized due to overshadowing by other symptoms of the primary malignancy. Patients undergoing treatment for cancer are not routinely screened using echocardiography, unless their chemotherapeutic regimen includes cardiotoxic agents.

Recovery from anthracycline cardiomyopathy after long-term support with a continuous flow left ventricular assist device.

We report the clinical course of a 16-year-old girl in remission from non-Hodgkin's lymphoma who presented in cardiogenic shock due to a severe anthracycline cardiomyopathy. The patient was initially stabilized using central extracorporeal membrane oxygenation support, followed by conversion to a left ventricular assist device. Unexpected evidence of cardiac recovery 9 months after implant enabled device weaning during a 3-month period, culminating in successful device explantation 1 year after implant.

Outcomes following de novo CNI-free immunosuppression after heart transplantation: a single-center experience.

Renal impairment at the time of heart transplantation complicates the choice of subsequent immunosuppressive therapy. Calcineurin (CNI)-free regimens utilizing proliferation signal inhibitors (PSI) may mitigate against nephrotoxicity in this group; however, their effectiveness remains unclear. We present our 7-year experience with de novo CNI-free, PSI-based immunosuppression after heart transplantation.

Pediatric experience with the VentrAssist LVAD.

Purpose: The purpose of this study is to describe the first experience of implanting a new left ventricular assist device in pediatric patients with end-stage heart failure.

Description: In two recent prospective, international, multicenter clinical trials, three children (aged
Evaluation: Despite the patients' disease severity (each child was in extremis at the time of implantation), VentrAssist (Ventracor Limited) implantation enabled each patient to be discharged home from the hospital.

The Alfred Hospital lung transplant experience.

There has been considerable evolution in the pre-, peri- and postoperative management of patients with severe lung disease undergoing LTx. Compared with where we started at the Alfred Hospital in 1990, in 2008 we now recognize that the majority of donor lungs that are offered for LTx (including DCD lungs) are useable, patients with a wide range of ages and disease processes are suitable to be considered for LTx and modern surgical, anesthetic and ICU management should result in a 90% one-year survival rate. It is likely that the procedural mix in LTX servicing will remain little changed in the years to come, with BLTx being the pre-eminent service modality for the majority of end-stage lung disease patients.

A prospective, multicenter trial of the VentrAssist left ventricular assist device for bridge to transplant: safety and efficacy.

Background: The increasing prevalence of chronic heart failure has stimulated the ongoing development of left ventricular assist devices (LVADs) for both bridge-to-transplant (BTT) and destination therapy (DT). The aim of this prospective, multicenter clinical trial was to determine the efficacy and safety of a third-generation LVAD, the VentrAssist, in a BTT cohort.

Methods: Patients (n = 33) with end-stage chronic heart failure who required circulatory support as BTT therapy were implanted with a VentrAssist device.

Initial clinical experience with the VentrAssist left ventricular assist device: the pilot trial.

Background: The VentrAssist (VA) is a novel, continuous flow left ventricular assist device (LVAD). The purpose of this trial was to investigate the safety and efficacy of the VA in elderly patients with end-stage heart failure.

Methods: In this prospective trial, patients requiring circulatory support either as destination therapy (DT) or as a bridge to transplant (BTT) were implanted with a VA device.

Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) Trial: rationale and design.

Background: Despite some concern that recent aspirin ingestion increases blood loss after coronary artery surgery, there is some evidence that this may reduce thrombotic complications. In contrast, antifibrinolytic drugs can reduce blood loss in this setting, but there is concern that they may increase thrombotic complications. Published guidelines are limited by a lack of large randomized trials addressing the risks and benefits of each of these commonly used therapies in cardiac surgery.

VentrAssist left ventricular assist device: clinical trial results and Clinical Development Plan update.

Objectives: To summarise the primary efficacy and safety results from the first international clinical trial with the VentrAssist left ventricular assist device and to provide an update on the VentrAssisttrade mark Clinical Development Plan.

Methods: The first prospective, single-arm, multicentre international clinical trial with the VentrAssist in bridge-to-transplant patients (CE Mark trial) was conducted in Australia, UK and Norway between 2004 and 2006. The primary outcome measure was survival until transplant or being transplant-eligible at postoperative day 154.

Incidence of malignancies in heart and/or lung transplant recipients: a single-institution experience.

Background: The purpose of this study was to determine the incidence and type of malignancies in heart and/or lung transplant recipients at a single institution in Victoria, Australia, and to compare these findings with the non-transplant general Victorian population.

Methods: Recipients of heart and/or lung transplants at the Alfred Hospital between February 1989 and January 2004 were cross-referenced with the Victorian Cancer Registry. The medical records of all patients with a cancer diagnosis by January 1, 2005 were reviewed.