Publications by authors named "Eyal Nachum"

Article Synopsis
  • Long-term support with the HeartMate 3 (HM3) left ventricular assist device (LVAD) has improved outcomes for end-stage heart failure patients, but there's limited data on those who had simultaneous cardiac surgeries during the procedure.
  • In a study of 131 patients between December 2016 and April 2022, 23 underwent concomitant cardiac surgical procedures (CCSP) while receiving HM3-LVAD, while 108 had only the HM3-LVAD implanted.
  • Results showed no significant differences in 30-day, 6-month, and 12-month mortality rates between the CCSP group and the HM3-only group, indicating that simultaneous surgeries do not adversely affect survival when getting an HM3-L
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Background: Cardiac implantable electronic devices (CIEDs) are increasingly being used; thus, there is an increasing need for transvenous lead extraction (TLE).

Objectives: To summarize our experience with TLE at single referral center in northern Israel.

Methods: The study included all patients who underwent TLE at our center between 2019 and 2022, regardless of the indication.

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Background: Unfractionated heparin is the preferred anticoagulant used during open heart surgeries, including left ventricular assist device (LVAD) implantation. In cases in which patients are heparin-induced thrombocytopenia positive (HIT+), the accepted practice has been to substitute heparin with bivalirudin. This practice may be associated with significant bleeding and adverse outcomes.

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Article Synopsis
  • - Severe respiratory failure from COVID-19 often necessitates mechanical ventilation and can involve ECMO; lung transplantation is a rare last resort with unclear patient selection and timing.
  • - A study of 20 patients supported by ECMO found that 16 remained for analysis, revealing that nine recovered while seven died while waiting for lung transplantation.
  • - Younger patients showed a better recovery chance without lung transplantation after about 59 days on ECMO compared to a median of 99 days for those who died, suggesting a delay of 8-10 weeks for referral to transplantation for potentially recoverable patients.
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Background: Ex-situ heart perfusion (ESHP) is commonly used for the reanimation and preservation of hearts following donation after circulatory determined death (DCD). The only commercially available existing ESHP device promotes perfusate lactate levels for assessment of heart viability. The reliability of this marker is yet to be confirmed for DCD heart transplantation.

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Background: Limited availability of suitable donor hearts remains a challenge to pediatric heart transplantation, contributing to waitlist mortality. Controlled donation after circulatory death (DCD) has demonstrated success in adults. Early series of pediatric DCD heart transplantation using cold storage alone reported significant early mortality.

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Donation after circulatory death in the context of heart transplants is attracting interest and becoming popular in clinical practice. Activity is growing in the United Kingdom, Australia, and the United States. We believe that a prolonged warm ischemic time (time from asystole to reperfusion of the heart on an ex vivo perfusion system) is a primary indicator of adverse outcomes.

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This video tutorial demonstrates the insertion of a temporary biventricular assist device as a bridge to a heart transplant in a patient with end-stage heart failure with decompensation and increasing pulmonary pressure . This technique utilizes cardiopulmonary bypass to maintain hemodynamic stability throughout the procedure. Transesophageal echocardiography is used to guide the correct positioning of the ventricular cannulae.

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We describe the insertion of the Impella 5.0, a peripherally placed mechanical cardiovascular microaxial pump, in a patient with ischemic left ventricular dysfunction. The Impella is a 7 Fr device capable of achieving a flow of 4.

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Background: In an effort to address the increasing demand for heart transplantation within the United Kingdom (UK), we established a clinical program of heart transplantation from donation after circulatory-determined death (DCD) donors in 2015. After 5 years, we report the clinical early outcomes and impact of the program.

Methods: This is a single-center, retrospective, matched, observational cohort study comparing outcomes of hearts transplanted from DCD donors from March 1, 2015 to February 29, 2020 with those from matched donation after brain death (DBD) donors at Royal Papworth Hospital (RPH) (Cambridge, UK).

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Article Synopsis
  • The study aimed to investigate how different time intervals before heart transplantation (HT) affect patient outcomes.
  • It defined three key time periods: brain injury time (time from brain injury to death), brain death interval (time from death to organ procurement), and allograft ischemia (time from organ procurement to implantation).
  • Results from 173 patients indicated that these time intervals had no significant impact on mortality or organ rejection rates, suggesting that timeframes prior to transplantation may not hinder organ success and could inform clinical practices for organ allocation.
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Background: Ethnicity may affect graft longevity and recipient mortality after heart transplantation (HTx). We hypothesized that differences in ethnic origin between Arabs and Jews undergoing HTx in Israel may contribute to differences in long-term outcomes.

Methods: The study population comprised all 254 patients who underwent HTx between 1991 and 2017 in a tertiary medical center located in the center of Israel.

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Article Synopsis
  • Heart transplantation (HT) at Sheba Medical Center, Israel's largest HT facility, has shown significant improvements over 27 years, including a rise in female patients and a shift from ischemic to non-ischemic cardiomyopathy as the leading cause for HT.
  • The study revealed that the use of left ventricular assist devices before HT has increased, and patients' metabolic profiles have improved, with lower rates of LDL cholesterol, diabetes, and hypertension post-surgery.
  • Additionally, advancements in immunosuppressive therapies have led to a sharp decline in cardiac allograft vasculopathy and acute rejection rates, aligning with global trends in HT outcomes.
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Background: The impact of donor-recipient ethnic matching on heart transplantation (HT) has been poorly studied with inconclusive results. We aimed to investigate the impact of ethnic matching on HT outcomes in Israeli multiethnic patients.

Methods: The study comprised 168 patients who underwent HT from 1990-2017.

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Article Synopsis
  • Surgery is the only effective treatment for constrictive pericarditis (CP), but concerns over high postoperative mortality often deter referrals.
  • A study involving 55 patients who underwent surgical pericardiectomy (SP) showed a 96% rate of complete resection, with only one patient dying during hospitalization and a 22% mortality rate during an average follow-up of 52 months.
  • The surgery significantly improved patients' functional status and reduced right atrial pressures, demonstrating that SP is a safe and effective option for treating CP, regardless of whether it is done alone or with other procedures.
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Background: Postpericardiotomy syndrome (PPS) is characterized by pleuro-pericardial inflammation, which occurs in patients undergoing surgical procedures involving the pleura, pericardium, or both. The syndrome is considered to be immune mediated. However, its pathogenesis is not fully understood.

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Background: Aortic valve replacement, particularly in elderly patients with small aortic annulus, could lead to patient-prosthesis mismatch. Sutureless bioprosthesis could be an ideal solution for these patients. We compared results of aortic valve replacement with sutureless versus stented bioprosthetic valves.

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Unlabelled: Background: Prolonged life expectancy has increased the number of elderly high risk patients referred for surgical aortic valve replacement (AVR). These referred high risk patients may benefit from sutureless bioprosthesis procedures which reduce mortality and morbidity.

Objectives: To present our initial experience with sutureless aortic bioprotheses, including clinical and echocardiographic results, in elderly high risk patients referred for AVR.

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Unlabelled: Background: The rate of mitral bioprosthesis implantation in clinical practice is increasing. Transcatheter valve-in- valve implantation has been described for high risk patients requiring redo valve surgery.

Objectives: To report our experience with transapical valve-in-valve implantation for failed mitral bioprosthesis.

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Background: Patients with Marfan syndrome are referred for cardiac surgery due to root aneurysm with or without aortic valve regurgitation. Because these patients are young and frequently present with normal-appearing aortic cusps, valve sparing is often recommended. However, due to the genetic nature of the disease, the durability of such surgery remains uncertain.

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