Tailored Approach to Temporary Mechanical Circulatory Support for Cardiogenic Shock: Strategies to Facilitate Patient Mobilization.

Purpose Of Review: This article discusses a tailored approach to managing cardiogenic shock and temporary mechanical circulatory support (tMCS). We also outline specific mobilization strategies for patients with different tMCS devices and configurations, which can be enabled by this tailored approach to cardiogenic shock management.

Recent Findings: Safe and effective mobilization of patients with cardiogenic shock receiving tMCS can be accomplished.

Time-varying analyses of survival and outcomes in patients with HeartMate 3 left ventricular assist devices.

Aims: As patients experience longer survival on HeartMate 3 left ventricular assist devices, there is a need to characterize long-term risks of adverse outcomes more precisely. This study characterized temporal variations in risks of mortality and adverse outcomes in patients with a HeartMate 3.

Methods And Results: From October 2015 to January 2023, 431 HeartMate 3 devices were implanted at Cleveland Clinic.

Temporary microaxial transvalvular left ventricular assist device for post-myocardial infarction ventricular septal rupture: Bridging a paradigm shift.

Objective: To characterize the clinical courses and outcomes of patients presenting with post-myocardial infarction (MI) ventricular septal rupture (VSR) receiving temporary microaxial transvalvular left ventricular assist device (tVAD) support.

Methods: Between December 2019 and July 2023, 10 consecutive patients presented with a post-MI VSR. All 10 patients received a tVAD.

Extended Duration Bridge to Orthotopic Heart Transplant Utilizing the Impella RP Flex.

We present a case of a 56 year old man presenting with cardiogenic shock from isolated right ventricular failure due to arrhythmogenic right ventricular cardiomyopathy who was successfully bridged to heart transplantation after 29 days on an Impella RP Flex right ventricular assist device. This represents the longest reported duration of support with the device to date and highlights the utility of this platform in the management of severe right ventricular failure.

Are there etiology-specific risk factors for adverse outcomes in patients on Impella 5.5 support?

Objectives: To identify possible etiology-specific differences in preoperative risk factors for major adverse events during Impella 5.5 support in patients with ischemic (ICM) and nonischemic cardiomyopathy (NICM).

Methods: From October 2019 to January 2023, 228 Impella 5.

Trajectories following Impella 5.5 support are associated with initial presentation acuity.

Background: Impella 5.5 is a temporary left ventricular assist device utilized to support patients with cardiogenic shock and those undergoing high-risk cardiac interventions.

Methods: From October 2019 to January 2023, 226 patients received Impella 5.

Efficacy and safety of a transaortic approach to midventricular and apical septal myectomy.

Objective: The study objective was to evaluate the safety and efficacy of a transaortic approach to midventricular and apical septal myectomy in patients with hypertrophic cardiomyopathy with left ventricular outflow tract or midventricular obstruction.

Methods: From January 2018 to August 2023, 940 patients underwent transaortic septal myectomy at the Cleveland Clinic, of whom 682 (73%) had midventricular or apical resection. Patients who underwent isolated basal myectomies were excluded.

Outcomes After Left Atrial Appendage Clip Placement During Cardiac Surgery: A Nationwide Analysis.

This study evaluated the nationwide associations between concomitant left atrial appendage clip (LAAC) placement during cardiac surgery and postoperative outcomes. We identified 1,260,999 patients who underwent coronary artery bypass grafting, valve, and aortic surgeries in the 2016 to 2020 Nationwide Readmissions Database and stratified by concomitant LAAC versus no LAAC placement. Patients who underwent surgical ablation were excluded.

Association of timing of percutaneous left ventricular assist device insertion with outcomes in patients undergoing cardiac surgery.

Objectives: The aim of this study was to explore the associations between percutaneous ventricular assist device (pVAD) insertion timing relative to cardiac surgery and patient outcomes.

Methods: The Nationwide Inpatient Sample was queried for patients undergoing cardiac surgery and pVAD insertion in the same admission from 2016 to 2019. Patients were stratified by timing of pVAD insertion.

Multifocal disease progression and subsequent intervention in patients with actin alpha-2 variants: A single-center experience.

Objectives: To describe patient characteristics and indications for surgical intervention, reoperation, and outcomes in patients with actin alpha-2 (ACTA2) variants.

Methods: A single-center retrospective cohort study with prospective follow-up was performed for 38 patients with an ACTA2 variant.

Results: From 1999 to 2020, 26 (70%) patients underwent surgery; 11 remain under surveillance (mean follow-up, 7.

Left Ventricular Assist Device With External Iliac Artery Outflow Graft Anastomosis.

Durable left ventricular assist devices (LVADs) are a cornerstone therapy for patients with end-stage heart failure, and thus efforts to develop techniques that facilitate their use in an expanded population of patients are critical. Although the preferred outflow graft anastomosis site is the ascending aorta, alternative sites have been described including the descending thoracic and supraceliac abdominal aorta, as well as the innominate and axillary arteries. However, these vessels can be unfavorable targets in the setting of atherosclerosis, aneurysm, insufficient caliber, dissection, or complicated anatomy due to prior interventions.

Programmatic approach to patients with advanced ischemic cardiomyopathy: Integrating microaxial support into strategies for the modern era.

Patients with advanced ischemic cardiomyopathy manifesting as left ventricular dysfunction exist along a spectrum of severity and risk, and thus decision-making surrounding optimal management is challenging. Treatment pathways can include medical therapy as well as revascularization through percutaneous coronary intervention or coronary artery bypass grafting. Additionally, temporary and durable mechanical circulatory support, as well as heart transplantation, may be optimal for select patients.

Chronic thoracoabdominal aortic dissection: endovascular options to obliterate the false lumen.

Background: Persistent false lumen patency in chronic thoracoabdominal aortic dissections after thoracic endovascular aortic repair (TEVAR) contributes to negative aortic remodeling. We have previously described the evolution of various endovascular techniques to treat persistent false lumen perfusion including false lumen embolization. Objectives of this study are to describe endovascular techniques to obliterate the false lumen and present updated outcomes in a recent series of patients undergoing false lumen embolization for chronic aortic dissection.