Modified bentall procedure with composite biologic grafts.

Objectives: The search continues for the ideal composite biologic graft (CBG). We have performed aortic root replacements with CBGs, initially with a stented pericardial valve in a Valsalva graft (Gen1) and subsequently with the stentless 3f valve (Gen2). The valve is sewn at the base of the graft sinuses, leaving residual proximal graft to sew separately to the left ventricular outflow tract.

Timing of temporary right ventricular assist device insertion for severe right heart failure after left ventricular assist device implantation.

Data on how the timing of a temporary right ventricular assist device (RVAD) insertion affects outcome are limited in patients receiving left ventricular assist device (LVAD). Of the 282 patients who underwent LVAD placement between January 2000 and November 2010, 40 (14%) required concomitant (n = 26) or delayed (n = 14) RVAD insertion as temporary support. We analyzed early and 1-year outcomes.

Outcome of unplanned right ventricular assist device support for severe right heart failure after implantable left ventricular assist device insertion.

Background: The use of a right ventricular assist device (RVAD) becomes necessary for severe right ventricular (RV) failure after left ventricular assist device (LVAD) insertion. Although temporary support could lead to successful RVAD weaning in certain patients, the data remain scarce.

Methods: We retrospectively reviewed 398 patients who underwent implantable LVAD insertion between January 2000 and December 2012.

The use of a tailored surgical technique for minimally invasive esophagectomy.

Objective: Uncertainty exists among surgeons as to whether minimally invasive esophagectomy (MIE) is a comparable operation to open esophagectomy (OE). The surgical technique and oncologic dissection should not be degraded when using a minimally invasive approach.

Methods: We reviewed a single hospital's experience with both OE and MIE.

Liver dysfunction as a predictor of outcomes in patients with advanced heart failure requiring ventricular assist device support: Use of the Model of End-stage Liver Disease (MELD) and MELD eXcluding INR (MELD-XI) scoring system.

Background: Liver dysfunction increases post-surgical morbidity and mortality. The Model of End-stage Liver Disease (MELD) estimates liver function but can be inaccurate in patients receiving oral anti-coagulation. We evaluated the effect of liver dysfunction on outcomes after ventricular assist device (VAD) implantation and the dynamic changes in liver dysfunction that occur during VAD support.

Tips on tuning each device: technical pearls.

Although the basic technique is relatively similar among the currently available left ventricular assist devices (LVAD), there are many subtle potential technical pitfalls for each device that could result in grave adverse events. In this article, the technical perils of the principal implantation technique and LVAD-related concomitant surgical procedures as well as of the implantation technique specific to currently available implantable LVADs, including HeartMate XVE, HeartMate II, HeartWare, and DuraHeart, are described.

Current technology: devices available for destination therapy.

Left ventricular assist device therapy as a destination therapy for end-stage heart failure has made a large leap with continuous flow devices. Continuous flow does not seem to have a detrimental effect on end-organ function, at least in the midterm. Various expected and unexpected complications have been reported associated with this technology.

Does lung allocation score maximize survival benefit from lung transplantation?

Objective: The lung allocation score was initiated in May 2005 to allocate lungs on the basis of medical urgency and posttransplant survival. However, the relationship between lung allocation score and candidate outcomes remains poorly characterized. The purpose of this study was (1) to describe outcomes by lung allocation score at the time of listing and (2) to estimate the net survival benefit of transplantation by lung allocation score.