Door-to-Diuretic Time is related to length of hospital stay independent of diuretic dose among acute decompensated heart failure patients.

Background: Acute decompensated heart failure (ADHF) treatment guidelines recommend initial dosages for diuretic drugs but lack guidance on treatment timing. Recent evidence indicates that faster treatment, or shorter Door-to-Diuretic (D2D) Time, may improve outcomes.

Objectives: This study assessed how diuretic dose, D2D Time, and their interaction affect hospital length of stay.

Prediction of Survival After Implantation of a Fully Magnetically Levitated Left Ventricular Assist Device.

Background: Clinical trials inform on average efficacy, but individualized risk assessments for outcome prediction are important in guiding treatment implementation.

Objectives: The authors developed and validated a patient-specific risk score to predict survival at 1 and 2 years after HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation.

Methods: The MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3) trial includes 2,200 HM3 LVAD patients in the pivotal trial and Continued Access Protocol study (2014-2018).

Variability in Blood Pressure Assessment in Patients Supported with the HeartMate 3TM.

Targeted blood pressure (BP) control is a goal of left ventricular assist device medical management, but the interpretation of values obtained from noninvasive instruments is challenging. In the MOMENTUM 3 Continued Access Protocol, paired BP values in HeartMate 3 (HM3) patients were compared from arterial (A)-line and Doppler opening pressure (DOP) (319 readings in 261 patients) and A-line and automated cuff (281 readings in 247 patients). Pearson (R) correlations between A-line mean arterial (MAP) and systolic blood pressures (SBP) were compared with DOP and cuff measures according to the presence (>1 pulse in 5 seconds) or absence of a palpable radial pulse.

Smoking and the Risk of Stroke in Patients with a Left Ventricular Assist device.

There are limited data on the association of smoking with the risk of stroke following left ventricular assist device (LVAD) implantation. We designed this study to analyze the impact of smoking status at the time of LVAD implantation on stroke. We hypothesized that current smokers are at increased risk of stroke when compared with patients who were former or never smokers.

Long-term milrinone therapy as a bridge to heart transplantation: Safety, efficacy, and predictors of failure.

Background: Studies of long-term inotrope use in advanced HF have previously provided limited and conflicting results. This study aimed to evaluate the safety and efficacy of long-term milrinone use and identify predictors of failure to bridge to orthotropic heart transplant (OHT) in a cohort of end-stage heart failure (HF) patients listed for heart transplantation and receiving inotrope therapy.

Methods: The study included 150 adults listed for OHT at a single center from 2001 to 2017 who received milrinone therapy for ≥30 days.

Outcomes of gastrointestinal bleeding in patients with left ventricular assist devices: a tertiary care experience.

 Left ventricular assist device (LVAD) placement is a therapeutic modality for patients with end-stage heart failure. Gastrointestinal bleeding is a common complication following LVAD implantation. The aim of this study was to report our experience in management and outcomes of gastrointestinal bleeding in a large cohort of patients with LVADs.

Complete Sternal-Sparing Approach Improves Outcomes for Left Ventricular Assist Device Implantation in Patients With History of Prior Sternotomy.

Objective: Early reports of less invasive techniques for left ventricular assist device (LVAD) implantation have demonstrated promising results. We sought to investigate the safety and feasibility of implementing the complete sternal-sparing (CSS) approach for LVAD implantation in patients with a history of prior cardiac operation.

Methods: This was a retrospective review of prospectively collected data for all patients implanted with a fully magnetically levitated LVAD from April 2017 through December 2018.

Extracorporeal life support to ventricular assist device: potential benefits of sternal-sparing approach.

Background: Advancements in left ventricular assist device (LVAD) technology have improved long-term survival for properly selected patients with advanced heart failure. However, the subset of patients in critical cardiogenic shock remain difficult to treat with persistently high patient morbidity and mortality. The goal of this study is to describe our institutional experience utilizing extracorporeal membrane oxygenation (ECMO) as a bridge to LVAD for patients in cardiogenic shock comparing the less invasive complete sternal-sparing (CSS) surgical technique to median sternotomy.

Potential for donation after circulatory death heart transplantation in the United States: Retrospective analysis of a limited UNOS dataset.

Donation after Circulatory Death (DCD) is an alternative to Donation after Brain death (DBD), and is a growing strategy for organ procurement in the United States(US). The purpose of this analysis was to review the number and quality of hearts in one United Network for Organ Sharing (UNOS) Region that were not utilized as a potential consequence of nonheart DCD donation. We retrospectively identified all successful US DCD solid organ donors from 1/2011 to 3/1/2017, defined an ideal heart donor by age and left ventricular ejection fraction (LVEF), and then reviewed the donor charts of unused hearts in New York and Vermont (UNOS Region 9).

Exercise Training and Heart Failure: A Review of the Literature.

Exercise and cardiac rehabilitation have been underused therapy options for patients with congestive heart failure despite being recommended in international guidelines and being covered by Medicare in the US. This article reviews the evidence behind this treatment strategy and details current trials that will contribute to the evidence base.

A Multimodal Skin Cancer Prevention Program for Heart Transplant Patients.

Background: Immunosuppressant medications are essential for long-term survival following transplantation but increase the risk of developing skin cancer. Prevention and early detection of skin cancer requires screening and sun protection behaviors that can be achieved with patient education.

Problem Statement: Our method for educating post heart transplant patients regarding skin cancer was inconsistent and was not effective.

Ambulatory Intra Aortic Balloon Pump in Advanced Heart Failure.

Cardiac transplantation is the gold standard treatment for patients with advanced congestive heart failure that is refractory to maximal medical therapy. However, donor heart availability remains the major limiting factor, resulting in a large number of patients waiting long periods of time before transplantation. As a result, mechanical circulatory support devices have been increasingly used as a 'bridge' in order to sustain organ function and stabilise haemodynamics while patients remain on the transplant waiting list or undergo left ventricular assist device surgery.

Implantable Cardioverter Defibrillators and Survival in Continuous-Flow Left Ventricular Assist Device Patients.

The association of an implantable cardioverter defibrillator (ICD) with survival in patients with left ventricular assist devices (LVADs) is not well understood. We evaluated all-cause mortality by the presence of an ICD at the time of LVAD implantation, or by ICD implantation after LVAD placement in 191 patients, using Kaplan-Meier survival analyses and Cox models with multivariate adjustment. During the median follow-up of 23 months, 33 of 129 patients (26%) with an ICD and 17 of 62 patients (27%) without an ICD died.

Renal Function Changes Following Left Ventricular Assist Device Implantation.

Limited data assessing the clinical significance of post-left ventricular assist device (LVAD) in renal function are available. We aimed to investigate the impact of changes in renal function after LVAD implantation on subsequent long-term outcomes. We followed 184 patients with HeartMate II LVADs implanted between May 2008 and November 2014.

Maximizing donor allocation: A review of UNOS region 9 donor heart turn-downs.

This study was performed to determine if organ selection practices for heart utilization by Region 9 transplant programs were optimal, and to identify opportunities to increase local organ recovery. A retrospective review of de-identified region-wide donor data January 1, 2010 through December 31, 2013 was performed. Over the study period 537 heart donors were identified, of which 321 (60%) were transplanted.

Psychometrics of the Kansas City Cardiomyopathy Questionnaire Adapted for Family Caregiver/Significant Other.

Background And Purpose: The Kansas City Cardiomyopathy Questionnaire (KCCQ) was adapted to be administered to the family caregiver/significant other (FC/SO) of hospitalized patients with heart failure (HF). The objective was to examine the psychometrics of the adapted scale (KCCQ-SO).

Methods: Factor analysis, Cronbach's alpha, and correlations were used.

Study of the wearable cardioverter defibrillator in advanced heart-failure patients (SWIFT).

Introduction: The wearable cardioverter defibrillator (WCD) may allow stabilization until reassessment for an implantable cardioverter defibrillator (ICD) among high-risk heart failure (HF) patients. However, there are limited data on the WCD benefit in the acute decompensated HF setting.

Methods And Results: The Study of the Wearable Cardioverter Defibrillator in Advanced Heart Failure Patients (SWIFT) was a prospective clinical trial carried out at two medical centers.

Temporary mechanical circulatory support after orthotopic heart transplantation: a single-centre experience.

Objectives: There are various strategies in the use of temporary mechanical circulatory support following orthotopic heart transplant (OHT). We sought to examine the outcomes following different temporary mechanical circulatory support strategies for acute graft failure.

Methods: Patients who received an OHT between 2001 and 2015 at a single institution were retrospectively reviewed.

Echocardiographic detection of left ventricular thrombus in patients undergoing HeartMate II left ventricular assist device implantation.

Purpose: Transthoracic (TTE) and transesophageal echocardiograms (TEE) are considered accurate in detecting the presence of left ventricular (LV) thrombus. A persistent LV thrombus poses risks of pump thrombosis and stroke in LVAD recipients. The relationship between preoperative echocardiography and intraoperative findings at LVAD implantation has not previously been studied.

Kansas City Cardiomyopathy Questionnaire Administered to Hospitalized Patients With Heart Failure.

Background And Purpose: The psychometric properties of the Kansas City Cardiomyopathy Questionnaire (KCCQ) have been examined primarily in community-dwelling patients with heart failure (HF). The objective of this research was to examine the properties of the KCCQ administered to patients hospitalized with HF (N = 233).

Methods: Confirmatory factor analysis, Cronbach's alphas, and correlations were performed to examine the scale's dimensions, reliability, and validity.