Toxicity-induced Cardiomyopathy in a Patient with Femoral Sarcoma: Heart Transplantation After Support with Ventricular Assist Device as Bridge to Transplantability.

This case report exemplifies how a ventricular assist device successfully supported a 15 year old tumor patient with anthracycline-induced cardiomyopathy for 419 days until she was confirmed free from tumor recurrence to undergo heart transplantation, presently with an 18 year follow up without any malignancy.

Mechanical circulatory support systems: evolution, the systems and outlook.

The joint efforts in the fields of surgery, medicine and biomedical engineering, sponsored by both the government and the industry, have led to the development of mechanical support devices that can provide reliable circulatory support, which can temporarily support a patient's circulation until either the heart recovers or until a new heart can be transplanted or permanently replace a failed heart. Their development has been driven by the shortage of donor organs. Various systems have eventually evolved for short or long-term support of patients suffering from cardiogenic and/or advanced heart failure (HF).

Heart transplantation: the Berlin experience and perspectives.

In patients with end-stage heart failure, heart transplants are now an ingrained practice, as they provide satisfying long-term results with good predictability and quality of life. The successful outcome has evolved from the development of effective immunosuppression, recognition of allograft rejection through diagnostic modalities and improvement in donor organ perfusion. Unfortunately, transplant availability is constrained by the shortage of donor organs and is therefore considered a casuistic therapy.

Weaning from ventricular assist device support after recovery from left ventricular failure with or without secondary right ventricular failure.

Although complete myocardial recovery after ventricular assist device (VAD) implantation is rather seldom, systematic search for recovery is worthwhile because for recovered patients weaning from VADs is feasible and can provide survival benefits with long-term freedom from heart failure (HF) recurrence, even if a chronic cardiomyopathy was the primary cause for the drug-refractory HF necessitating left ventricular (LVAD) or biventricular support (as bridge-to-transplantation or definitive therapy) and even if recovery remains incomplete. LVAD patients explanted for myoacardial recovery compared to those transplanted from LVAD support showed similar survival rates and a significant proportion of explanted patients can achieve cardiac and physical functional capacities that are within the normal range of healthy controls. In apparently sufficiently recovered patients, a major challenge remains still the pre-explant prediction of the weaning success which is meanwhile reliably possible for experienced clinicians.

Organ-saving surgical alternatives to treatment of heart failure.

Over time, various surgical treatment strategies have evolved to manage advanced heart failure (HF). Scientific and technological breakthroughs through the last 50 years have put forward various surgical alternatives to patients with advanced HF encompassing surgical ventricular restoration to surgical gene therapy and stem cell replacement of the diseased ventricles. Organ-saving surgical options which used to be promising included dynamic cardiomyoplasty, partial resection of ventricle and cardiac wrapping with Acorn CorCap cardiac support device.

The role of ventricular assist device in children.

The first and successful implantation of a ventricular assist device in 1990 has allowed an 8-year-old child with an end-stage heart failure to undergo a heart transplantation. This milestone paved the way to consider support with ventricular assist in the armamentarium of heart failure management in infants, children and adolescents. Several systems have evolved and faded owing to unacceptable complications.

Evolution of heart transplantation since Barnard's first.

Barnard's first human heart transplantation in 1967 has paved the channel to numerous extensive researches and clinical experiences, mostly from the Stanford group, on orchestrating criteria for donor and recipient selection, immunosuppression, distant heart procurement, re-transplantation, and further global performance of the procedure until it became the gold standard therapy for end-stage heart failure, even in the face of an utterly limited organ availability. Much has happened since Barnard's first. There has been a rapid rise to 4,000-5,000 transplants per year.

Resumé of the challenges and burden of living with transplanted hearts for >31 years.

Heart transplantation has extended the lives of many patients with end-stage heart failure. Although beset with the arduous aftermaths of immunosuppression, those who survived live meaningful lives similar to that of the general population. In this series, heart transplantation has led to a considerable extension of life span of >31-34 years.

Heart failure in the young: Insights into myocardial recovery with ventricular assist device support.

Background: Data on ventricular unloading-promoted myocardial recovery and post-weaning outcome in children is scarce. We analyzed the weaning outcome in children with heart failure (HF) supported with ventricular assist device (VAD).

Methods: A multi-institutional data on VAD implanted in 193 children and adolescents with HF between April 1990 and November 2015 was reviewed.

Accurate assessment of right heart function before and after long-term left ventricular assist device implantation.

Introduction: Because end-stage heart failure (HF) often involves both ventricles even if its initial cause was left-sided heart disease, assessment of RV size, geometry and function before, during and after LVAD implantation is of crucial importance.

Areas Covered: This review discusses the usefulness, benefits, particular challenges and limits of RV assessment in patients with end-stage HF due to primarily impaired LV function who necessitate LVAD support, with or without an additional RV mechanical support.

Expert Opinion: Although LV unloading often induces reduction of the pulmonary vascular resistance facilitating RV reverse remodeling and functional improvement, drug-refractory RVF after LVAD implantation is not always avoidable.

Pediatric ventricular assist devices: what are the key considerations and requirements?

: The development of ventricular assist devices (VADs) have enabled myocardial recovery and improved patient survival until heart transplantation. However, device options remain limited for children and lag in development.: This review focuses on the evolution of pediatric VADs in becoming to be an accepted treatment option in advanced heart failure, discusses the classification of VADs available for children, i.

Consecutive surgical sequelae in children and adolescents with Marfan syndrome after primary cardiovascular surgical interventions.

Objectives: This study focuses on the consecutive sequelae of children and adolescents with Marfan syndrome after primary cardiovascular surgical interventions and the long-term outcomes.

Methods: A retrospective review of children with Marfan syndrome who underwent primary surgical intervention in childhood (<18 years) and sequential cardiovascular operations between July 1986 and September 2014 was undertaken.

Results: Thirty-six children (mean age 12.

Role of paediatric assist device in bridge to transplant.

Background: While heart transplantation has gained recognition as the gold standard therapy for advanced heart failure, the scarcity of donor organs has become an important concern. The evolution of surgical alternatives such as ventricular assist devices (VADs), allow for recovery of the myocardium and ensure patient survival until heart transplantation becomes possible. This report elaborates the role of VADs as a bridge to heart transplantation in infants and children (≤18 years old) with end-stage heart failure.

Extra-anatomical bypass in complex and recurrent aortic coarctation and hypoplastic arch.

Objectives: Our goal was to report the selection schemes, technical variations and long-term outcome of extra-anatomical bypass to correct complex, recurrent aortic coarctation and hypoplastic aortic arch.

Methods: Between 1989 and 2012, 53 patients (mean age 13.2 ± 4.

Extraanatomic bypass technique for the treatment of midaortic syndrome in children.

Background: This report aims to introduce the extraanatomic bypass technique to treat the midaortic syndrome and to document its long-term effectiveness and durability.

Methods: Fourteen patients (mean age, 6.7 ± 3.