Intrapericardial Left Ventricular Assist Device for Advanced Heart Failure.

Background: Mechanical circulatory support with a left ventricular assist device (LVAD) is an established treatment for patients with advanced heart failure. We compared a newer LVAD design (a small intrapericardial centrifugal-flow device) against existing technology (a commercially available axial-flow device) in patients with advanced heart failure who were ineligible for heart transplantation.

Methods: We conducted a multicenter randomized trial involving 446 patients who were assigned, in a 2:1 ratio, to the study (centrifugal-flow) device or the control (axial-flow) device.

Patients Awaiting Heart Transplantation on HVAD Support for Greater Than 2 Years.

Advanced heart failure patients who are classified as bridge to transplant (BTT) often remain on mechanical circulatory support (MCS) for long durations because of the limited supply of donor organs. Here, we present the outcomes of patients who have been supported by the HeartWare ventricular assist device system for more than 2 years. In the HeartWare BTT and continued access protocol trial, 74 of the 382 total patients (19.

An analysis of pump thrombus events in patients in the HeartWare ADVANCE bridge to transplant and continued access protocol trial.

Background: The HeartWare left ventricular assist device (HVAD, HeartWare Inc, Framingham, MA) is the first implantable centrifugal continuous-flow pump approved for use as a bridge to transplantation. An infrequent but serious adverse event of LVAD support is thrombus ingestion or formation in the pump. In this study, we analyze the incidence of pump thrombus, evaluate the comparative effectiveness of various treatment strategies, and examine factors pre-disposing to the development of pump thrombus.

Left ventricular assist device management in the ICU.

Objectives: To review left ventricular assist device physiology, initial postoperative management, common complications, trouble shooting and management of hypotension, and other common ICU problems.

Data Source: Narrative review of relevant medical literature.

Data Synthesis: Left ventricular assist devices prolong the lives of patients with end-stage heart failure, and their use is increasing.

Current status of left ventricular assist device technology.

The use of long-term left ventricular assist devices (LVADs) has revolutionized the treatment of end-stage heart failure. The most significant advance in this field has been the longer durability of devices secondary to a simpler pump design with fewer or no mechanical bearings and valves. Continuous-flow LVADs have recently been shown to provide safe and effective circulatory support and have replaced the first-generation fill-to-empty devices.

Relationship between routine multi-detector cardiac computed tomographic angiography prior to reoperative cardiac surgery, length of stay, and hospital charges.

While multi-detector cardiac computed tomography angiography (MDCCTA) prior to reoperative cardiac surgery (RCS) has been associated with improved clinical outcomes, its impact on hospital charges and length of stay remains unclear. We studied 364 patients undergoing RCS at Washington Hospital Center between 2004 and 2008, including 137 clinically referred for MDCCTA. Baseline demographics, procedural data, and perioperative outcomes were recorded at the time of the procedure.

Use of an intrapericardial, continuous-flow, centrifugal pump in patients awaiting heart transplantation.

Background: Contemporary ventricular assist device therapy results in a high rate of successful heart transplantation but is associated with bleeding, infections, and other complications. Further reductions in pump size, centrifugal design, and intrapericardial positioning may reduce complications and improve outcomes.

Methods And Results: We studied a small, intrapericardially positioned, continuous-flow centrifugal pump in patients requiring an implanted ventricular assist device as a bridge to heart transplantation.

Fluoroscopy use and left anterior descending artery angiography to guide transapical access in patients with prior cardiac surgery.

Background: Patients with severe aortic stenosis (AS) and prior cardiac surgery undergoing aortic valve replacement (AVR) are at high risk. Transapical AVR might reduce the risk in patients not suitable for the transfemoral approach. We aimed to describe the fluoroscopy and left anterior descending artery (LAD) angiography guidance technique for transapical AVR access and the initial related procedural results.

Patients with severe asymptomatic carotid artery stenosis do not have a higher risk of stroke and mortality after coronary artery bypass surgery.

Background And Purpose: Stroke development is a major concern in patients undergoing coronary artery bypass grafting (CABG). Whether asymptomatic severe carotid artery stenosis (CAS) contributes to the development of stroke and mortality in such patients remains uncertain.

Methods: A retrospective analysis of 878 consecutive patients with documented carotid duplex ultrasound who underwent isolated CABG in our institution from January 2003 to December 2009 was performed.

Comparison of frequency of atrial fibrillation after coronary artery bypass grafting in African Americans versus European Americans.

In the general population, African Americans experience atrial fibrillation (AF) less frequently than European Americans. This difference could also exist in the incidence of this arrhythmia after cardiac surgery, but this possibility has been insufficiently examined. To test the association of such an ethnic difference, we compared the incidence of postoperative AF in a consecutive series of 2,312 African Americans and 6,054 European Americans who underwent isolated coronary artery bypass grafting from July 2000 to June 2007.

Association of body mass index with new-onset atrial fibrillation after coronary artery bypass grafting operations.

Background: Postoperative atrial fibrillation (AF) frequently complicates coronary artery bypass grafting (CABG) operations. As the frequency of obesity has increased in the United States, the number of obese patients undergoing CABG has kept pace. This study sought to define the association between body mass index (BMI) and postoperative AF.

Is vasoplegic syndrome more prevalent with open-heart procedures compared with isolated on-pump CABG surgery?

Postoperative vasoplegic syndrome (PVS) is a frequent complication and can affect the early postoperative course. Our study investigated the incidence and risk factors of PVS after on-pump isolated coronary artery grafting bypass (CABG) and on-pump open-heart surgery. A total of 629 patients underwent on-pump cardiac surgery from November 21, 2005, to June 9, 2006, at our institution.

A randomized, open-label pilot study comparing desirudin and argatroban in patients with suspected heparin-induced thrombocytopenia with or without thrombosis: PREVENT-HIT Study.

Because of an extreme risk for thromboemboli, patients with suspected heparin-induced thrombocytopenia (HIT) require immediate initiation of an alternative anticoagulant. The only therapies approved by the Food and Drug Administration require intravenous infusion of expensive direct thrombin inhibitors. This prospective, randomized, open-label, exploratory study compared the clinical and economic utility of subcutaneous desirudin vs argatroban, the most frequently used agent for suspected or immunologically confirmed HIT, with or without thrombosis.

Perioperative outcomes in reoperative cardiac surgery guided by cardiac multidetector computed tomographic angiography.

Background: Preoperative evaluation with contrast-enhanced multidetector computed tomographic angiography (MDCTA) is considered an "appropriate" indication based on expert consensus. We aimed to evaluate how the presurgical evaluation with MDCTA impacts the outcomes after reoperative cardiac surgery (RCS).

Methods: We retrospectively studied 364 patients undergoing RCS between 2004 and 2008, including 137 referred for MDCTA.

Is cardiac surgery safe in extremely obese patients (body mass index 50 or greater)?

Background: We investigated the impact of extreme obesity (body mass index [kg/m(2)] 50 or greater) on short-term clinical outcomes and report 1-year mortality.

Methods: Fifty-seven patients were found to have a body mass index of 50 or greater among 14,449 patients who underwent cardiac surgery between July 2000 and June 2007. Multivariable logistic regression analyses were used to assess the independent influence of extreme obesity on the major outcomes.

Off-pump coronary artery bypass grafting improves in-hospital mortality in patients with dialysis-dependent renal failure.

Objective: Patients with chronic dialysis-dependent end-stage renal disease are increasingly referred for coronary artery bypass grafting (CABG) and their early outcome is less favorable. Off-pump CABG (OPCAB) has achieved encouraging results in high-risk patients. Therefore, we designed this retrospective study to test the hypothesis that OPCAB reduced surgical risks in dialysis patients.

Early readmission of low-risk patients after coronary surgery.

Background: Early readmission after coronary artery bypass grafting (CABG) is an expensive adverse outcome. Although the perioperative experience of high-risk CABG patients has been studied extensively, little attention has been paid to low-risk CABG patients. The primary goal of this study was to identify the preoperative characteristics and to define risk predictors of readmission and preventive factors for readmission in low-risk isolated-CABG patients.

Is incidence of postoperative vasoplegic syndrome different between off-pump and on-pump coronary artery bypass grafting surgery?

Objective: Postoperative vasoplegic syndrome (PVS) is a potentially lethal condition with increased mortality and other postoperative morbidities. Many previous studies have examined the outcomes associated with on-pump coronary artery bypass grafting (CABG) surgery, little is known about the incidence of PVS after off-pump CABG.

Methods: From November 21, 2005 to June 9, 2006, 334 patients underwent isolated on-pump CABG and 362 had off-pump CABG surgery.

Comparison of the quality of life after conventional versus off-pump coronary artery bypass surgery.

Purpose: Numerous studies have focused on off-pump coronary artery bypass graft (off-pump CABG) morbidity and mortality outcomes, but few looked at the patient's perception of the technique and its effect on postoperative quality of life (QOL). We investigated and compared postoperative QOL in patients who had undergone either conventional or off-pump CABG myocardial revascularization.

Methods: During a six-month period, 191 patients who underwent CABG surgery were prospectively studied through preoperative and six-month postoperative short-form 36 (SF-36) general health status surveys.

Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents for patients with multivessel coronary artery disease.

Background: Advances in coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) with drug-eluting stents have dramatically improved results of these procedures. The optimal treatment for patients with multivessel coronary artery disease is uncertain given the lack of prospective, randomized data reflecting current practice. This study represents a "real-world" evaluation of current technology in the treatment of multivessel coronary artery disease.

Bi-ventricular circulatory support with the Abiomed AB5000 system in a patient with idiopathic refractory ventricular fibrillation.

A 45-year-old man had life-threatening recurrent idiopathic ventricular fibrillation and persistent cardiogenic shock develop. The episodes of ventricular fibrillation were refractory to aggressive medical management; therefore an Abiomed AB5000 bi-ventricular support system was implanted for arrhythmia control. The device was able to maintain hemodynamic stability during the following 2 weeks.

Comparisons of cardiac surgery outcomes in Jehovah's versus Non-Jehovah's Witnesses.

Jehovah's Witnesses is a Christian faith whose members will not accept blood or blood products under any circumstances on the basis of religious grounds. To date, no comparative studies have evaluated the outcome of open heart surgery in Jehovah's Witnesses compared with patients who accept the transfusion of blood products. The present study was conducted to systematically compare the operative mortality and early clinical outcome after open cardiac surgery in Jehovah's Witnesses versus non-Jehovah's Witnesses.