Origins and Evolution of Extracorporeal Circulation: JACC Historical Breakthroughs in Perspective.

Midway through the 20th century, direct open-heart operations were not yet a reality, awaiting safe methods to support the cardiopulmonary circulation during cardiac surgery. The scientific advancements collectively leading to safe cardiopulmonary bypass are considered some of the most impactful advances of modern medicine. Stimulated by the work of physiologists and engineers in the late 19th century, primitive pump and oxygenator designs were the forerunners of major work by DeBakey and others in roller pump design and by Gibbon in oxygenator development.

Cardiothoracic Surgery at the University of Alabama at Birmingham (UAB): A Legacy of Innovation, Education, and Contributions.

Cardiothoracic Surgery at the University of Alabama at Birmingham (UAB) represents a transformative enterprise whose origins lie in local practice and education in a Southern state with a challenging history, transformed by the visions of a few to become a dominant force in the historical fabric of regional, national, and international cardiothoracic surgery. Throughout its history, numerous individuals have participated in important innovations, education, and contributions to a consistent theme of surgical excellence. This review will recapitulate a sample of relevant historical events and the impact of the leaders of cardiothoracic surgery at UAB.

Clinical characteristics and outcomes of patients requiring prolonged inotropes after left ventricular assist device implantation.

Limited data exist regarding patients with continuous-flow left ventricular assist device (LVAD) support who require long-term inotropes. Our primary objective was to evaluate the clinical characteristics and all-cause mortality of LVAD recipients with prolonged inotrope use (PIU). Secondary endpoints were to compare predictors of PIU, mortality, risk of late re-initiation of inotropes, time to gastrointestinal bleed (GIB), infection, and arrhythmias.

Innovation in Medical Devices-Lessons from the Past, Planning for the Future: Hastings Lecture 2019.

The development of devices for cardiac and pulmonary support is an example of innovation that opened important therapeutic options for patients with life-limiting diseases. The history of this important advance provides guidance for future developments in the field. Integrity is fundamental to maintaining the trust necessary for success.

Evaluation of flow-modulation approaches in ventricular assist devices using an in-vitro endothelial cell culture model.

Background: Continuous-flow ventricular assist devices (CF-VADs) produce non-physiologic flow with diminished pulsatility, which is a major risk factor for development of adverse events, including gastrointestinal (GI) bleeding and arteriovenous malformations (AVMs). Introduction of artificial pulsatility by modulating CF-VAD flow has been suggested as a potential solution. However, the levels of pulsatility and frequency of CF-VAD modulation necessary to prevent adverse events are currently unknown and need to be evaluated.

Utility of nuclear stress imaging in predicting long-term outcomes one-year post CABG Surgery.

Background: Early MPI after CABG is currently considered rarely appropriate in asymptomatic patients. This study aimed to identify prognostic value of nuclear stress-imaging post-CABG.

Methods: This was a single center prospective study looking at long-term outcomes post-CABG.

Use of Computed Tomography in Preoperative Planning for Heartware Left Ventricular Assist Device Placement.

Optimal left ventricular assist device (LVAD) cannula position is important for adequate ventricular unloading and LVAD function. Poor inflow cannula position predisposes to pump thrombosis, inotrope dependence, and mortality. We describe a novel technique of preoperative left ventricular apex marking using CT guidance and demonstrate in three cases the use of this method to achieve optimal inflow cannula positioning for lateral thoracotomy Heartware LVAD implantation.

INTERMACS Analysis of Stroke During Support With Continuous-Flow Left Ventricular Assist Devices: Risk Factors and Outcomes.

Objectives: This study sought to evaluate predictors of stroke during left ventricular assist device (LVAD) support from data available prior to implantation, and quantify stroke-related morbidity and mortality.

Background: Stroke is a major complication after LVAD. Pre-implant factors that influence stroke are not well understood.

Ventricular Assist Device in Acute Myocardial Infarction.

Background: Patients with acute myocardial infarction (AMI) complicated by acute heart failure or cardiogenic shock have high mortality with conventional management.

Objectives: This study evaluated outcomes of patients with AMI who received durable ventricular assist devices (VAD).

Methods: Patients in the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) registry who underwent VAD placement in the setting of AMI were included and compared with patients who received VAD for non-AMI indications.

Benefits of a novel percutaneous ventricular assist device for right heart failure: The prospective RECOVER RIGHT study of the Impella RP device.

Background: Right ventricular failure (RVF) increases morbidity and mortality. The RECOVER RIGHT study evaluated the safety and efficacy of a novel percutaneous right ventricular assist device, the Impella RP (Abiomed, Danvers, MA), in a prospective, multicenter trial.

Methods: Thirty patients with RVF refractory to medical treatment received the Impella RP device at 15 United States institutions.

Assessment and management of right ventricular failure in left ventricular assist device patients.

Mechanical circulatory support devices, including ventricular assist devices (VADs) and the total artificial heart, have evolved to become accepted therapeutic options for patients with severe congestive heart failure. Continuous-flow left VADs are the most prevalent option for mechanical circulatory assistance and reliably provide years of support. However, problems related to acute and chronic right heart failure in patients with left VADs continue to cause important mortality and morbidity.

Changes over time in risk profiles of patients who undergo coronary artery bypass graft surgery: the Veterans Affairs Surgical Quality Improvement Program (VASQIP).

Importance: Today's coronary artery bypass grafting (CABG) population appears to comprise sicker patients than in the past; however, little is known about the change in the risk profile.

Objective: To evaluate the change with time in the risk profile of patients who undergo CABG.

Design, Setting, And Participants: Retrospective review of records from the Veterans Affairs (VA) Surgical Quality Improvement Program (VASQIP); 65,097 patients who underwent isolated primary CABG from October 1, 1997, to April 30, 2011, were evaluated.

Perioperative outcomes after on- and off-pump coronary artery bypass grafting.

Although numerous reports describe the results of off-pump coronary artery bypass grafting (CABG) at specialized centers and in select patient populations, it remains unclear how off-pump CABG affects real-world patient outcomes. We conducted a large, multicenter observational cohort study of perioperative death and morbidity in on-pump (ON) versus off-pump (OFF) CABG. We reviewed Veterans Affairs Surgical Quality Improvement Program data for all patients (N=65,097) who underwent isolated CABG from October 1997 through April 2011 (intention-to-treat data were available from 2005 onward).

Completeness of coronary revascularization and survival: Impact of age and off-pump surgery.

Objectives: We conducted a multicenter observational cohort study of the effect of completeness of revascularization on long-term survival after coronary artery bypass grafting. We also investigated the impact of age and off-pump surgery.

Methods: The Veterans Affairs Continuous Improvement in Cardiac Surgery Program was used to identify all patients (N=41,139) with left main and 3-vessel coronary artery disease who underwent nonemergency coronary artery bypass grafting from October 1997 to April 2011.

Consequences of radial artery harvest: results of a prospective, randomized, multicenter trial.

Importance: To date, no study has defined the consequences of radial artery harvest based on a large number of patients in a prospective randomized trial.

Objective: To compare pain at the harvest site and functional changes associated with harvesting the radial artery vs saphenous vein for coronary artery bypass grafting.

Design, Setting, And Participants: This study compares the consequences of radial artery harvest with saphenous vein harvest in patients undergoing elective coronary artery bypass grafting procedures in Veterans Affairs hospitals.