Advances in the understanding and management of heart transplantation.

Cardiac transplantation represents one of the great triumphs in modern medicine and remains the cornerstone in the treatment of advanced heart failure. In this review, we contextualize pivotal developments in our understanding and management of cardiac transplant immunology, histopathology, rejection surveillance, drug development and surgery. We also discuss current limitations in their application and the impact of the left ventricular assist devices in bridging this gap.

Advanced hybrid closed chest revascularization: an innovative strategy for the treatment of multivessel coronary artery disease†.

Objectives: Conventional hybrid revascularization (CHR) combines minimally invasive placement of an internal mammary artery graft to the anterior wall and percutaneous coronary intervention (PCI) of non-anterior wall targets. In this study we assess perioperative and midterm outcomes of advanced hybrid revascularization (AHR) defined as the combination of single or multivessel (MV) totally endoscopic coronary artery bypass grafting (TECAB) with single or multivessel PCI.

Methods: In total, 90 AHR patients [median age 62 years (35-86)] were compared with 90 CHR patients [median age 60 years (35-85)] in terms of perioperative and mid-term outcomes.

Durability of the survival effect of cardiac resynchronization therapy by level of left ventricular functional improvement: fate of "nonresponders".

Background: Although improvement in left ventricular (LV) function has been shown to portend superior short-term outcomes in patients with heart failure undergoing cardiac resynchronization therapy (CRT), the durability of this effect at 5 years has not been established.

Objective: To determine the long-term outcomes of patients undergoing CRT on the basis of the degree of echocardiographic response.

Methods: We extracted clinical data on a cohort of 880 consecutive patients undergoing the new implantation of a CRT device between September 30, 2003, and August 6, 2007.

QRS narrowing is associated with reverse remodeling in patients with chronic right ventricular pacing upgraded to cardiac resynchronization therapy.

Background: Patients with chronic right ventricular pacing (RVP) upgraded to cardiac resynchronization therapy (CRT) have been excluded from the majority of clinical trials of CRT. Little is known about the predictors of response in this population. We hypothesized that reversal of RVP-induced electrical dyssynchrony (indexed by QRS duration) by CRT would predict a favorable response.

Cardiac venous left ventricular lead removal and reimplantation following device infection: a large single-center experience.

Background: Early series of biventricular device removal have contained mostly younger cardiac venous (CV) left ventricular leads and few have reported on rates of successful reimplantation.

Methods And Results: We performed a retrospective analysis of all patients referred to the Cleveland Clinic between February 2, 2001 and July 27, 2011 for removal of a biventricular device with a CV pacing lead for an infectious indication. A total of 173 patients were included.

Hybrid thoracoabdominal aneurysm repair with antegrade visceral debranching from the ascending aorta: concomitant cardiac surgery and stent-grafting.

Patients with thoracoabdominal aneurysm that require concomitant cardiac surgery present a complex surgical challenge. A staged hybrid technique including combined cardiac surgery and visceral revascularization from the ascending aorta, followed by endovascular aneurysmal exclusion is reported in four patients. No perioperative death and no neurological complications were observed.

Predictors of response to cardiac resynchronization therapy in patients with a non-left bundle branch block morphology.

Patients with non-left bundle branch block (LBBB) morphologies are thought to derive less benefit from cardiac resynchronization therapy (CRT) than those with LBBB. However, some patients do exhibit improvement. The characteristics associated with a response to CRT in patients with non-LBBB morphologies are unknown.