Optimal heart rate (HR) is a promising therapeutic target in patients with heart failure with reduced ejection fraction. Nevertheless, the implication of optimal HR in patients with left ventricular assist devices (LVAD) remains unknown. The cohort included consecutive patients with sinus rhythm undergoing LVAD implantation between 2014 and 2018. Ideal HR was calculated as follows: 93 - 0.13 × (deceleration time [msec]). The impact of "HR difference," defined as an HR difference between the actual HR at discharge and the calculated ideal HR, on the 1-year mortality and heart failure readmissions was investigated. A total of 143 patients (55 years old, 101 men) was identified and tertiled considering their HR differences: (1) the optimal HR group (n = 49; HR difference < 27 bpm), (2) the suboptimal HR group (n = 47; HR difference = 27-42 bpm), and (3) the nonoptimal HR group; HR difference (n = 47; HR difference > 43 bpm). The nonoptimal HR group had a significantly higher 1-year cumulative incidence of the primary endpoint compared with the optimal HR group (38% versus 16%, P = 0.029) with a hazard ratio of 1.69 (95% confidence interval 1.02-2.57) adjusted for 6 potential confounders. In conclusion, nonoptimized HR negatively affected clinical outcomes in LVAD patients. The implication of deceleration time-guided HR optimization in LVAD patients should be further investigated.
Introduction: The intravascular ventricular assist device is a newly developed ambulatory and portable counter pulsation heart assist system. The purpose of this study is to compare the early and late outcomes of counter pulsation devices between iVAS and axillary intra-aortic balloon pump (IABP) as a bridge to heart transplantation. Methods: This is a single-center, retrospective study. Between April 2016 and March 2020, 24 patients underwent iVAS implantation (Group A), and 73 patients underwent axillary IABP (Group B) as a bridge to heart transplantation. We reviewed and compared perioperative data, as well as late survival outcomes. Results: There were no significant differences in baseline characteristics. All patients in Group A and 97.3% of patients in Group B were able to ambulate and participate in physical therapy(p=0.28). There were no in-hospital deaths in the two groups. The median duration of device support in Group A was significantly longer than in Group B(A:37.0days vs B:15.0days,p<0.01). After the US Food and Drug Administration approved the discharge of patients with an iVAS, four patients (4/14,28.6%) were discharged home with the device. The success rate of bridge to transplantation was not significantly different between the groups (A:21/24, 87.5% vs B:68/73, 93.2%, p=0.40). Late survival after heart transplantation also did not differ between the groups (A:85.7% at 3-year vs B:94.0% at 3-year, log rank=0.22). Conclusions: Both iVAS and axillary IABP showed comparable success rates of bridge to transplantation and late survival after transplantation. The mobile design of iVAS facilitated excellent ambulatory capability and enabled patients to be discharged home.
Abstract Kommerell’s diverticulum is a rare congenital vascular anomaly. Dysphagia is one indication for surgical intervention. We report on 4 consecutive patients who presented with dysphagia caused by Kommerell’s diverticulum and underwent staged surgical treatment. The key to surgical treatment for such patients is to remove the vascular structure completely from the vicinity of the oesophagus.
Abstract OBJECTIVES It remains unknown if the left atrial appendage closure (LAAC) at the time of left ventricular assist device (LVAD) surgery can reduce ischaemic cerebrovascular accidents. METHODS Consecutive 310 patients who underwent LVAD surgery with HeartMate II or 3 between January 2012 and November 2021 were included in this study. The cohort was divided into 2 groups: patients with LAAC (group A) and without LAAC (group B). We compared the clinical outcomes including the incidence of cerebrovascular accident between 2 groups. RESULTS Ninety-eight patients were included in group A, and 212 patients in group B. There were no significant differences between 2 groups in age, preoperative CHADS2 score and history of atrial fibrillation. In-hospital mortality did not differ significantly between the 2 groups (group A: 7.1%, group B: 12.3%, P = 0.16). Thirty-seven patients (11.9%) experienced ischaemic cerebrovascular accident (5 patients in group A and 32 patients in group B). The cumulative incidence from ischaemic cerebrovascular accidents in group A (5.3% at 12 months and 5.3% at 36 months) was significantly lower than that in group B (8.2% at 12 months and 16.8% at 36 months; P = 0.017). In a multivariable competing risk analysis, LAAC was associated with reducing ischaemic cerebrovascular accidents (hazard ratio 0.38, 95% confidence interval 0.15–0.97, P = 0.043). CONCLUSIONS Concomitant LAAC in LVAD surgery can reduce ischaemic cerebrovascular accidents without increasing perioperative mortality and complications.
We experienced two cases of successful surgical correction of HeartMate 3 outflow graft twisting through a subcostal approach. They were diagnosed with computed tomography or pull back pressure measurement. Technically, a subcostal approach allowed us to access directly to the twisted outflow graft and the device connector in a less invasive fashion without a re-sternotomy. Diagnostic modality and surgical tips are presented.
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