First-in-Man Use of a Modified Controller to Resolve HVAD Failure-to-Restart.

We report a case of Medtronic HeartWare ventricular assist device (HVAD) pump failure-to-restart. Despite HVAD withdrawal from the market in June 2021, up to 4,000 patients remain on HVAD support worldwide, and many are at high risk for this serious complication. This report describes the first-in-man use of a new HVAD controller that restarted a defective HVAD pump and avoided a fatal outcome. This new controller has the potential of preventing unnecessary VAD exchanges and saving lives.

Post-Heart Transplant Care Pathway's Impact on Reducing Length of Stay.

BACKGROUND: Prolonged length of stay (LOS) has undesirable consequences including increased cost, resource consumption, morbidity, and disruptions in hospital flow. LOCAL PROBLEM: A high-volume heart transplant center in the Pacific Northwest had a mean index hospital LOS of 23 days, with a goal of 10 days according to the institutional heart transplant care pathway. METHODS: A retrospective, regression analysis was used to identify the factors contributing to LOS of 41 post-heart transplant patients. INTERVENTIONS: The post-heart transplant care pathway and order set were modified accordingly and reintroduced to the health care team. RESULTS: Factors contributing to LOS included number of days (1) until the first therapeutic calcineurin inhibitor level, (2) until intravenous diuretics were no longer required, and (3) outside of a therapeutic calcineurin inhibitor range. The interventions reduced the mean LOS by 8 days. CONCLUSIONS: Increased awareness of LOS, education, and consistent use of care pathways can significantly reduce length of stay.