PAs in Poland: The inaugural surgical PA curriculum.

ABSTRACT: After many years of consultations with the international physician assistant (PA) community and a successful pilot program, in November 2021, the Polish Ministry of Health approved a specialty training program for surgical PAs. The inaugural class began studies in July 2022. This article details the circumstances and the process that led to the creation of this new program.

A Successful Heart Transplantation Coupled with Temporary Right Ventricular Assist Device Implantation in a Patient with (ir)Reversible Pulmonary Hypertension.

Pulmonary hypertension (PH) constitutes one of the main contraindications to heart transplantation (OHT), and elevated pulmonary vascular resistance (PVR) is associated with high risk of posttransplant right heart failure (RVF). In the present case report, a patient with PH is introduced who qualified for heart lung transplantation (HLT) and underwent successful OHT with temporary right ventricle assist device (tRVAD) due to the lack of a suitable heart-lung donor. Temporary RVAD support coupled with optimal medical management may help reverse pulmonary vascular resistance, which was previously deemed as permanent in patients requiring heart transplantation.

Short- and long-term outcomes of continuous-flow left ventricular assist device therapy in 79 patients with end-stage heart failure.

INTRODUCTION: An increasing number of patients with end­stage heart failure, along with a shortage of heart donors, necessitates the use of mechanical circulatory support. OBJECTIVES: This single­center retrospective study evaluated short- and long term outcomes of continuous­flow left ventricular assist device (CF LVAD) therapy in patients with end stage heart failure. PATIENTS AND METHODS: We collected and assessed data of 79 patients (77 men, 2 women; mean age, 50.3 years; mean INTERMACS profile, 3.1) implanted with a CF­LVAD between 2009 and 2017 (HeartMate 3 in 19 patients [24%]; HeartMate 2 in 9 [11.4%]; and HeartWare in 51 [64.6%]). RESULTS: The mean time on CF-LVAD support was 604 days (range, 1­1758 days). There were 2 device exchanges due to pump thrombosis and 1 explantation due to heart regeneration; 9 patients (11.4%) underwent heart transplant. Stroke (nondisabling, 48%) occurred in 27.8% of patients (ischemic in 9 patients; hemorrhagic, in 14; both types, in 1) despite the standardized anticoagulation regimen. Major gastrointestinal bleeding and pump thrombosis were reported in 13 patients (16.5%), while 18 patients (22.8%) developed driveline infections (recurrent in 15 patients [19%]). Hemorrhagic stroke and bacteremia had a negative impact on survival. Hemorrhagic stroke was the main cause of death. Survival probability was 0.9 at 1 month and 0.81, 0.71, 0.61, and 0.53 at 1, 2, 3, and 4 years, respectively. CONCLUSIONS: Although CF­LVAD support is associated with substantial adverse events, they do not significantly affect mortality (except hemorrhagic stroke and bacteremia). Novel devices seem to overcome these limitations, but larger studies are needed to support these findings.

Simplified, less-invasive left ventricular assist device implantation in patients with post-coronary artery bypass grafting.

Less-invasive left ventricular assist device implantation is becoming the technique of choice for implementation of new-generation heart pumps. The less-invasive technique is particularly useful for patients with a history of cardiac surgical procedures, such as coronary artery bypass grafting. Yet, in redo cases, severe pericardial adhesions may force experienced operators to opt for alternative outflow graft placement, such as in the descending aorta. We propose a surgical technique in which the left ventricular device is implanted through a limited thoracic incision, with the outflow graft anastomosed to the ascending aorta, avoiding collision with coronary bypass grafts. The key element of the proposed technique is a tunnel connecting 2 pleural cavities, in which the outflow graft is placed, entirely bypassing the pericardium.

Emergency HeartWare Ventricular Assist Device (HVAD) exchange due to pump thrombosis using minimally invasive technique.

Left ventricular assist device (LVAD) thrombosis remains a dreadful complication of mechanical circulatory support, with an incidence of 8-12% depending on the pump type and patient's comorbidities. Fibrinolysis may be considered early in pump thrombosis, but when contraindicated a pump exchange remains the only alternative. This short report documents an emergency LVAD exchange in a 55-year-old man who underwent LVAD (HeartWare Inc) implantation in 2013 as a bridge to transplantation. Four months after the initial surgery, he suffered from a hemorrhagic stroke despite properly managed anticoagulation. On February 17th, 2017 he was re-admitted with LVAD pump thrombosis. As fibrinolysis was contraindicated, an emergency pump exchange was performed via a limited thoracic incision in order to minimize surgical trauma, reduce intraoperative complications and facilitate immediate post-operative recovery. This report documents the very first LVAD pump exchange as well as the first one performed via a minimally invasive approach in Poland.