Temporary mechanical circulatory support: insights and evolving strategies.

PURPOSE: The goal of this study is to evaluate the utilization and outcomes of temporary mechanical circulatory support (MCS) among patients listed for cardiac transplantation (CT). There is a constant threat of sudden clinical deterioration in these patients that could necessitate emergent MCS. All advanced heart failure and transplant centers in India are plagued by issues of late referrals, low organ donation rates, and financial constraints. Here, we share our experience and explain our evolving strategies tailored to improve outcomes. METHODS: Single-center retrospective analysis of temporary MCS implanted in patients listed for CT from January 1, 2015, to December 31, 2019. RESULTS: A total of 35 patients had 41 MCS implantations. Twenty-four cases were pre-transplant and 11 cases were post-transplant. Veno-arterial extracorporeal membrane oxygenator was the most commonly (20 cases, 44.4%) used MCS modality. Primary outcome of in-hospital mortality was noted in 17 patients (48.5%) in this high-risk profile. All but 2 of the 12 patients that underwent pre-transplant MCS, and were bridged to cardiac transplant, survived the index hospitalization accounting for 90% survival in this subset of patients. The secondary outcome of MCS-related vascular injury was observed in 9 patients (25.7%). CONCLUSION: This single-center observational study demonstrates that early planning and timely institution of MCS improves outcomes in high-risk MCS patients bridged to cardiac transplant. The incidence of MCS-related vascular complications can be improved with development of standard operating protocols.

Suture fixation of migrated septal occluder device to prevent further migration: a simple surgical technique.

As the use of percutaneous intervention is increasing for the closure of the atrial septal defect, the procedure related complications are also on rise, migration of the device being most common. The migrated devices with failed percutaneous retrieval must be removed surgically under cardiopulmonary bypass. During establishment of cardiopulmonary bypass, the handling of heart may cause further migration of the device into other chambers of heart which leads to difficulty in finding and retrieval of the device. The authors propose a simple and unique technique to prevent further migration of the septal occluder device.

Decompression syndrome (Caisson disease) in an Indian diver.

Acute decompression syndrome (Caisson's disease) is an acute neurological emergency in divers. It is caused due to release of nitrogen gas bubbles that impinge the blood vessels of the spinal cord and brain and result in severe neurodeficit. There are very few case reports in Indian literature. There are multiple factors in the pathogenesis of Acute decompression syndrome (Caisson's disease) such as health problems in divers (respiratory problems or congenital heart diseases like atrial septal defect, patent ductus arteriosus etc), speed of ascent from the depth and habits like smoking that render divers susceptible for such neurological emergency. Usually, immediate diagnosis of such a condition with MRI is not possible in hospitals in the Coastal border. Even though, MRI is performed, it has very low specificity and sensitivity. Facilities like hyperbaric oxygen treatment are virtually non-existent in these hospitals. Therefore, proper education of the divers and appropriate preventive measures in professional or recreational divers is recommended.

Use of pericardial strip for reinforcement of proximal anastomosis in Bentall's procedure.

Bleeding from a proximal suture line is not uncommon following composite graft anastomosis in Bentall's procedure. Passage of valve sutures through the pericardial strip, which is used to encircle the sewing ring of the composite graft, strengthens the repair. The strip can also be sutured to the left ventricular outflow tract in case of bleeding from proximal anastomosis in that particular region.