An international survey: Tobacco smoking cessation strategies within left ventricular assist device centers.

BACKGROUND: Tobacco smoking is a significant source of morbidity in patients with a durable left ventricular assist device. While various cessation strategies have been investigated, the ability of ventricular assist device centers to implement a successful tobacco cessation program remains uncertain. We explored various cessation strategies employed by ventricular assist device centers and assessed perspectives of their effectiveness, as well as institutional investment in these programs. METHODS: A 37-question online self-report survey was created using Survey Monkey® and distributed worldwide. We investigated (1) programmatic strategies utilized for smoking cessation, (2) the respondent's perspective on the effectiveness of these strategies, (3) the structure with which these therapies are administered, and (4) overall organizational support for these treatments. RESULTS: A total of 47 centers worldwide completed the survey. The most common methods of tobacco cessation were pharmacologic and nicotine replacement therapy (78% and 66%). However, only about half (47% and 50%, respectively) of the centers indicated that these strategies were effective. When asked whether a respondent's center perceives that tobacco smoking should be a deciding factor in destination therapy evaluations, nearly a third (15, 32%) responded in the affirmative. CONCLUSION: While significant overlap exists among centers regarding treatments used for smoking cessation with left ventricular assist device patients, the most common treatments are not thought to be effective. While the current recommendations require tobacco smoking cessation in only bridge-to-transplant patients and not destination therapy patients, a number of centers disagree with the national guidelines and believe smoking should be prohibited in both populations.

A successful heart and liver transplantation requiring intraoperative extracorporeal membrane oxygenation for primary cardiac allograft dysfunction in a patient with Fontan failure.

We report a case of successful heart and liver transplantation requiring intraoperative extracorporeal membrane oxygenation (ECMO) for primary cardiac allograft dysfunction in a patient with Fontan failure. A successful outcome for both the heart and the liver can be achieved with the timely management of ECMO support. In describing our experiences treating a Fontan patient requiring multiorgan transplantation, we have shown that challenging cases such as this one can have successful outcomes if multidisciplinary collaborations and proper treatment strategies are utilized at the optimal timing, along with family support and patient cooperation.