Three-month outcomes after the implantation of two HeartMate 3 devices in total artificial heart configuration.

BACKGROUND: Total artificial heart (TAH) implantation is a rarely performed procedure. Contrarily, left ventricular assist device (VAD) implantation is rather common in many centers. As transplantation is quantitatively limited cardiac replacement with artificial hearts is a viable alternative in the treatment of severe biventricular heart failure. An alternative to TAH is the implantation of two VADs in a TAH configuration. We hereby present the first multi-center study on 3-months outcomes of patients treated by cardiectomy and placement of two HeartMate 3s in a TAH configuration. METHODS: We retrospectively investigated a cohort of 15 patients that underwent HM3-TAH-implantation at three international institutions. Follow-up was 3 months after implantation. Baseline, intra- and postoperative parameters as well as survival data and adverse events were collected. RESULTS: A total of 1089 days on HM3-TAH were observed. Thirty-day survival after HM3-TAH implantation was 53% (8/15) and three month survival was 40% (6/15). The longest duration on device was 274 days. Causes of death were multi-organ failure, sepsis, and neurological adverse events. No technical complications were documented. Two patients remained on the device. Four patients (26%) were successfully bridged to transplantation. CONCLUSIONS: The implantation of two HeartMate 3s in a TAH configuration is a last resort and off-label concept in cases of extreme biventricular heart failure. In a diligently selected patient cohort, HM3-TAH implantation is a feasible method to increase the chance of survival in a severely ill patient cohort and successfully bridge patients to heart transplantation that would otherwise have died.

Deep sternal wound infection after coronary artery bypass: How to manage?

Mediastinitis is a devastating sternal wound complication. The aim of this study was to identify the incidence, risk factors, mortality, and different treatment modalities of mediastinitis after isolated coronary artery bypass grafting. From January 2007 to May 2010, 1424 patients who underwent isolated coronary artery bypass grafting were studied retrospectively; 1398 (group 1) had no mediastinitis, and 26 (group 2) developed mediastinitis. The diagnosis and classification of mediastinitis were based on the criteria of the Center for Disease Control and Prevention and the Emory classification, respectively. Multivariate analysis showed only 4 risk factors: diabetes mellitus, obesity, prolonged postoperative intensive care unit stay, and prolonged intubation time. On univariate analysis, female sex, renal failure, and reexploration for bleeding were also significant risk factors. The incidence of mediastinitis (1.83%) and the subsequent mortality rate (7.69%) were comparable to those of previous reports. Early detection and aggressive management of mediastinitis play major roles in decreasing the related mortality and morbidity. The Emory classification with some modification is very helpful in choosing the proper treatment modality.

Blood component transfusion in primary coronary artery bypass surgery in Kuwait.

OBJECTIVE: The aims of this study were to determine the rate of blood product transfusion, associated perioperative factors and cost of such blood product transfusion in primary coronary artery bypass surgery (CABG). SUBJECTS AND METHODS: The medical records of 159 consecutive primary CABG patients (142 male, 17 female) from January 1, 2003 to June 30, 2003 at Chest Diseases Hospital, Kuwait, were reviewed. Urgent and emergency cases were included. RESULTS: The mean age of the patients was 57.2 (range 36-77 years). Overall, 128 (80.5%) patients received blood product transfusion during primary CABG: 113 (70.5%) packed red blood cells (RBC), 54 (33.9%) fresh frozen plasma, and 13 (8%) platelets. Overall, 23 patients (12.6%) received more than two RBC transfusions intraoperatively. Significant factors for intraoperative RBC transfusion were: age >60 years, female gender, preoperative hemoglobin <12 g/dl, and 3 or more coronary bypass grafts constructed. One hundred and fifty-nine patients consumed 342 units of RBC at an average of 2.1 RBC units per patient. The cost per patient was 80 Kuwaiti dinar (KD; USD 240). CONCLUSION: The findings indicate a high rate of blood component transfusion in primary CABG patients in Kuwait that could expose the patients to the possible adverse effects, and such transfusions have high economic impact.