Outcomes of Left Ventricular Assist Device Implantation in Patients With Uncommon Etiology Cardiomyopathy.

The impact of uncommon etiology cardiomyopathies on Left-ventricular assist device (LVAD)-recipient outcomes is not very well known. This study aimed to characterize patients with uncommon cardiomyopathy etiologies and examine the outcomes between uncommon and ischemic/idiopathic dilated cardiomyopathy. This observational study was conducted in 19 centers between 2006 and 2016. Baseline characteristics and outcomes of patients with uncommon etiology were compared to patients with idiopathic dilated/ischemic cardiomyopathies. Among 652 LVAD-recipients included, a total of 590 (90.5%) patients were classified as ischemic/idiopathic and 62 (9.5%) patients were classified in the "uncommon etiologies" group. Main uncommon etiologies were: hypertrophic (n = 12(19%)); cancer therapeutics-related cardiac dysfunction (CTRCD) (n = 12(19%)); myocarditis (n = 11(18%)); valvulopathy (n = 9(15%)) and others (n = 18(29%)). Patients with uncommon etiologies were significantly younger with more female and presented less co-morbidities. Additionally, patients with uncommon cardiomyopathies were less implanted as destination therapy compared with ischemic/idiopathic group (29% vs 38.8%). During a follow-up period of 9.1 months, both groups experienced similar survival. However, subgroup of hypertrophic/valvular cardiomyopathies and CTRCD had significantly higher mortality compared to the ischemic/idiopathic or myocarditis/others cardiomyopathies. Conversely, patients with myocarditis/others etiologies experienced a better survival. Indeed, the 12-months survival in the myocarditis/others; ischemic/idiopathic and hypertrophic/CTRCD/valvulopathy group were 77%; 65%, and 46% respectively. In conclusion, LVAD-recipients with hypertrophic cardiomyopathy, valvular heart disease and CTRCD experienced the higher mortality rate.

Incidence, predictors, and clinical impact of electrical storm in patients with left ventricular assist devices: New insights from the ASSIST-ICD study.

BACKGROUND: Ventricular arrhythmias (VAs) can occur after continuous flow left ventricular assist device (LVAD) implantation as a single arrhythmic event or as electrical storm (ES) with multiple repetitive VA episodes. OBJECTIVE: We aimed at analyzing the incidence, predictors, and clinical impact of ES in LVAD recipients. METHODS: Patients analyzed were those included in the multicenter ASSIST-ICD observational study. ES was consensually defined as occurrence of ≥3 separate episodes of sustained VAs within a 24-hour interval. RESULTS: Of 652 patients with an LVAD, 61 (9%) presented ES during a median follow-up period of 9.1 (interquartile range [IQR] 2.5-22.1) months. The first ES occurred after 17 (IQR 4.0-56.2) days post LVAD implantation, most of them during the first month after the device implantation (63%). The incidence then tended to decrease during the initial years of follow-up and increased again after the third year post LVAD implantation. History of VAs before LVAD implantation and heart failure duration > 84 months were independent predictors of ES. The occurrence of ES was associated with an increased early mortality since 20 patients (33%) died within the first 2 weeks of ES. Twenty-two patients (36.1%) presented at least 1 recurrence of ES, occurring 43.0 (IQR 8.0-69.0) days after the initial ES. Patients experiencing ES had a significantly lower 1-year survival rate than did those free from ES (log-rank, P = .039). CONCLUSION: There is a significant incidence of ES in patients with an LVAD. The short-term mortality after ES is high, and one-third of patients will die within 15 days. Whether radiofrequency ablation of arrhythmias improves outcomes would require further studies.

Left ventricular assist pump pocket infection: conservative treatment strategy for destination therapy candidates.

BACKGROUND: Heart failure is a major cause of mortality and morbidity, particularly among patients with advanced disease and no access to cardiac transplantation. LVAD implantation is not only a bridge-to-transplantation option for patients awaiting a heart donor, but is often used as bridge-to-destination therapy in patients unsuited for transplantation for various reasons. LVAD infection is considered the second-most common cause of death in patients who survive the initial 6 months on LVAD support. Few reports describe the indications for chronic suppressing antibiotic therapy, device exchange, methods for exchanging infected devices, post-exchange antimicrobial management status, and the outcomes of such patients. CASE PRESENTATION: This is the case of a 74-year-old male patient with numerous comorbidities who received urgent surgical management for severe heart failure with a HeartMate II. Six months later he developed an LVAD pump infection with methicillin-resistant Staphylococcus epidermidis, which was diagnosed with leucocyte scintigraphy. The patient received an omental graft over the LVAD and a chronic suppressive antibiotic regime. A marked leukocyte scintigraphy showed the infection's regression 6 months after the initiation of antibiotic treatment. DISCUSSION: We concisely reviewed the driveline infections and the main aspects of the LVAD pump infection. We reviewed options for conservative and nonconservative management and showed that conservative management of the LVAD pump infection is possible. CONCLUSIONS: There are no defined recommendations for the management of LVAD pump infection. This case is among the few in the literature showing that conservative treatment of an LVAD pump infection is possible.

Particularities of cardiac surgery in chronic hemodialysis patients.

INTRODUCTION: Cardiovascular disease is the most common cause of death in chronic hemodialysis patients(1). Cardiac surgery in hemodialysis patients exposes to higher risks inherent in the particular status of these patients. The aim of our study is to report the perioperative particularities of hemodialysis patients undergoing cardiac surgery, and to determine the impact of preoperative clinical status on hospital and late morbidity and mortality. METHODS: Between January 1998 and December 2012, 48 patients in chronic hemodialysis (HD) and candidates for cardiac surgery on cardiopulmonary bypass were retrospectively included. RESULTS:   The mean age was 56 years. Causes of renal insufficiency were dominated by diabetes (n = 20; 42%) and nephroangiosclerosis (n= 9, 18.8%). The duration of HD was 48.22 ± 44.5 months (1 month -11 years). Surgical procedures included coronary artery bypass grafting CABG (n = 33, 68.75%), Valvular replacement (n = 13, 27%) and combined surgery (n = 2, 4.25%). Nine patients (18.8%) underwent emergency surgery. The mean Euroscore I was 8.82 ± 7.76. Hospital mortality was 20.8%. Postoperative complications were observed in 87.5%patients. Age, diabetic nephropathy, Duration of hemodialysis greater than 54 months, preoperative hemoglobin <9 g / dl, combined surgery and emergency surgery were independent predictors of hospital mortality with odds ratio respectively 1.21; 2.7; 2.54; 1.83; 2.54 and 2.85. The survival rates at 1, 4 and 7 years were respectively 75, 65 and 50%. CONCLUSION:   Age, diabetic nephropathy, Duration of hemodialysis greater than 54 months, preoperative hemoglobin <9 g / dl, combined surgery and emergency surgery are predictive factors for hospital mortality. Early diagnosis of coronary and valvular damage and preoperative preparation considering these factors could improve the prognosis.

Value of euroscore II to predict operative mortality in infectious endocarditis surgery.

BACKGROUND: Stratification of surgical risk is an important step in cardiac surgery, often based on the estimation of operative mortality. The EuroSCORE II (ES II) incorporates several factors in the calculation of mortality, but few are specific to Infectious endocarditis (IE). AIM: Our study is aimed to evaluate the predictive power of the Es II in the surgery of IE and to test its discriminating power according to certain specific parameters of the IE. METHODS: 55 surgical procedures were carried out between January 2000 and June 2012 (37 EI on native valves and 18 on prosthesis). The mortality observed was compared with the mortality predicted by Es II. The discriminant capacity of the Es II model was tested using the receiver operating characteristic (ROC) curve model by comparing the areas under the curve (AsC). RESULTS: For our cohort The observed mortality was 30.9 % , the mortality predicted by Es II was 10.5%. in general, the EsII discriminatory capacity for mortality was satisfactory: the ROC AsC was 0,76. By analyzing the subgroups of the endocarditis, Es II lost its discriminating power: theROC AsC was: 0.64 for staphylococcal, 0.62 for the annular abscess and 0.56 for endocarditis on prosthesis. CONCLUSION: The EuroSCORE II model has a satisfactory discriminating power in the IE. However, analysis of subgroups leads to decrease in this discriminating power. Thus, some specific parameters of the IE, which do not appear in the EuroSCORE II model, should be taken into accountwhen analyzing mortality.

Sternal Wound Infection after Cardiac Surgery: Management and Outcome.

BACKGROUND: Sternal Wound Infection (SWI) is a severe complication after cardiac surgery. Debridement associated with primary closure using Redon drains (RD) is an effective treatment, but data on RD management and antibiotic treatment are scarce. METHODS: We performed a single-center analysis of consecutive patients who were re-operated for SWI between 01/2009 and 12/2012. All patients underwent a closed drainage with RD (CDRD). Patients with endocarditis or those who died within the first 45 days were excluded from management analysis. RD fluid was cultured twice weekly. Variables recorded were clinical and biological data at SWI diagnosis, severity of SWI based on criteria for mediastinitis as defined by the Centers for Disease Control (CDC), antibiotic therapy, RD management and patient's outcome. RESULTS: 160 patients developed SWI, 102 (64%) fulfilled CDC criteria (CDC+) and 58 (36%) did not (CDC- SWI). Initial antibiotic treatment and surgical management were similar in CDC+ and CDC- SWI. Patients with CDC+ SWI had a longer duration of antibiotic therapy and a mortality rate of 17% as compared to 3% in patients with CDC- SWI (p = 0.025). Rates of superinfection (10% and 9%) and need for second reoperation (12% and 17%) were similar. Failure (death or need for another reoperation) was associated with female gender, higher EuroScore for prediction of operative mortality, and stay in the ICU. CONCLUSION: In patients with SWI, initial one-stage surgical debridement with CDRD is associated with favorable outcomes. CDC+ and CDC- SWI received essentially the same management, but CDC+ SWI has a more severe outcome.

[Morgagni hernia in elderly patients: a study about two cases]. / La hernie de morgagni chez l'adulte: a propos de 2 cas.

Two cases of retrocostoxiphoid hernia are reported. Both patients were adults. The hernia was strangled in one case and symptomatic in the second case. The diagnosis was confirmed by radiology. Reduction of the visceral hernia and closure of the orifice was carried out after laparotomy. A review of literature and of clinicopathological features are given in the present article. Histogenesis and differential diagnosis are also discussed.