The Lebanese left ventricular assist device experience, a success story despite the odds.

BACKGROUND AND AIM: Heart failure is still a leading cause of mortality and morbidity. Assist devices are reserved for advanced heart failure patients with no other therapeutic options. We aim in this paper to describe the characteristics and outcome of Lebanese left ventricular assist device (LVAD) patients. RESULTS: From 2010 till December 2019, 78 patients were implanted with assist devices at the Beirut cardiac Institute, 82 pumps were used. To the most recent follow up after 10 years, 26 patients died (34%). 24 patients of 35 (68%) survived more than 5 years. Seven patients only (9%) died during one month of surgery. One year mortality was 19% (15 patients). The leading cause of early mortality was infection, whereas cerebrovascular accidents CVA were the leading cause of late mortality. Pump thrombosis occurred in 12% of the cases. The most serious long term complication was haemorrhagic CVA. Only seven patients (9%) received heart transplantation, with a mean time on support prior to transplantation of 1303 ± 213 days. CONCLUSION: In this manuscript we reported the characteristics and outcome of the largest population of LVAD patients in Lebanon. The survival rate was 81% at one year. These findings were comparable to the international registries except for rates of heart transplantation. More efforts should be made to encourage organ donation in Lebanon.

Wound healing after radical vulvectomy and inguino-femoral lymphadenectomy: experience with granulocyte colony stimulating factor (filgrastim, r-metHuG-CSF).

After radical vulvectomy, infection and wound breakdown occurs in approximately 40-60% of patients resulting in significant morbidity and increased hospital stay. Wound breakdown is primarily due to infection of and tension on the wound. Post-operative defects in the immune system and neutrophil dysfunction may contribute to the high rate of this complication. To investigate this phenomenon in patients with a known high risk for postoperative infection, we studied the effect of filgrastim on primary or secondary wound healing (surgical wound breakdown)--per incisional side--in women requiring radical vulvectomy and inguino-femoral lymphadenectomy (RVIFL). The results were compared with a historical control group and indicate a reduction in the rate of surgical wound breakdown. Besides the clinical importance of decreasing the incidence of wound infection and tissue breakdown on patients quality of life, the benefits in terms of social-economic impact (days of hospitalization, post-operative nursing care health care budget) should also be taken into account.