Patient-tailored silicone plug for HeartMate 3™ left ventricular assist device explantation.

Patient-tailored silicone plug for HeartMate 3™ left ventricular assist device explantation in two successive males proceeded successfully. Given medical therapeutic advancements, FDA-approved plug systems designed by LVAD manufacturers themselves will be necessary for the near future to provide a safe and simple device explantation alternative that fulfills all regulatory standards.

Amphetamine abuse as a rare cause of recurrent LVAD pump thrombosis.

We report a patient with recurrent left ventricular assist device (LVAD) thrombosis due to amphetamine addiction. The management of this complication is reviewed.

Single centre experience with prolonged waiting time on transplant list with "high-urgency" status.

INTRODUCTION: The waiting list for heart transplantation (HTx) in Eurotransplant area has grown to a record size of nearly 1,300 patients, whereas only around 600 hearts were transplanted last year. The prolonged time for patients awaiting HTx on the high-urgency (HU) status leads mostly to serious medical complications. OBJECTIVE: The aim of this study was to study the trend of changes in the frequency of ventricular assist device (VAD) implantation in patients on the HU status. METHODS: A total of 22 adult patients awaiting transplantation on the HU status at our hospital between January 2011 and December 2011 were analyzed, assessing risk profile, blood group, and complication rates in terms of VAD implantation or death. Results were compared with 16 consecutive patients who were on transplant list with the HU status between January 2010 and December 2010 at our institution. RESULTS: Mean age was 49.5 ± 12.1 (2010 group) years and 51.4 ± 10.7 years (2011 group; p = 0.62). Mean logEuroSCORES raised not significantly from 9.1 ± 6.3% (2010 group) to 10.7 ± 14.7% (2011 group; p = 0.68). Six patients died on the HU status and seven patients had to be supplied with a VAD in 2011. In comparison with the preceding year, only two patients died in 2010 and none of our patients on the HU status had to be provided with mechanical circulatory support. CONCLUSION: Because of the prolonged waiting time on the HU list, the earlier-mentioned data demonstrate a negative trend in transplant medicine. Especially when taking into consideration that five of seven patients who needed a VAD implantation during the HU waiting period had blood group O. Furthermore, the data derived from Eurotransplant show that the waiting period for patients with blood group O was considerably longer when compared with patients of the same average body height and weight but with other blood groups.

128-slice CT in the assessment of saphenous vein grafts at redo coronary artery bypass grafting.

Reoperations for coronary artery bypass grafting (CABG) are increasing. The general rule of replacing all saphenous vein grafts older than five years of age at the time of reoperation is still an object of discussion. We report here the clinical usefulness of the new 128-slice computed tomographic scan to detect or rule out coronary artery disease in a 79-year-old patient who had undergone CABG 22 years before.

A new ex vivo beating heart model to investigate the application of heart valve performance tools with a high-speed camera.

High-speed camera examination of heart valves is an established technique to examine heart valve prosthesis. The aim of this study was to examine the possibility to transmit new tools for high-speed camera examination of heart valve behavior under near-physiological conditions in a porcine ex vivo beating heart model. After explantation of the piglet heart, main coronary arteries were cannulated and the heart was reperfused with the previously collected donor blood. When the heart started beating in sinus rhythm again, the motion of the aortic and mitral valve was recorded using a digital high-speed camera system (recording rate 2,000 frames/sec). The image sequences of the mitral valve were analyzed, and digital kymograms were calculated at different angles for the exact analysis of the different closure phases. The image sequence of the aortic valve was analyzed, and several snakes were performed to analyze the effective orifice area over the time. Both processing tools were successfully applied to examine heart valves in this ex vivo beating heart model. We were able to investigate the exact open and closure time of the mitral valve, as well as the projected effective orifice area of the aortic valve over the time. The high-speed camera investigation in an ex vivo beating heart model of heart valve behavior is feasible and also reasonable because of using processing feature such as kymography for exact analysis. These analytical techniques might help to optimize reconstructive surgery of the mitral valve and the development of heart valve prostheses in future.

Increased transcript levels of TNF-alpha, TGF-beta, and granzyme B in endomyocardial biopsies correlate with allograft rejection.

OBJECTIVES: Endomyocardial biopsies are the criterion standard in diagnosing acute cardiac transplant rejection. This study sought to analyze mRNA expression profiles of various immuneresponse-related genes in endomyocardial biopsies of heart transplant patients and to correlate the results with histologic findings. MATERIALS AND METHODS: Forty-three biopsies obtained from 6 heart transplant recipients experiencing acute rejection were analyzed for granzyme B, CTLA4, IL-6, TGF-beta, and TNFa expression using real-time polymerase chain reaction. The results were compared with the histologic findings. Biopsies obtained before, during, and after acute rejection episodes were grouped according to the International Society of Heart and Lung Transplantation standard biopsy grading from 1990. Group 1 consisted of biopsies with International Society of Heart and Lung Transplantation grade 0 (n=12), group 2 of International Society of Heart and Lung Transplantation grade 1A (n=14), and group 3 of International Society of Heart and Lung Transplantation grades 1B, 2, 3A, and 4 (n=17). RESULTS: A strong correlation was seen between histologic groups and gene expression of granzyme B, which showed the highest overall transcript levels. CTLA4 was elevated in group 2, but no further increase in the rejecting group 3 was seen. For IL-6, TGF-beta, and TNFa gene expression was strongly elevated in group 3 compared with groups 1 and 2. On analysis of biopsies with International Society of Heart and Lung Transplantation, grade 0 and 1A, relative to the time point of rejection, we found a substantial increase in mRNA expression of all analyzed immune response-related genes before a rejection episode. The strongest up-regulation was seen for granzyme B, TNFa, and TGF-beta. CONCLUSIONS: Our data suggest that analyses of gene expression provides valuable information in diagnosing heart transplant rejection. Furthermore, analyses of granzyme B, TGF-beta, and TNFa might not only confirm an ongoing rejection episode, but also may have a positive predictive value.

Comparison of dual source computed tomography versus intravascular ultrasound for evaluation of coronary arteries at least one year after cardiac transplantation.

This study evaluated the ability of dual-source computed tomography (DSCT) to detect coronary allograft vasculopathy (CAV) in heart transplant recipients using intravascular ultrasound (IVUS) as the standard of reference. Thirty patients with heart transplants (81% men, mean age 40 years) underwent DSCT (330-ms gantry rotation, 2 x 64 x 0.6-mm collimation, 60- to 80-ml contrast agent, no additional beta blockers) before invasive coronary angiography including IVUS of 1 vessel. Detection of CAV by DSCT was qualitatively defined as the presence of any coronary plaque. Mean heart rate during dual-source computed tomographic scanning was 80 +/- 14 beats/min. Four hundred fifty-nine segments with a vessel caliber >or=1.5 mm according to quantitative coronary angiography were evaluated in 30 patients. Of these, 96% were considered to have excellent or good image quality. IVUS detected CAV in 17 of 30 patients (57%) and in 41 of 110 coronary segments (37%). Compared to IVUS, sensitivity, specificity, positive and negative predictive values for the detection of CAV by DSCT were 85%, 84%, 76%, and 91%, respectively. In conclusion, DSCT permits the investigation of transplant recipients concerning the presence of CAV with good image quality and high diagnostic accuracy.

Axial flow pump support in a Marfan patient with an aortic mechanical heart valve: case report and literature review.

The presence of a mechanical heart valve in the aortic position is usually considered a contraindication for the use of cardiac assist devices. Only a few cases with the combination of mechanical circulatory support and valve prostheses have been reported in the literature to date, and the experience is even more limited in the new generation of miniaturized axial flow pumps. We present a case report of a patient with a mechanical aortic heart valve who was successfully supported with a continuous flow pump and discuss the literature available on this problem. Further on, the patient was weaned from his ventricular assist device after 456 days of support.