Background The lung microbiome plays a crucial role in chronic lung allograft dysfunction (CLAD), as each indication for lung transplantation showcases unique microbiome features, which influence postoperative results. Moreover, dynamic changes in the allografts microbiome also possess the ability to negatively alter long-term outcomes. Aim of this review is to summarize the current literature regarding pre- and postoperative lung microbiome, its influence on CLAD and possible therapeutic implications.

20 years of experience with 1000 minimally invasive mitral valve procedures. The first attempts to perform minimally invasive mitral procedures through mini-thoracotomy took place at the late nineties. The Department of Cardiac Surgery, Medical University Innsbruck followed the first pioneers of the technique and established the first program in Austria in 2001. In October 2020 one thousand operations have been performed in this center. The spectrum of pathologies which have been treated include conventional prolapse of the posterior, the anterior and both leaflets as well as flail leaflet. More complex pathologies such as functional prolapse, post-endocarditis syndrome as well as active infective endocarditis in selected cases have been addressed through a port-access. The total mortality of this case series is 0.9%. We observed a trend for improvement of perioperative mortality, mainly due to better patient selection and increasing experience. The rates of complications such as peri-operative myocardial infarction, stroke and reopera-tion are exceptionally low. The long-term results are very supportive and reveal long-lasting repair with extremely low rates of residual mitral regurgitation. J Kardiol 2022; 29 (7-8): 193-7.

Background: Minimally invasive mitral valve surgery (MIMVS) has evolved over the last two decades. Clinical results have been improved over time due to increased experience and technical developments. Crucial developments include remote access perfusion, optimization of cardioplegia, 3D endoscopy and chordal replacement techniques. The aim of the study was to identify the impact of era and technical improvements on perioperative outcome after MIMVS.

PurposeFor patients, for whom the calculated LAS is not appropriately reflecting benefit of lung transplantation (LTx), a so-called exceptional LAS (eLAS) value can be requested. The aim of this study was to investigate the outcome after a first eLAS request.MethodsAll patients with an eLAS request in Eurotransplant in the period between December 10, 2011 and July 31, 2019 were included (N=256). Patients were followed for at least one year until LTx or death on the waiting list (DOWL) occurred. Waiting list outflow was analyzed using competing risk method. Differences were tested using log likelihood tests. Multivariate analysis was performed to study factors determining the acceptance of an eLAS request.ResultsOf 256 patients, 97 (38%) eLAS requests were approved and 159 (62%) were declined. Within 1 year after the first request, 78 (80.4%) of the accepted patients underwent a LTx and 14 (14.4%) had died on the waiting list. In the declined group 104 (65.4%) were transplanted and 27 (17%) died on the waiting list. Patients in the approved group were significantly more likely to undergo LTX vs. the declined group (p<0.0001). No statistical difference was observed with relation to DOWL (p=0.64) (Figure) Factors significantly associated with acceptance of the eLAS request were primary diagnosis and the need for IV prostanoids (Table). No association was observed for cardiac index, ECMO, recipient age, year, and country of request.ConclusionApproval of an eLAS request was associated with an increased probability of transplantation whereas decline did not result in an increased risk of death on the waiting list. For patients, for whom the calculated LAS is not appropriately reflecting benefit of lung transplantation (LTx), a so-called exceptional LAS (eLAS) value can be requested. The aim of this study was to investigate the outcome after a first eLAS request. All patients with an eLAS request in Eurotransplant in the period between December 10, 2011 and July 31, 2019 were included (N=256). Patients were followed for at least one year until LTx or death on the waiting list (DOWL) occurred. Waiting list outflow was analyzed using competing risk method. Differences were tested using log likelihood tests. Multivariate analysis was performed to study factors determining the acceptance of an eLAS request. Of 256 patients, 97 (38%) eLAS requests were approved and 159 (62%) were declined. Within 1 year after the first request, 78 (80.4%) of the accepted patients underwent a LTx and 14 (14.4%) had died on the waiting list. In the declined group 104 (65.4%) were transplanted and 27 (17%) died on the waiting list. Patients in the approved group were significantly more likely to undergo LTX vs. the declined group (p<0.0001). No statistical difference was observed with relation to DOWL (p=0.64) (Figure) Factors significantly associated with acceptance of the eLAS request were primary diagnosis and the need for IV prostanoids (Table). No association was observed for cardiac index, ECMO, recipient age, year, and country of request. Approval of an eLAS request was associated with an increased probability of transplantation whereas decline did not result in an increased risk of death on the waiting list.

Objectives: Redo cardiac surgery is associated with significant mortality and morbidity, recent publications report early mortality rates around 10%. Not surprisingly, transcatheter procedures for mitral valve (MV) treatment are on the horizon. The aim of this study is to retrospectively evaluate a single center experience with redo patients for mitral MV disease regarding mortality, and to identify risk factors for adverse outcome.

The observed variations require further investigation to optimize lung allocation for specific patient populations in Eurotransplant.

Purpose An effect of donor-recipient gender mismatching on long-term survival outcomes following organ transplantation has been postulated but remains controversial. We aimed to investigate the influence of gender mismatches on long-term survival after lung transplantation in the Eurotransplant area. Methods In this retrospective, multicentre study in the Eurotransplant area, all lung transplants performed from DBD lungs in the period from 01.01.2000 until 31.12.2015 were included. A total of 7688 lung transplant recipients (≥ 14 years old) for long-term survival and the effect of gender mismatches (Kaplan-Meier, multivariate regression). Results More men (4079; 52 %) were transplanted compared to women (3609; 48%). Women had better survival outcomes compared to men with a median survival of 3159 days for women compared to 2396 days for men (p<0.0001). Mean age was 50 years for women (range 14-69 years) respectively 53 years (range 14-72 years) for men (p<0.0001). Lungs were mostly donated by men (52.8%). Gender of the donor alone did not influence survival. A combination of a female donor transplanted into a male (FM; n= 964) showed a median survival of 1681 days, whereas a gender matched transplant showed a median survival of 3207 (female-female (FF); n= 2910) respectively 2594 days (male-male (MM) n=3116) (p<0.0001). A male donor transplanted into a female showed a median survival of 2754 days (n= 698). Although donor age (HR 1.00-1.005) and recipient age (HR 1.01 -1.015) influenced survival, multivariate analysis showed that especially the female donor lung transplanted into a male recipient was of influence (FM vs. FF, HR 1.303-1.581; FM vs. MM, HR 1.173-1.412; FM vs MF, HR 1.109-1.44) Conclusion Women had better survival outcomes than men but women were significantly younger when transplanted. A female donor transplanted into male had a significant worse survival and needs further elucidation. An effect of donor-recipient gender mismatching on long-term survival outcomes following organ transplantation has been postulated but remains controversial. We aimed to investigate the influence of gender mismatches on long-term survival after lung transplantation in the Eurotransplant area. In this retrospective, multicentre study in the Eurotransplant area, all lung transplants performed from DBD lungs in the period from 01.01.2000 until 31.12.2015 were included. A total of 7688 lung transplant recipients (≥ 14 years old) for long-term survival and the effect of gender mismatches (Kaplan-Meier, multivariate regression). More men (4079; 52 %) were transplanted compared to women (3609; 48%). Women had better survival outcomes compared to men with a median survival of 3159 days for women compared to 2396 days for men (p<0.0001). Mean age was 50 years for women (range 14-69 years) respectively 53 years (range 14-72 years) for men (p<0.0001). Lungs were mostly donated by men (52.8%). Gender of the donor alone did not influence survival. A combination of a female donor transplanted into a male (FM; n= 964) showed a median survival of 1681 days, whereas a gender matched transplant showed a median survival of 3207 (female-female (FF); n= 2910) respectively 2594 days (male-male (MM) n=3116) (p<0.0001). A male donor transplanted into a female showed a median survival of 2754 days (n= 698). Although donor age (HR 1.00-1.005) and recipient age (HR 1.01 -1.015) influenced survival, multivariate analysis showed that especially the female donor lung transplanted into a male recipient was of influence (FM vs. FF, HR 1.303-1.581; FM vs. MM, HR 1.173-1.412; FM vs MF, HR 1.109-1.44) Women had better survival outcomes than men but women were significantly younger when transplanted. A female donor transplanted into male had a significant worse survival and needs further elucidation.

To date the CardioWest (TM) total artificial heart is the only clinically available implantable biventricular mechanical replacement for irreversible cardiac failure.This article presents the indications, contraindications, implantation procedere and postoperative treatment.In addition to a overview of the applications of the total artificial heart this article gives a brief presentation of the two patients treated in our department with the CardioWest (TM).The clinical course, postoperative rehabilitation, device-related complications and control mechanisms are presented.The total artificial heart is a reliable implant for treating critically ill patients with irreversible cardiogenic shock. A bridge to transplantation is feasible with excellent results.

Purpose GEP (AlloMap) score instability has been shown to predict of events of graft dysfunction or death in an analysis of the IMAGE data set by Deng et al. Our goal is to test this hypothesis in the independent CARGO 2 patient data set. Methods and Materials In a case-cohort design, patients with >2 serial GEP tests were studied in multivariate Cox regression models to predict future clinical events. Intra-patient GEP score instability was defined as the standard deviation of an individual’s cumulative test scores. GEP score (range 0-39), GEP score ≥34, and GEP score stability were studied. Results GEP scores tend to rise and become more stable in the whole population during the first year post-transplantation than after 1 year. After 12 months, GEP score instability (p=0.001) and GEP ≥34 (p=0.06) predict future events. [ figure 1 ]