INTRODUCTION:Left ventricular assist devices (LVAD) have become an established therapy for end-stage heart failure over the last three decades. In currently available devices, the blood flow is estimated using a power consumption algorithm. In this study, intraoperative direct LVAD flow measurement with an ultrasonic flow probe was analyzed. METHODS:As part of our routine evaluation of optimal LVAD flow, intraoperative direct flow measurement at the outflow graft was performed using a 14-mm ultrasonic flow probe. Direct LVAD flow measurements were performed at different speed levels: 4400 rpm, 4800 rpm, 5200 rpm, and the optimal flow setting before chest closure. In twenty consecutive patients who underwent a durable LVAD implantation via median sternotomy in our institution between January and April 2025, direct flow measurement was compared with the estimated flow provided by the device. RESULTS:Median age was 63 [60;68] years, 17 (85%) were male, 8 (40%) had a history of acute myocardial infarction. Temporary mechanical circulatory support with a microaxial flow pump was necessary in 8 (40%) patients prior to durable LVAD implantation. Destination therapy was indicated in 12 (60%) cases. Mean flows at 4400 rpm were 2.9 ± 0.3 and 3.4 ± 0.4 L/min calculated by the pump and measured by the probe, respectively. Mean difference between the measurements was 0.56 L/min (95% CI [0.40, 0.70], p < 0.001). Mean flows at 4800 rpm were 3.5 ± 0.3 and 4.1 ± 0.5 L/min, respectively. Mean difference between the measurements was 0.55 L/min (95% CI [0.33, 0.77], p < 0.001). Mean flows at 5200 rpm were 4.2 ± 0.3 and 4.7 ± 0.5 L/min, respectively. Mean difference between the measurements was 0.53 L/min (95% CI [0.40, 0.70], p = 0.001). Mean optimal speed for patients was 5400 rpm, mean difference between the measurements was 0.49 L/min (95% CI [0.23, 0.74], p = 0.001). CONCLUSION:LVAD flow measured with an ultrasonic flow probe shows significantly higher results (approximately +0.5 L/min) compared to the flow estimated by the device. The difference remains constant at different LVAD speed modes. Intraoperative flow measurement employing an ultrasonic flow probe is a valuable tool for hemodynamic evaluation during implantation of a durable LVAD.

Zur Minderung der Invasivität und Beschleunigung der postoperativen Erholung können koronare Bypass-Operationen ohne Sternotomie durchgeführt werden. Chirurgische Operationsroboter ermöglichen eine videobasierte Operation über endoskopische Zugangswege. Die endoskopische Präparation der linken A. thoracica interna (Left internal thoracic artery, LITA) ist technisch anspruchsvoll und mit einer erheblichen Lernkurve assoziiert. Aufgrund der hohen Offenheitsrate der LITA im Langzeitverlauf und der damit verbundenen besseren Prognose nach Bypass-Operationen muss die Entnahme atraumatisch erfolgen. Virtuelle chirurgische Co-Piloten-Systeme könnten Chirurg:innen in der Lernphase während der endoskopischen Graft-Entnahme unterstützten und damit die Patientensicherheit weiter erhöhen. Entwicklung und Validierung eines echtzeitfähigen virtuellen chirurgischen Co-Piloten – des „LIM-AR-Systems“ –zur Vermeidung akzidentieller Graft-Verletzungen während der Präparation der LITA bei robotisch-assistierten koronararteriellen Bypass-Operationen. In dieser Pilotstudie werden stereoskopische Bilddaten von 100 Patient:innen, die sich einer robotischen Bypass-Operation unterzogen haben, analysiert. Fünfzig annotierte Fälle dienen der Entwicklung des Co-Piloten-Systems, und weitere 50 Fälle werden für die Validierung eingesetzt. Die Bilddatenverarbeitung erfolgt unter Verwendung eines speziell entwickelten Multi-Task-Deep-Learning-Modells. Entwicklung und anschließende Validierung des echtzeitfähigen „LIM-AR-Systems“. Erwartet wird ein funktionsfähiger chirurgischer Co-Pilot, der bei roboterassistierten Bypass-Operationen präemptiv vor einer akzidentiellen Verletzung der LITA warnt. Für die Entwicklung werden zwei Jahre veranschlagt.

Background Patients with end-stage heart failure undergoing durable left ventricular assist device (dLVAD) implantation are at risk of developing de novo or progressive aortic regurgitation (AR) during long-term support. Case Summary We report a dLVAD patient with significant AR, in whom transcatheter aortic valve replacement was unsuitable because of an enlarged aortic annulus and aortic thrombus. A complex hybrid approach included open thrombus removal from the ascending aorta under short circulatory arrest, temporary interventional occlusion of a not-accessible dLVAD outflow-graft, and surgical aortic valve replacement (SAVR). Discussion Aortic thrombus in dLVAD patients carries the risk of coronary, cerebral or peripheral embolism. In addition to this contraindication, SAVR was favored over transcatheter aortic valve replacement because of an aortic annulus diameter >28 mm, according to the institutional treatment algorithm. Take-Home Message In a dLVAD patient with AR and aortic thrombus, an individualized hybrid strategy enabled effective outflow-graft occlusion facilitating safe thrombus evacuation and SAVR.

BACKGROUND:Protected cardiac surgery is a proactive strategy that applies temporary mechanical circulatory support to prevent perioperative low cardiac output syndrome in high-risk cardiac surgery. Rather than escalating vasoactive agents after hemodynamic decline, the approach emphasizes early identification of physiologic vulnerability and timely initiation of support. METHODS:We conducted a structured literature review of peer-reviewed studies published from 2000 to 2024 on temporary mechanical circulatory support in adult cardiac surgery. There were 52 studies selected based on relevance to early or prophylactic support, timing of initiation, risk stratification, and systems of care. Clinical insights from multidisciplinary experts also informed the review framework. RESULTS:Inotropic escalation after hemodynamic deterioration is consistently associated with poor outcomes. High pharmacologic requirements and severe metabolic derangements predict very high mortality, whereas conventional risk scores often fail to identify vulnerable patients. In contrast, early initiation of mechanical support has been associated with lower in-hospital mortality, reduced dependence on vasoactive agents, and improved recovery. Physiologic markers, such as filling pressures and lactate levels, may provide earlier signals of circulatory decline. Effective implementation also requires institutional coordination, team-based planning, and regional referral systems. CONCLUSIONS:Protected cardiac surgery reframes success in high-risk cardiac surgery by focusing on recovery rather than survival alone. It integrates physiology-guided support with structured planning and system-level readiness to improve outcomes in vulnerable surgical populations.

OBJECTIVES:External compression of the outflow graft causing obstruction (eOGO) is a potentially lethal complication in patients on long-term mechanical circulatory support with the HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD). This complication results from the build-up of gelatinous substance between the bend relief and outflow graft and can be resolved by percutaneous intervention, surgery, or transplantation. This single-centre follow-up study evaluated the suitability of percutaneous intervention as a treatment strategy and long-term outcomes of eOGO patients in terms of laboratory, LVAD, and quality-of-life parameters. METHODS:On October 31, 2024, a search of the implantation centre's electronic database identified HM3 patients diagnosed with eOGO. Individual patient data concerning 31 cases was analyzed. A quality-of-life survey was conducted using the short version of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). RESULTS:The patient cohort had a median support time to eOGO diagnosis of 1219 days [976, 1917] and a post-treatment follow-up of 686 days [447, 1003]. 64.5% of patients (n = 20) underwent percutaneous intervention showing immediate LVAD flow improvement of 0.5 L/min post-intervention (p = 0.04). Of eight post-interventional survey respondents, 62.5% (n = 5) were assigned a fair-excellent health status according to the KCCQ-12. CONCLUSIONS:Percutaneous intervention is a suitable treatment strategy for eOGO, resolving low flow and providing satisfactory long-term quality of life outcomes. Given the increasing eOGO incidence after 1 year of support and overall mortality of 29.0%, clinicians should remain on high alert for this complication. We suggest computed tomography (CT) imaging be considered early on when eOGO is suspected.

Purpose The effect of pulmonary hemodynamics on outcomes after the implantation of the HeartMate 3 left ventricular assist device (HM3-LVAD) is still not fully understood, although some studies indicate positive results. We conducted an analysis using the EUROMACS international database, which includes many patients from various sites across Europe. Methods We identified adults who underwent HM3-LVAD implantation from the EUROMACS Database of the European Association of Cardiothoracic Surgery from January 2018 through April 2024. We excluded those with previous cardiac surgery, undergoing concomitant cardiac procedures, on an IABP or ECMO, and those with missing hemodynamic data. Based on the pre-transplant hemodynamic profile, patients were categorized into: Group 1 with a mean pulmonary artery PA pressure (mPAP) < 20 mmHg and a pulmonary vascular resistance (PVR) < 2 WU; Group 2 with a mPAP > 20 mmHg and a PVR < 2 WU; and Group 3 with a PVR > 2 WU. We compared 1- and 2-year mortality rates, major bleeding, and right ventricular (RV) failure after adjusting for factors in the HM3 Survival Risk Score. Results 632 individuals were identified: 47 (7.4%) in group 1, 144 (22.8%) in group 2, and 441 (69.8%) in group 3. Groups differed in age, gender, body mass index, race, and pre-LVAD use of some medications. Post-implant 1-year and 2-year death rates were 14.1% (n=89) and 18.7% (n=118), respectively while 16.0% (n=103) experienced a major bleed. After adjusting for factors in the HM3 Risk Score, no differences were seen in the odds of 1-year death when group 1 (Odds Ratio [OR] 1.09, 95% confidence interval [CI] 0.46-2.59) and group 2 (OR 0.61, 95% CI 0.61-1.86) were compared with group 3 (Figure). Similar results were seen for 2-year mortality (group 1 vs. group 3, p = 0.561; group 2 vs group 3, p = 0.330) and major bleeding (group 1 vs. group 3, p = 0.476; group 2 vs group 3, p = 0.958) with no difference between the groups. While, compared with group 3, group 1 increased the odds of late (>14 days) RV failure, no other differences in late or early (14 days) failure were seen. Conclusions In this retrospective study, elevated PA pressure and/or resistance did not affect the mortality and bleeding rates up to 2 years after HM3-LVAD implantation in adults enrolled in the EUROMACS database.

OBJECTIVES:This study investigates differences in short- and mid-term outcomes in patients without malperfusion undergoing surgery for acute type A aortic dissection between specialized aortic surgeons and non-aortic surgeons. METHODS:Patients who underwent surgery for acute type A aortic dissection between 2013 and 2023 defined as M0 (no malperfusion) according to the type-entry-malperfusion classification were included and divided into 2 groups according to the surgeon's expertise: aortic surgeon vs non-aortic surgeon group, whereas an aortic surgeon was defined by expertise in extensive aortic arch surgery including frozen elephant trunk implantation on a regular basis (average ≥5/year). After propensity score matching, the groups were compared in terms of intraoperative variables and outcomes including a primary combined end-point consisting of 30-day mortality and/or CT-confirmed stroke. RESULTS:The matched cohort comprised 2 balanced groups with 234 patients (117 in each group). Cardiopulmonary bypass, cross-clamp and distal arrest times did not differ significantly between the groups. However, more extensive aortic surgery was performed by aortic surgeons: aortic root replacement (Bentall) (P = .007; odds ratio [OR] 1.18 [CI, 1.05-1.32]), valve-sparing root replacement (David) (P = .013; OR 1.05 [CI, 1.01-1.10]), and frozen elephant trunk implantation (P < .001; OR 1.18 (CI, 1.09-1.27]). The combined end-point of 30-day mortality and/or CT-confirmed stroke was 26% in the non-aortic surgeon vs 23% in the aortic surgeon group (P = .54; OR 0.97 [CI, 0.86-1.08]). Further clinical outcomes, including 5-year survival, did not differ significantly (P = .170). CONCLUSIONS:Patients without preoperative malperfusion undergoing surgery for ATAAD show no differences in terms of short- and mid-term outcomes between specialized aortic and non-aortic surgeons. However, more extensive aortic repair may be performed safely by specialized aortic surgeons. These results support the definition of an aortic surgeon based on experience with the frozen elephant trunk technique and may advocate for call coverage by an aortic surgeon for type A repair at high-volume centres.

OBJECTIVES:Microaxial flow pumps (mAFP) effectively bridge patients with cardiogenic shock to durable left ventricular assist device (dLVAD) implantation. The partial-support mAFPs provide only up to 3.5 L/min, which might be insufficient for an effective circulatory support and preconditioning for a dLVAD implantation. Alternatively, patients with refractory shock on partial support may benefit from an escalation to a full-support mAFP. METHODS:A retrospective analysis of 130 patients was performed across 17 European cardiac centres who underwent dLVAD implantation following mAFP with or without venoarterial extracorporeal life support (VA-ECLS) between February 2015 and August 2022. Ninety-two patients (70.8%) were bridged on partial-support mAFP, while 38 patients (29.2%) underwent an escalation to full-support mAFP. RESULTS:Median support duration was significantly longer in the escalation group (7 days [4, 11] vs 12 days [9, 21], P < .001). Patients in the escalation group were more likely to be weaned from VA-ECLS before dLVAD implantation, 10 (71.4%) vs 6 (11.3%), P < .001. Thirty-day survival was similar between the escalation and no-escalation groups, 89.5% vs 84.8% (IPTW-weighted OR, 1.00 [95% CI, 0.46-2.22], P = .992). Estimated 1-year survival was higher in the escalation group: 84.0% [95% CI, 73.0-96.6] vs 63.7% [95% CI, 54.3-74.6], HR 0.41 [95% CI, 0.17-0.99], P = .048. Patients with a combination of partial-support mAFP and VA-ECLS had a higher mortality risk than all other patients, HR 2.06 [95% CI, 1.16-3.36], P = .013. CONCLUSIONS:In patients with partial-support mAFP and concomitant VA-ECLS, an escalation to a full-support mAFP may translate to improved survival and should be considered to facilitate VA-ECLS weaning.

Background Endovascular aortic repair (EVAR) is the gold standard for abdominal aortic aneurysm, but complex anatomy may require individualized strategies. Case Summary We report a 72-year-old multimorbid man with a left ventricular assist device and stage 3 chronic kidney disease, presenting with abdominal aortic aneurysm (up to 7.7 cm), residual type B dissection with unfavorable remodeling, and the left renal artery originating from the false lumen. An interdisciplinary approach consisted of a laparoscopic nephrectomy with ex vivo preservation, followed by EVAR and renal autotransplantation into the right iliac fossa. Postoperative recovery was uneventful, with stable renal function and satisfactory imaging showing exclusion of the entry tear. Discussion Standard EVAR would have compromised perfusion of the left kidney. More complex endovascular strategies, including branched or fenestrated repair, were technically prohibitive. Take-Home Message Renal autotransplantation may serve as a viable bailout strategy enabling EVAR in highly selected patients requiring organ preservation.

Background:Takotsubo syndrome (TTS) is a reversible form of acute heart failure characterized by apical ballooning, which may lead to cardiogenic shock (CS). When CS occurs, mechanical circulatory support (MCS) may be used to bridge patients until cardiac recovery. However, the role, optimal timing, and choice of MCS remain unclear. Methods:On February 22, 2024, a search of the clinic's electronic database was performed for patients diagnosed with TTS. The search yielded 47 patients, with 9 patients receiving MCS. Individual patient data concerning these 9 cases were extracted and analyzed. Results:Of 9 TTS patients with MCS, 5 were supported by an Impella system, with the remaining 4 patients receiving a combination of Impella and extracorporeal membrane oxygenation. Left ventricular ejection fraction measured at admission ranged from 10% to 36%, with 4 patients showing full recovery of left ventricular ejection function. Three patients died in the hospital and 1 patient remains on long-term support with a HeartMate 3 left ventricular assist device. Conclusions:This retrospective single-center study on the use of MCS in TTS management supports results from previous studies reporting on the benefit of Impella therapy. Our experience shows that Impella support provides stabilization of CS and unloading of the left ventricle, allowing full recovery of left ventricular function and reversing TTS findings. For patients who do not adequately respond to Impella support alone, escalation to a combination of Impella and extracorporeal membrane oxygenation strategy is feasible to further improve cardiac output, while protecting the left ventricle from the increased afterload.

Acute type A aortic dissection (ATAAD) is a life-threatening emergency requiring urgent surgery. Advanced age is a major risk factor for operative mortality and strongly influences treatment decisions. This systematic review evaluates perioperative characteristics, surgical strategies in regard to outcomes and mortality in patients older than 70 years undergoing ATAAD repair. A PRISMA-guided database search identified original studies published between 2000 and 2025. Early and late outcomes were pooled, with thirty-day mortality as the primary endpoint and postoperative complications, organ dysfunction and quality of life as secondary endpoints. Key aspects of ATAAD management, including patient selection, extent of repair, cerebral protection and perioperative organ protection strategies, were systematically analyzed. Of 1,910 screened studies, 41 publications including 3,969 elderly patients were analyzed, encompassing randomized, observational and case-control designs. Preoperative malperfusion occurred in 22.8% of patients, most commonly cerebral (16.7%) and renal (13.5%). When analyzed within their respective cohorts, the majority of patients received standard of care ascending aorta or hemiarch replacement. This was followed by total arch replacement and root replacement. Mean cardiopulmonary bypass, cross-clamp and circulatory arrest times were 201, 104 and 45 min, respectively, at 23 °C. Postoperative morbidity was substantial, with neurological complications (12%), delirium (30%), respiratory failure (21%) and dialysis-dependent renal failure (22%). 30-day mortality was in average 21% and was mainly due to bleeding, low cardiac output and multiple organ failure. Long-term quality of life, assessed by SF-36, remained satisfactory. However, data was overall heterogeneously presented and therefor limited interpretability concerning the addressed endpoints. ATAAD surgery in elderly patients remains challenging due to frailty and comorbidities. Careful patient selection and treatment in specialized centers are essential. Despite the emerging hybrid and endovascular approaches, open repair was the most commonly reported intervention. The available data suggests that advanced age was not consistently associated with withholding surgical treatment, especially in cases of absence of malperfusion

BACKGROUND:Surgically implanted microaxial flow pumps (mAFP) are increasingly used for cardiogenic shock treatment. Standard mAFP explantation is performed bedside with a shortening of the vascular prosthesis, which may represent a potential source of infection in future. We analyzed the impact of gentamicin-impregnated collagen sponge (GICS) application in the wound during mAFP explantation on the incidence of prosthetic graft infections. METHODS:Between 01/2020 and 07/2024, 235 patients underwent bedside full-support mAFP explantation at our institution. Since 11/2022, GICS has been routinely applied in 115 patients, while 120 previously were treated without it. RESULTS:In the GICS-group, after a median follow-up of 221 [24; 351] days, 17 (14.8%) patients developed graft infection, resulting in 0.23 events per patient year (EPPY); surgery was necessary in 16 patients (13.9%). In the control group, after a median follow-up of 399 [113; 654] days, infection occurred in 14 (11.7%) cases, 0.10 EPPY; surgical removal of the graft was necessary in 12 (10%). The GICS-groups presented an increased risk for graft infections: sHR 2.49 [1.11; 5.59], p = 0.027. After propensity score matching for relevant demographic parameters, there was no significant difference in the risk reduction of total graft infections sHR 1.92 [0.79; 4,72], p = 0.15. CONCLUSIONS:Local application of GICS did not reduce the risk of access site infections in patients undergoing bedside explantation of mAFP from the graft surgically anastomosed to an axillary artery.

Trotz sinkender Komplikationsraten bleibt die Implantation von kardial implantierbaren elektronischen Systemen (CIED [Cardiac Implantable Electronic Device]) weiterhin ein Eingriff mit einem relevanten Risiko für peri- und postoperative Komplikationen. Bei der CIED-Implantation sind akute Komplikationen zu beachten, deren Auftreten durch ein standardisiertes, evidenzbasiertes Vorgehen minimiert werden können. Schwieriger zu erkennen und zu behandeln sind jedoch Komplikationen, die sich über einen längeren Zeitraum entwickeln. Eine besondere Herausforderung hierbei stellt die Abklärung des Verdachts auf eine CIED-Infektion dar. In diesem Artikel wird ein praxisorientierter Überblick über das Erkennen, die korrekte Behandlung und das Vermeiden von Komplikationen im Rahmen von kardialen Device-Operationen gegeben.

Despite declining complication rates, the implantation of cardiac implantable electronic devices (CIEDs) remains a procedure with a significant risk of peri- and postoperative complications. In CIED implantation, acute complications must be taken into account, and their occurrence can be minimized through a standardized, evidence-based approach. However, complications that develop over a longer period of time are more difficult to detect and treat. A particular challenge in this context is the evaluation of suspected CIED infection. This article provides a practice-oriented overview of how to recognize, correctly manage, and prevent complications associated with cardiac device procedures.

Objective: To investigate differences in neurologic outcomes between unilateral and bilateral antegrade cerebral perfusion during prolonged circulatory arrest in surgery for acute type A aortic dissection (ATAAD). Methods: Patients who underwent surgery for ATAAD between 2013 and 2023 receiving either unilateral antegrade cerebral perfusion (uACP) or bilateral antegrade cerebral perfusion (bACP) during prolonged caudal circulatory arrest (≥30 minutes) were included in the primary study cohort. Preoperative computed tomography scans were analyzed in terms of Type-Entry-Malperfusion classification and supra-aortic dissection patterns. After propensity score matching, the groups were compared in terms of clinical outcomes, including new postoperative strokes. Results: A total of 382 patients (206 uACP and 176 bACP) were included. The matched cohort comprised 2 balanced groups with 170 patients (85 in each group). The median circulatory arrest time was 44 (interquartile range [IQR], 36-57) minutes in the uACP group and 44 (IQR, 40-56) minutes in the bACP group (P = .87). Thirty-day mortality occurred in 15 patients (18%) in each group (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.89-1.12; P = 1.00). New postoperative stroke was detected in 6 uACP patients (7%) and in 4 bACP patients (5%) (OR, 0.98; 95% CI, 0.91-1.05; P = .52). Postoperative delirium occurred in 30 uACP patients (35%) and in 35 bACP patients (41%) (OR, 1.06; 95% CI, 0.92-1.23; P = .43). Conclusions: Both uACP and bACP are adequate cerebral perfusion strategies during circulatory arrest exceeding 30 minutes in surgery for ATAAD. Additional intraoperative and anatomic factors may be considered to determine the optimal selective cerebral perfusion strategy.

Perioperative low cardiac output syndrome (LCOS) remains a significant complication in adult cardiac surgery, contributing to substantial morbidity, prolonged intensive care, and increased mortality. Its incidence is expected to rise further due to the evolving complexity of referred surgical patients, often characterised by advanced age, multiple comorbidities, challenging anatomy, and impaired haemodynamics. Despite advances in pharmacological and perioperative care, outcomes for high-risk patients have not shown significant improvement, prompting interest in temporary mechanical circulatory support (tMCS) as a proactive strategy. This Expert Consensus Document from the European Association for Cardio-Thoracic Surgery (EACTS) presents the first dedicated guidance on the pre-emptive use of tMCS in high-risk adult cardiac surgical patients. Developed by a multidisciplinary task force, it emphasises structured risk stratification, early initiation, and individualised device management informed by interdisciplinary Heart Team discussions. The document proposes clinical pathways for patient selection, defines criteria for tMCS initiation, and provides practical algorithms for various scenarios, including advanced heart failure, cardiogenic shock, and post-cardiotomy LCOS. It reviews the current evidence on available tMCS devices, such as intra-aortic balloon pumps, microaxial flow pumps, veno-arterial extracorporeal life support and hybrid strategies, and addresses perioperative care, intensive care unit protocols, ethical considerations, as well as informed consent and support withdrawal. Despite promising results, substantial knowledge gaps remain, including long-term outcome data, device selection criteria, and cost-effectiveness analyses. This consensus aims to support clinical decision-making, standardise practice, and stimulate research to improve outcomes in a growing population of high-risk surgical patients.

Temporary mechanical circulatory support is recommended for cardiogenic shock management. Although surgical device implantation usually requires general anesthesia and orotracheal intubation with inherent hemodynamic risk, local anesthesia with analgosedation in spontaneously breathing patients offers a promising alternative. This retrospective, single-center study analyzed 374 patients receiving surgical implantation of a micro-axial flow pump (mAFP) between January 2023 and December 2024. Fifty (13.4%) of them were performed under local anesthesia. Of the 49 investigated patients, 79.6% were male, with a median age of 62 years (53-67). Cardiogenic shock was caused by dilated (51.0%) and ischemic (26.5%) cardiomyopathy. Preoperatively, 91.8% of patients required catecholamines, with a median vasoactive inotropic score of 11 (3.8-24.0) and a median lactate level of 1.9 (1.4-3.4) mmol/L. According to the SCAI Shock classification (SCAI), 49.0% of patients were classified as stage C and 38.8% as stage D. Ten patients (20.4%) received combined mAFP and venoarterial extracorporeal life support. Sedation was most commonly achieved with remifentanil, and lidocaine 2% was used for local anesthesia at the implantation site. Four patients required conversion to general anesthesia due to respiratory or cardiac complications. Procedure-related complications were infrequent (n = 6). Implantation of mAFP under analgosedation and local anesthesia appears to be feasible.

Objective:Microaxial flow pumps are increasingly used in cardiogenic shock as a bridge to a permanent left ventricular assist device. Aortic valve insufficiency after left ventricular assist device implantation is a common complication impairing effective unloading of the left ventricle. Microaxial flow pumps may potentially damage the aortic valve and thus increase the risk of relevant aortic regurgitation during long-term left ventricular assist device support. The aim of this study was to evaluate the impact of microaxial flow pumps on the development of late aortic insufficiency after left ventricular assist device implantation. Methods:In this retrospective single-center study, adult patients with a native aortic valve who received a left ventricular assist device between January 2015 and December 2021 were analyzed for aortic insufficiency by echocardiography before and at least 6 months after left ventricular assist device implantation (n = 291). Patients with moderate or severe aortic insufficiency requiring concomitant valve replacement at the time of the index procedure were excluded. Patients were divided into 2 groups: patients with (microaxial flow pump group) and without microaxial flow pumps (no microaxial flow pump group) support before left ventricular assist device implantation. Propensity score matching based on preoperative parameters resulted in well-balanced groups with 59 patients each. Results:Overall, 20 patients (16.4%) developed moderate or severe aortic insufficiency during a median follow-up time of 665 (473-829) days. Patients with microaxial flow pumps before implantation of left ventricular assist device developed a moderate (8) or severe aortic insufficiency (3) in 18.6% of patients, whereas patients with no microaxial flow pumps before left ventricular assist device developed a moderate (9) or severe aortic insufficiency (0) in 15.3% of patients (paired odds ratio, 1.33; 95% CI, 0.46-3.84; P = .594). Conclusions:In this single-center retrospective analysis, microaxial flow pump support did not increase the risk for aortic valve insufficiency after durable left ventricular assist device implantation.