Introduction End-stage heart failure is associated with high morbidity and mortality rates and can be complicated by sustained ventricular tachycardia (VT) with increased risk of ventricular fibrillation and sudden cardiac death. Transaortic microaxial left ventricular assist devices can be surgically implanted using an axillary approach and provide temporary mechanical circulatory support (tMCS). We report a case of combining repeated VT ablations with tMCS to successfully bridge to heart transplantation (OHT) in a patient with recurrent electrical storm. Case Report We report a case of a 66-year-old male with dilated cardiomyopathy due to myocarditis, who suffered a non-ST-elevation myocardial infarction due to three-vessel coronary artery disease. Despite urgent coronary bypass surgery, he showed no improvement of heart function and presented episodes of sustained VT. Due to poor RV function a durable left ventricular assist device was deemed not a suitable therapeutic strategy and he was evaluated for OHT. He underwent VT/premature ventricular contraction ablation in three areas of the right ventricular outflow tract (RVOT; free wall, posterolateral and HIS area). However, he suffered an intrahospital cardiac arrest with refractory cardiogenic shock and a resuscitation time of 75 minutes with subsequent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation. Following the surgical implantation of a transaortic microaxial pump, the VA-ECMO was successfully weaned. He showed good neurological outcome and underwent physiotherapy with full mobilization and ambulation on the ward. Under hemodynamic support he underwent another high-risk VT ablation and concomitant stellate ganglion blockade and postprocedural stable sinus rhythm was achieved. After 34 days of tMCS the patient underwent OHT. Postoperative course was uneventful. 13 days after OHT he was discharged to a rehabilitation facility, after which he was discharged home after three weeks. Summary In patients with end-stage heart failure and recurrent electrical storm a surgically implanted transaortic microaxial pump can allow hemodynamic stabilization during high-risk procedures such as VT ablation and neuromodulation as a feasible bridge to OHT strategy.

Purpose Vasoplegic syndrome (VS) is a possible complication after cardiac surgery using cardiopulmonary bypass (CPB) and is mainly characterized by a loss of systemic resistance leading to refractory hypotension and inadequate peripheral tissue perfusion. The objective of this retrospective study is to determine the impact of VS on short- and long-term morbidity and mortality after heart transplantation (OHT). Methods We retrospectively reviewed data of 156 consecutive adult patients who underwent OHT at our center between 2010 and 2021. VS was defined as persistent low systemic vascular resistance (<800 dynes/s/cm5) with preserved cardiac index (>2.5 L/min/m2) and catecholamine resistant hypotension despite intravenous vasopressors at a high dose (>0.2μg/kg/min norepinephrine) within the first 6-24 hours after surgery. Patients were divided into two groups classified by the presence or absence of vasoplegia. Results The incidence of VS was 11.5% (18 patients) with comparable donor and recipient characteristics in both groups. The mean age of vasoplegic patients was 51±10 (vs. 50±12) years and 88.9 % (vs.71.0%) were male. 61.6% (vs. 48.1%) had a history of prior cardiac surgery of which 44.4 % (vs. 28.1%) were implantations of left ventricular assist devices. Vasoplegic patients showed increased lactate levels at the end of CPB (9.0±5.3 vs. 4.9±3.1 mmol/L, p<.001) and higher rate of reoperation for bleeding (55,6% vs. 15.2% p<.001). Of the 18 vasoplegic patients, five patients (27.8%) received immediate mechanical circulatory support (MCS) at the end of CPB for a mean of 5±2.7 days, six patients (33.3%) received delayed MCS after a mean of 7.8±5.7 hours postoperatively for 6.1±4.6 days and seven patients (38.9%) were treated without MCS. 30-day survival rates were 100 % in patients receiving immediate MCS, 50% in patients with delayed MCS and 71.4% in patients without MCS, respectively. Overall 30-day survival rate was lower in vasoplegic patients (72.2% vs 94.9%, p<.001). If patients survived the first 30 days there was no significant difference in 1-year survival (92.3 % vs 90.2%). Conclusion Vasoplegic syndrome following heart transplantation was associated with increased perioperative 30-day mortality. Early MCS implantation seemed to be beneficial for short-term survival. Vasoplegic patients surviving the first 30 days had a comparable and good long-term outcome.

Purpose Use of a special designed plug is one of the recommended methods for LVAD explantation in case of myocardial recovery (IIa in EACTS expert opinion). The study presents the results from the evaluation of the long-term follow up in patients that received a titanium sintered plug after LVAD explantation. Methods In this retrospective, multi-center analysis 67 patients were enrolled who received a titanium sintered plug after LVAD explantation. Information were collected through a questionnaire containing questions about demographics, surgical procedure and the follow-up. Results Date of last follow-up was successfully recorded for 67 patients and was measured in months. The mean follow-up was 29±27 months; 64% of patients presented > 1 year follow up. At the time of the last follow-up 82% of patients were alive, one patient developed plug infection due to infected part of incorporated driveline. Conclusion In this multicenter study, the use of an individually manufactured titanium plug to close the opening of the apex after LVAD explantation resulted in low incidence of plug-related complications. With the volume of patient undergoing an LVAD explantation after myocardial recovery increasing, the need of industry manufactured plugs is evident.

PURPOSE:Various options of temporary mechanical circulatory support (tMCS) exist for the treatment of cardiogenic shock, however, all forms of tMCS carry a risk of complications. The aim of this study was to compare bleeding complications and thromboembolic events under extracorporeal life support + Impella 2.5/CP (ECMELLA) and isolated Impella 5.0 therapy in the same patient cohort.MATERIAL:We retrospectively analyzed data of patients who underwent ECMELLA implantation and subsequent Impella 5.0 therapy. Implantation strategy and anticoagulation protocol were comparable in both groups.RESULTS:We included 15 patients (mean age 57.2 years; 80% of male patients) who were weaned from ECMELLA undergoing subsequent Impella 5.0 implantation. Mean duration of ECMELLA and Impella 5.0 therapy (10.5 vs. 11.2 days) did not differ significantly (p = .731). The average number of transfused packed red blood cells (PRBC) and thrombocyte concentrates (TC) was significantly decreased during Impella 5.0 treatment (PRBC: 30.3 vs 12.3, p = .001; TC: 5.9 vs 2.2, p = .045). Additionally, the transfusion rates per day were significantly reduced under Impella 5.0 support.CONCLUSIONS:The need for transfusions is significantly lower in the phase of Impella 5.0 therapy compared to the initial phase on ECMELLA. Therefore, we recommend replacing ECMELLA by an Impella 5.0 device early, if possible.

Durch Vorgaben von Eurotransplant und der Bundesärztekammer werden in Deutschland derzeit erwachsene Patienten (Pat.) im Rahmen der Evaluation zur Herz- (HTx) und/oder Lungentransplantation (LuTx) regelhaft Ösophagogastroduodenoskopien (ÖGDs) und Koloskopien unterzogen. Eine systematische Analyse von Nutzen und Risiko dieses Vorgehens liegt nicht vor.

Background: Due to the shortage of organ donors the number of continuous flow left ventricular assist device (cfLVAD) implantation is increasing. The aim of this study was to compare early quality of life (QoL) and mental recovery of patients with cfLVAD compared with patients after heart transplantation (HTx).

Cardiogenic shock carries a high risk for mortality despite various treatment options. Initial treatment using peripheral veno-arterial extracorporeal life support (ECLS) has shown to improve survival in patients in need of biventricular and lung failure, but is associated with bleeding, ischemic and infectious complications. The catheter based surgically implanted transaortic axial flow left ventricular assist device (LVAD) Impella 5.0 (Abiomed) seems to be a less invasive but equivalent hemodynamic alternative if right ventricular function allows switching from ECMO to Impella 5.0 to reduce peripheral ECLS associated complications.

Background Minimally invasive left ventricular assist device (LVAD) implantation may reduce peri-/postoperative complications and risks associated with resternotomies. In this study, we describe our first results using a minimally invasive LVAD implantation technique (lateral thoracotomy [LT] group). These results were compared with LVAD implantations done via full median sternotomy (STX group). Methods HVAD (HeartWare, Framingham, Massachusetts, United States) implantations in 70 patients (LT group n = 22, 52 ± 15 years old; STX group n = 48, 59 ± 11 years old) were retrospectively analyzed. Minimally invasive access via left thoracotomy was feasible in 22 patients. Peri- and postoperative analyses of survival and adverse events were performed. Results No survival differences were observed between the LT and STX group (p = 0.43). LT patients without temporary right ventricular assist device (tRVAD) showed a significantly better survival rate compared to LT patients with concomitant tRVAD implantation (p = 0.02), which could not be demonstrated in the STX group (p = 0.11). Two LT and four STX patients were successfully bridged to heart transplantation and three STX patients were successfully weaned with subsequent LVAD explantations. LVAD-related infections (n = 4 LT group vs n = 20 STX group, p = 0.04) were less likely in the LT group. No wound dehiscence occurred in the LT group, whereas five were observed in the STX group (p = 0.17). The amount of perioperative blood transfusions (within the first 7 postoperative days) did not differ in both study groups (p = 0.48). Conclusion The minimally invasive approach is a viable alternative with the possibility to reduce complications and should be particularly considered for bridge-to-transplant patients.

Extracorporeal membrane oxygenation (ECMO) is an established short-term mechanical circulatory support in patients with postcardiotomy failure. The duration of ECMO is associated with overall outcome and the development of complications. Therefore, we ought to investigate if the course of routine laboratory values can predict early survival.

Patients suffering from end-stage cardiovascular diseases are underrepresented in achieving palliative care approaches, mostly focused on cancer. The aim of this study was to evaluate the need of palliative care in an out-of-hospital setting and specify the distinct problems of VAD patients.

The shortage of suitable donor organs is a problem in lung transplantation. This dilemma is even worse in recipients with small chest cavities. In order to exploit a larger donor pool, we electively accepted bigger organs for small patients and performed lobar lung transplants. We further compared this patient group with patients receiving regular bilateral lung transplantation concerning survival and lung function. In our lung transplant program 10 patients (8 women and 2 men, 45.9±12.2 years old) received elective lobar lung transplantation between March 2009 and August 2014 with a mean waiting time of 227±163 days. The underlying diseases were IPF (n=6), CF (n=3) and PHT (n=1). The mean recipient height was 164±8 cm and their calculated total lung capacity (TLC) was 5.3±1.0 L. Donor lungs from 9 males and 1 female with a calculated TLC of 7.7±0.3 L and 5.3 L and a donor height of 185±4 cm and 165 cm respectively were accepted. Mean donor age was 44.9±7.2 years. All recipients were successfully transplanted via bilateral anterior or clamshell incisions using intraoperative ECMO support. In 5 cases, we transplanted a right upper (RUL) + right middle lobe (RML) and a left upper lobe (LUL). The remaining patients received RUL and LUL (n=2), RLL and LLL (n=2), and RML + RLL and LLL (n=1). There were no postoperative complications needing further interventions. The 30-day survival was 90 %. The one year survival was 72.7 %. All other patients are still alive in 11/2015 at 49.3 (±25.3) months. The Kaplan-Meier curve is slightly better compared to our patients, who received regular bilateral lung transplantation (n=49). Cause of death (n=3) during the first year were graft failure (day 11), encephalopathy (day 77) and sepsis (day 134), respectively. Further complications have been BOS at stage III in one patient and 10 hospitalizations due to infections at some point. Their last measured VC and FEV1 was 64.7±18.7% and 58.3±11.3%, respectively. This is again comparable to our results after regular lung transplants. In this study it is shown that elective lobar lung transplantation can be performed safely with similar overall results as regular lung transplantation. It is an option for mainly female patients with small thoraces.

Infections are major complications in patients with ventricular assist devices (VAD) and reasons for high urgency listing for transplantation. Whereas results after transplantation are comparable in patients with and without driveline infections (DI), large registry results showed that the mortality is higher in those with a device infection or mediastinitis. Positron emission tomography-computed tomography (PET-CT) is a diagnostic tool to scan for tissue with high metabolism like in infections. The specificity of PET-CT to discriminate between infection and high metabolism due to an aseptic reaction to the device is not clear. Until September 2015 a total number of 100 patients underwent VAD implantations an our institution. 23 patients (mean age 54.3±4.9years) underwent PET-CT scans for a suspected infection. 9 patients had two PET-CT scans at different time points. All radiologic results were compared to clinical and intraoperative parameters. In six patients with elevated laboratory findings, PET-CT scan ruled out any VAD related infections and during three months of follow-up these patients experienced no clinical signs of an infection leading to no further treatment. In 17 patients, the positive PET-CT results correlated with laboratory, clinical and intraoperative signs of an infection. All patients with positive PET-CT scans were treated by iv-antibiotics. Nine patients had DI confirmed by local inflammation and were treated by antibiotics alone, four patients had an impaired wound healing with and without mediastinitis treated by VAC therapy, four patients had device infections, two with and two without DI. The PET-CT was able to show the device infection at an early stage. The positive findings for device infection were first undervalued, but later on confirmed intraoperatively. In 9 patients who had two PET-CT scans at different time points the results correlated with clinical improvement of the infection. PET-CT scan results correlated well with clinical parameters and were specific for infection. Therefore, it may have the potential to guide the clinician in correct handling of infectious complications after VAD implantation.