Introduction This case report details the remarkable recovery of a critically ill 52-year-old male with end-stage heart failure supported by a left ventricular assist device (LVAD). The patient presented with severe ICU-acquired weakness (ICU-AW), had multiple comorbidities, and required prolonged mechanical ventilation. His case was marked by extreme clinical complexity, including hemodynamic instability, recurrent sepsis, mechanical ventilation dependency, an initial Medical Research Council (MRC) strength of 2/5, and an ICU Mobility Scale (IMS) score of 0. Rehabilitation was initially contraindicated. Patient's Main Concerns and Clinical Findings The patient expressed profound fears of becoming permanently dependent and losing dignity after being admitted for acute abdominal pain and shock following bowel resection with stoma formation, complicated by paralytic ileus. Key findings included generalized hypotrophy, symmetrical limb weakness (MRC 2/5), diminished reflexes, ventilator dependency via tracheostomy, VAD-related hemodynamic constraints, anemia, and elevated inflammatory markers. These findings were compounded by prior stroke and device infections. Primary Diagnoses, Interventions, and Outcomes Primary diagnosis was severe ICU-AW in an LVAD recipient with sepsis and multi-organ dysfunction. Interventions included 49 physiotherapy sessions (passive mobilization progressing to walker-assisted walking) and 28 respiratory therapy sessions (bronchial clearance, muscle training, tracheostomy care), coordinated by a multidisciplinary team from January 30 to April 1, 2025. Outcomes featured muscle strength gains to MRC 4/5 and IMS improvement from 0 to 8, enabling ambulation. Tracheostomy decannulation was performed on March 10, 2025, with no adverse events, and there were sustained outpatient gains in endurance, quality of life, and psychological well-being. Conclusion Proactively preparing for rehabilitation through serial reassessment helps identify the earliest safe intervention window, even when initially contraindicated. Synergizing physiotherapy and respiratory therapy within multidisciplinary teams can amplify recovery in complex ICU cases, while fostering hope, patient engagement, and team motivation, and redefining limits in seemingly hopeless prognoses.

Acute right ventricular failure (ARVF) is commonly seen in the intensive care unit and constitutes a significant clinical challenge, with associated high in-hospital mortality. Recently, the treatment of ARVF has significantly changed, with the progressive implementation of mechanical circulatory support devices that now represent important tools for clinicians in treating this condition. However, despite recent advancements, the optimal approach for ARVF remains elusive, and precise treatment algorithms and comprehensive management protocols are still lacking. In the present review, we explore the pathophysiology of ARVF, highlighting the different mechanisms that may lead to this clinical entity and emphasizing the left and right heart's complex interplay. We analyze the different therapeutic options that are now available for short- and long-term management of ARVF, with a particular focus on the advantages and disadvantages of the mechanical circulatory support devices actually used. Furthermore, we propose future directions in the field and a possible flowchart for the treatment of this condition.

Ventricular arrhythmias (VAs) are common and clinically important complications in patients supported by left ventricular assist devices (LVADs), occurring in up to 50% of cases within the first year after implantation. Despite the hemodynamic support provided by LVADs, VAs are linked to increased morbidity and mortality, primarily through recurrent implantable cardioverter defibrillator (ICD) shocks and right ventricular failure. The underlying mechanisms of VAs in this population are multifactorial, involving structural myocardial remodeling, device-related factors, and pre-existing arrhythmic substrates. Catheter ablation has become a valuable treatment option when antiarrhythmic drug therapy and device reprogramming are inadequate, though procedural timing (pre-, intra-, or post-implantation) and approaches remain under discussion. Epicardial access during LVAD surgery may provide advantages for selected patients, while ablation after implantation poses technical challenges due to altered anatomy and electromagnetic interference. This review offers a comprehensive overview of the epidemiology, pathophysiology, risk stratification, and management of VAs in LVAD recipients, emphasizing technical considerations, procedural safety, and clinical outcomes of catheter ablation. A multidisciplinary approach remains essential in guiding personalized treatment and optimizing outcomes for this complex population. Undergoing studies will provide more insight into optimal management of arrhythmias, particularly regarding the optimal timing of catheter ablation. The impact of new technologies such as non-invasive mapping alongside pre-procedural imaging needs also to be further evaluated.

Augmented reality (AR) has the potential to complement numerical simulations for enhanced post-processing and bring digital models into the daily clinical practice of healthcare professionals. In complex cardiac anatomies, the decision-making process for device implantation involves challenging evaluations of device positioning and efficacy. This study shows the case of a 79-year-old lady underwent closure of the left atrial appendage (LAA) with the AtriCliop device. Mini-invasive surgical treatment was chosen due to the infeasibility of percutaneous closure caused by anatomical constraints. Epicardial left atrial appendage closure (LAAC) was therefore the only possible solution to mitigate the risk of atrial fibrillation and heart arrest. We developed a framework to generate realistic animation of the LAAC procedure with the AtriClip PRO2 epicardial clip (AtriCure, Inc, Ohio, USA) starting from the computational simulation and ending to augmented reality (AR). This case proves the contribution provided by AR for the visualization of the simulation for accurate placement of the device and the successful execution of the cardiothoracic surgical procedure. We conclude that the synergy between physicians' expertise and AR can enhance ability to visualize the implications of biomedical device implants in complex cardiac anatomies, benefiting both physicians, simulation experts and patients.

BACKGROUND:Right ventricular (RV) myocardial work (RVMW) recently emerged as a non-invasive alternative for the assessment of RV contractility. However, none of the prior studies assessed its variations under different haemodynamic conditions. We aimed to evaluate the variations of the components of RVMW in heart failure (HF) patients with pulmonary hypertension (PH) undergoing a reversibility test. METHODS:Consecutive HF patients with reduced ejection fraction who underwent right heart catheterization and echocardiography at our institution were prospectively enrolled. Patients with PH and augmented pulmonary vascular resistance who achieved normalization of pulmonary pressures after the reversibility test using vasodilators underwent a second echocardiographic assessment under the same haemodynamic conditions. Four components of RVMW were analysed: (1) RV global work index (mmHg%); (2) RV global constructive work (mmHg%); (3) RV global wasted work (RVGWW) (mmHg%); (4) RV global work efficiency (RVGWE) (%). RESULTS:One hundred two patients were enrolled (53 with PH and 49 without). Global RVMW was higher in patients with PH, due to a significantly higher RVGWW [81 (55-119) mmHg% vs. 49 (28-72) mmHg%; P = 0.013], while RVGWE was similar between the two groups (80 ± 10% vs. 82 ± 12%; P = 0.332). In patients with PH, 27/52 (51.9%) had combined PH, while 25/52 (48.1%) had isolated post-capillary PH. A reversibility test was performed in 26/27 (96.2%) patients with combined PH and pulmonary pressure normalization was observed in 16/26 (61.5%) subjects. In patients with PH normalization, RVGWE remained almost unchanged (from 82.8 ± 6.9% to 85.3 ± 6.6%; P = 0.596), while RVGWW significantly decreased [from 60 (49-90) mmHg% to 41 (31-53) mmHg%; P = 0.027]. Among all the echocardiographic and haemodynamic parameters adopted for assessing RV function, RVGWE was the least variable during the reversibility test (mean variation 3 ± 10%). CONCLUSIONS:RVGWE is comparable between HF patients with and without PH and remains stable across different haemodynamic conditions. This consistency suggests that it can be a reliable parameter for assessing RV contractility. Larger studies are needed to confirm this hypothesis and to test its prognostic significance.

BACKGROUND:Advanced heart failure is a condition where pharmacological therapies have a limited impact on prognosis. Left ventricular assist devices (LVAD) have been shown to improve survival and quality of life in well-selected patients in this setting. LVAD technology has evolved over time, leading to more efficient devices with fewer complications. METHODS:This retrospective, single-center study analyzes outcomes of LVAD implants at ISMETT, comparing two devices: HeartWare (HVAD) and HeartMate 3 (HM3). Event analyses were conducted over the first year of follow-up. The primary endpoint was mortality, while secondary endpoints included adverse events such as stroke, driveline infections, heart failure, and pump thrombosis. RESULTS:Between 2010 and 2024, a total of 109 LVAD were implanted (10.75 implants/year). One-year survival was higher in HM3 patients (84.6%) compared to HVAD patients (78.6%). Cerebrovascular events were significantly less frequent in the HM3 group. Driveline infections were comparable between the two devices. Pump thrombosis occurred in 15.7% of HVAD patients and in none of HM3 patients. Gastrointestinal bleeding risk was significantly higher in the HVAD group, whereas the risk of right ventricular failure was similar between groups. CONCLUSIONS:HM3 LVADs offer a superior safety profile, with reduced mortality and fewer complications compared to HVADs, reflecting technological advancements in mechanical support for advanced heart failure. This study provides new insights into LVAD patient outcomes in Italy, contributing to improved treatment strategies for this high-risk population.

Background. Advanced heart failure is a condition where pharmacological therapies have a limited impact on prognosis. Left ventricular assist devices (LVAD) have been shown to improve survival and quality of life in well-selected patients in this setting. LVAD technology has evolved over time, leading to more efficient devices with fewer complications. Methods. This retrospective, single-center study analyzes outcomes of LVAD implants at ISMETT, comparing two devices: HeartWare (HVAD) and HeartMate 3 (HM3). Event analyses were conducted over the first year of follow-up. The primary endpoint was mortality, while secondary endpoints included adverse events such as stroke, driveline infections, heart failure, and pump thrombosis. Results. Between 2010 and 2024, a total of 109 LVAD were implanted (10.75 implants/year). One-year survival was higher in HM3 patients (84.6%) compared to HVAD patients (78.6%). Cerebrovascular events were significantly less frequent in the HM3 group. Driveline infections were comparable between the two devices. Pump thrombosis occurred in 15.7% of HVAD patients and in none of HM3 patients. Gastrointestinal bleeding risk was significantly higher in the HVAD group, whereas the risk of right ventricular failure was similar between groups. Conclusions. HM3 LVADs offer a superior safety profile, with reduced mortality and fewer complications compared to HVADs, reflecting technological advancements in mechanical support for advanced heart failure. This study provides new insights into LVAD patient outcomes in Italy, contributing to improved treatment strategies for this high-risk population.

Background: Gastrointestinal bleeding (GIB) is a common complication of left ventricular assist device (LVAD) support. The UTAH bleeding risk score (UBRS) is the only dedicated GIB prediction model, but its efficacy has not been confirmed in an external validation cohort. Furthermore, the reliability of other bleeding risk scores, such as ARC-HBR and HASBLED, has never been tested in this specific population. This study aims to validate the UBRS and compare its accuracy with the ARC-HBR and HASBLED scores. Methods: Major adverse events (MAEs) and bleeding events of 75 consecutive patients who had undergone LVAD implantation between 2010 and 2021 at a referral hospital for a heart transplant were retrospectively analyzed. The accuracy of the UBRS, ARC-HBR and HASBLED scores was evaluated using a ROC curve model. Results: At a mean follow-up of 905.9 ± 724 days, 58 (77.3%) patients had an MAE and 28 (37.3%) had a major bleeding event. Out of the 39 major bleeding events, the majority were GI (43%) and intracranial bleeding (33.3%). Compared with patients without major bleeding, those who experienced major bleeding showed a lower survival probability, regardless of the nature of the bleeding (GIB vs. other bleeding events). The UBRS effectively stratified the bleeding risk with an AUC of 0.86. In contrast, the ARC-HBR and HASBLED scores demonstrated lower discriminatory power, with AUCs of 0.61 and 0.52, respectively. Conclusions: UBRS accuracy was confirmed in our study population. Gastrointestinal bleeding is a common life-threatening complication and one of the main causes of re-hospitalization during VAD support, leading to a lower patient survival probability.

Razionale. L’insufficienza cardiaca avanzata rappresenta una condizione in cui le terapie farmacologiche hanno un impatto sulla prognosi limitato. I dispositivi di assistenza ventricolare sinistra (LVAD) hanno dimostrato di prolungare la sopravvivenza e migliorare la qualità di vita in questo scenario, in pazienti ben selezionati. La tecnologia degli LVAD si è evoluta, rendendo i dispositivi progressivamente più efficienti e gravati da meno complicanze.Materiali e metodi. Questo studio retrospettivo monocentrico analizza i risultati di impianti LVAD presso ISMETT, confrontando l’utilizzo di due dispositivi: HeartWare (HVAD) e HeartMate 3 (HM3). Le analisi sugli eventi sono state condotte considerando il primo anno di follow-up. L’evento primario considerato è la mortalità, mentre gli eventi secondari includono eventi avversi quali ictus, infezioni della driveline, scompenso cardiaco e trombosi di pompa.Risultati. Tra il 2010 e il 2024 sono stati impiantati 109 LVAD (10.75 impianti/anno). Il tasso di sopravvivenza a 1 anno è risultato superiore nei pazienti con HM3 (84.6%) rispetto a quelli con HVAD (78.6%). Gli eventi cerebrovascolari sono risultati significativamente meno frequenti nel gruppo HM3. Le infezioni della driveline sono risultate simili tra i due dispositivi. Il 15.7% dei pazienti portatori di HVAD è andato incontro a trombosi di pompa, mentre non sono state registrate trombosi di pompa nei pazienti HM3. Il rischio di sanguinamenti gastrointestinali è risultato significativamente più alto nei pazienti HVAD, mentre il rischio di insufficienza ventricolare destra era sovrapponibile tra i due gruppi.Conclusioni. Gli LVAD HM3 offrono un profilo di sicurezza superiore, con una riduzione della mortalità e delle complicanze rispetto ai dispositivi HVAD, riflettendo il progresso tecnologico nel supporto meccanico nell’insufficienza cardiaca avanzata. Lo studio fornisce nuovi dati sugli esiti dei pazienti con LVAD in Italia, contribuendo a migliorare le prospettive di trattamento per questa popolazione ad alto rischio.

Aims Sodium-glucose cotransporter inhibitors (SGLT2-i) improve outcomes in patients with heart failure (HF) and reduced ejection fraction (HFrEF). However, evidence in patients with advanced HF is lacking. We aimed to determine the effect of SGLT2-i in advanced HFrEF compared to their effect on a non-advanced population. Methods Consecutive HFrEF outpatients who started SGLT2-i were observed for 6-months. Patients were categorized as having advanced or non-advanced HFrEF. The primary outcome was the trend of NTproBNP in the two groups. Secondary outcomes included changes in New York Heart Association (NYHA) class, glomerular filtration rate (GFR), and ejection fraction (LVEF). The association between advanced HF diagnosis and including N-terminal pro-brain natriuretic peptide (NTproBNP) reduction was tested using multivariate analysis. Results Overall, 105 patients (45 advanced, 60 non-advanced) were included. Mean age was 56±10 years, 22% were female, and 35% had ischemic heart disease. Median NTproBNP at baseline for advanced and non-advanced patients was 1672pg/ml (IQR 520-3320) vs. 481 pg/ml (IQR 173-917), respectively (p<0.001). At follow-up, only non-advanced patients reduced their NTproBNP (-32% (95% CI -51 to -3), p<0.001), while advanced patients had an increase in NTproBNP. LVEF and NYHA class improved only in non-advanced patients. GFR was stable in both subgroups. At multivariate analysis a diagnosis of advanced HF was independently associated with a reduced probability of NTproBNP reduction (OR 0.041 (95% CI 0.002-0.752), p=0.031). Only one patient discontinued the drug due to side effects. Conclusion In advanced HFrEF, SGLT2-i do not impact on NTproBNP, LVEF or NYHA class but are well tolerated.

BACKGROUND:Molecular analysis (MA) on heart valve (HV) improves the microbiologic diagnosis of infectious endocarditis (IE). The main drawback of MA is the lack of antimicrobial susceptibility information.METHODS:We conducted a prospective cohort observational study of consecutive adult patients from April 2012 to May 2021 who underwent valve surgery at our hospital. The performance of MA, blood cultures (BC) and valve cultures (VC), and the diagnostic and therapeutic impact of MA were evaluated. Molecular antibiogram results were compared to culture-based antimicrobial susceptibility testing (AST).RESULTS:A total of 137 patients with definite IE and 52 patients with no IE were enrolled in the study. Among IE cases BC, VC, and MA were positive in 75 (55%), 30 (22%), and 120 (88%) of IE cases, respectively. Among 62 cases of BC-negative IE (BCNE), 57 achieved diagnosis with MA. MA led to a change of antimicrobial therapy in 92% of BCNE. MA was negative in 100% of patients with no IE. Molecular antibiogram performed on 17 valve specimens that resulted positive for pathogens potential carrier of genes encoding for multidrug resistant mechanisms showed 100% concordance with AST.CONCLUSIONS:MA showed a high specificity and sensitivity in etiological diagnosis of IE. Molecular antibiogram could overcome the major limitation of MA that is the lack of susceptibility testing. We advocate for the inclusion of MA among diagnostic criteria for IE and for a more extensive use of molecular antibiogram when the culture result is negative, and MA is the only positive test.

AIMS:MicroRNAs play a role in pathogenic mechanisms leading to heart failure. We measured a panel of 754 miRNAs in the myocardial tissue and in the serum of patients with heart failure with reduced ejection fraction due to dilatative idiopathic cardiomyopathy (DCM, N = 10) or ischaemic cardiomyopathy (N = 3), referred to left ventricular assist device implant. We aim to identify circulating miRNAs with high tissue co-expression, significantly associated to echocardiographic and haemodynamic measures. METHODS AND RESULTS:We have measured a panel of 754 miRNAs in the myocardial tissue [left ventricular (LV) apex] and in the serum obtained at the same time in a well selected study population of end-stage heart failure with reduced ejection fraction due to either DCM or ischaemic cardiomyopathy, referred to continuous flow left ventricular assist device implant. We observed moderate agreement for miR-30d, miR-126-3p, and miR-483-3p. MiR-30d was correlated to LV systolic as well as diastolic volumes (r = 0.78, P = 0.001 and r = 0.80, P = 0.005, respectively), while miR-126-3p was associated to mPAP and PCWP (r = -0.79, P = 0.007 and r = -0.80, P = 0.005, respectively). Finally, serum miR-483-3p had an association with right ventricular end diastolic diameter (r = -0.73, P = 0.02) and central venous pressure (CVP) (r - 0.68 p 0.03). CONCLUSIONS:In patients with DCM, few miRNAs are co-expressed in serum and tissue: They are related to LV remodelling (miR-30d), post-capillary pulmonary artery pressure (miR-126-3p), and right ventricular remodelling/filling pressures (miR-483-3p). Further studies are needed to confirm their role in diagnosis, prognosis or as therapeutic targets in heart failure with reduced ejection fraction.

Background:The aim of this study was to assess the impact of septal thickness on long-term outcomes of surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) and correction of mitral subvalvular anomalies.Methods:Sixty-six consecutive patients (58 ± 12 years, 56% female) undergoing extended septal myectomy and subvalvular mitral apparatus remodeling from 2007 to 2021 were retrospectively reviewed. Patients were divided into 2 groups according to septal thickness: moderate [< 18 mm, 29 patients (44%)] and severe [≥ 18 mm, 37 patients (56%)]. End points included survival, symptom improvement, reduction of left ventricle outflow tract (LVOT) gradient, resolution of mitral regurgitation (MR), and reoperation.Results:The mean interventricular septal thickness was 19 ± 3 mm, 15.8 ± 0.8 mm in patients with moderate and 21.4 ± 3.2 mm in those with severe hypertrophy. Preoperative data, intraoperative variables, postoperative complication rates, pre-discharge echocardiographic and clinical parameters did not differ between the two study groups [except for procedures involving the posterior mitral leaflet (p = 0.033) and septal thickness after myectomy (p = 0.0001)]. Subvalvular apparatus remodeling (secondary chordae of mitral valve resection and papillary muscle and muscularis trabecula procedures including resection, splitting, and elongation) was invariably added to septal myectomy (100%). Four (6%) procedures involved the posterior mitral leaflets. Mitral valve replacement was carried out in two patients (3%, p = 0.4). Reoperation for persistent MR was necessary in one patient (1%, p = 0.4). Neither iatrogenic ventricular septal defect nor in-hospital mortality occurred. During follow-up (mean 4.8 ± 3.8 years), two deaths occurred. NYHA class was reduced from 2.9 ± 0.7 to 1.6 ± 0.6 (p < 0.0001), the LVOT gradient from 89.7 ± 34.5 to 16.3 ± 8.8 mmHg (p < 0.0001), mitral valve regurgitation grade from 2.5 ± 1 to 1.2 ± 0.5 (p < 0.0001), and septal thickness from 18.9 ± 3.7 to 13.9 ± 2.7 mm (p < 0.0001).Conclusions:Regardless of septal thickness, subvalvular apparatus remodeling with concomitant septal myectomy can provide satisfactory long-term outcomes in terms of symptom improvement, LVOT obstruction relief, and MR resolution (without mitral valve replacement in most cases) in patients with HOCM.

The Left Ventricular Assist Devices (LVAD) is considered a good way to improve survival and quality of life in patients with end stage left ventricular failure compared to the optimal medical therapy alone. Long-term survival of patients receiving LVADs may be complicated by different cardiac (heart failure and arrhythmia) and extra-cardiac diseases: Bleeding, infections, and thrombosis, many of which could require different intervention. Endoventricular thrombolysis may have a pivotal role in LVAD thrombosis. The coexisting risk of angiodysplasia gastrointestinal bleeding, often elevated in patient with this type of non pulsatile ventricular assistance device should be considered by single case.

Background: Identifying candidates for left ventricular assist device surgery at risk of right ventricular failure remains difficult. The aim was to identify the most accurate predictors of right ventricular failure among clinical, biological, and imaging markers, assessed by agreement of different supervised machine learning algorithms. Methods: Seventy-four patients, referred to HeartWare left ventricular assist device since 2010 in two Italian centers, were recruited. Biomarkers, right ventricular standard, and strain echocardiography, as well as cath-lab measures, were compared among patients who did not develop right ventricular failure (N = 56), those with acute-right ventricular failure (N = 8, 11%) or chronic-right ventricular failure (N = 10, 14%). Logistic regression, penalized logistic regression, linear support vector machines, and naive Bayes algorithms with leave-one-out validation were used to evaluate the efficiency of any combination of three collected variables in an "all-subsets" approach. Results: Michigan risk score combined with central venous pressure assessed invasively and apical longitudinal systolic strain of the right ventricular-free wall were the most significant predictors of acute-right ventricular failure (maximum receiver operating characteristic-area under the curve = 0.95, 95% confidence interval = 0.91-1.00, by the naive Bayes), while the right ventricular-free wall systolic strain of the middle segment, right atrial strain (QRS-synced), and tricuspid annular plane systolic excursion were the most significant predictors of Chronic-RVF (receiver operating characteristic-area under the curve = 0.97, 95% confidence interval = 0.91-1.00, according to naive Bayes). Conclusion: Apical right ventricular strain as well as right atrial strain provides complementary information, both critical to predict acute-right ventricular failure and chronic-right ventricular failure, respectively.

Obesity and hypertension independently promote pathological left ventricular remodelling (LVR) and left ventricular hypertrophy (LVH), but to what extent they do so when they do not coexist is unclear. We used data from the Cardiovision Brno 2030 study to assess-for the first time in a region where no investigations have been previously carried out-the independent association of obesity and hypertension with LV geometry, and to evaluate the effects of hypertension in normal weight patients and the effects of obesity in normotensive patients. Overall, 433 individuals, aged 25⁻65 years, with no history of cardiovascular disease and/or antihypertensive treatment, were stratified into four groups according to BMI and hypertension: normal weight non-hypertensive (NWNH), normal weight hypertensive (NWH), overweight/obese non-hypertensive (ONH) and overweight/obese hypertensive (OH). LVR was classified as normal, concentric LVR (cLVR), concentric LVH (cLVH) or eccentric LVH (eLVH). Linear regression analysis demonstrated that body mass index (BMI) and systolic blood pressure (SBP) are the main predictors of LV mass and that they interact: SBP had a stronger effect in overweight/obese (β = 0.195; p = 0.033) compared to normal weight patients (β = 0.134; p = 0.048). Hypertension increased the odds of cLVR (OR = 1.78; 95%CI = 1.04⁻3.06; p = 0.037) and cLVH (OR = 8.20; 95% CI = 2.35⁻28.66; p = 0.001), independent of age, sex and BMI. Stratified analyses showed that NWH had a greater odd of cLVH (OR = 7.96; 95%CI = 1.70⁻37.08; p = 0.008) and cLVR (OR = 1.62; 95%CI = 1.02⁻3.34; p = 0.047) than NWNH. In the absence of hypertension, obesity was not associated with LVM and abnormal LV geometry, suggesting that it is not per se a determinant of LVR. Thus, antihypertensive therapy still remains the first-line approach against LVH in hypertensive patients, though weight loss interventions might be helpful in those who are obese.

Objective To investigate the impact on survival of pre and post heart transplant (HT) use of mechanical circulatory support (MCS).Methods Data were collected retrospectively. ECMO was the MCS used to treat severe early graft failure (EGF). Log-rank test was used to compare Kaplan-Meier survival curves. A p-value <0.05 was considered statistically significant. Results 147 HT were done from 2004 to October 2016. The average male and female recipient’s age was 50±13 years and 47±14 years, respectively. Percentage of use of MCS and IABP to bridge patients to HT were 16% and 7%, respectively. MCS included: 8 HeartWare LVAD (5.4%), 6 ECMO (4.1%), 6 Levitronix BiVAD (4.1%), 2 Thoratec LVAD (1.4%) and 2 Levitronix LVAD (1.4%). Hospital mortality was 14.3% (21pt). 1-year survival was 82% and 5-year survival was 75%. Overall pre-transplant MCS was not correlated to worse post-transplant prognosis, p=0.822. Left sided MCS showed a worse survival compared to the no-MCS group (p=0.045) and to the ECMO and BiVAD (p=0.02). Severe primary EGF strongly impact the early mortality after heart transplantation (p<0.001). Excluding the 90 day mortality, the survival between patients with EGF and those without is similar (p=0.874).The risk of mortality increased almost 2 fold according each hour of ischemic time [OR=1.7, 95% IC, 1.1-2.7, p=0.017].Conclusions ECMO because of severe EGF remains associated with worse post-transplant outcomes however, patients discharged after severe EGF, showed a long term survival comparable to those without EGF. A LVAD before HT seems to affect the hospital mortality.

Background To assess the role of the mitral valve apparatus (leaflets, chordae and papillary muscles, (PM)) in left ventricle outflow tract (LVOT) obstruction, and results of the surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM). Methods Twenty-eight consecutive patients (58 +/- 11 years, 53% female) undergoing HOCM surgery from 2007 to 2016 at our institute were retrospectively reviewed. Endpoints included the involvement of the mitral valve in LVOT obstruction, mortality, and changes in clinical and echocardiographic characteristics after HOCM surgery. Result Secondary chordae tendineae tractioning the anterior mitral leaflet to the interventricular septum, and systolic anterior motion were detected in 78% of the patients. Anomalous, hypertrophied, and fused PM with muscularis trabeculae hypertrophy were found in 50%, 25%, and 35% of the patients, respectively. Four patients had posterior leaflet redundancy. Secondary chordae (92%), PM, and muscularis trabeculae resection (71%), and PM splitting and elongation (28%) were added variably to septal myectomy (100%). Nine procedures (32%) on mitral valve leaflets were performed, involving six posterior and three anterior mitral leaflets. Long-term follow-up was 4 +/- 2.8 years. There was no hospital mortality, and NYHA was reduced from 3 +/- 0.5 to 1 +/- 0.7 (p < 0.0001), the LVOT gradient from 88 +/- 35 to 20 =18 mmHg (p < 0.0001), mitral valve regurgitation from grade 3 +/- 1 to 1 +/- 0.7 (p < 0.0001), and septum thickness from 18 +/- 3 to 14 +/- 2 mm (p < 0.0001). Conclusions The mitral valve apparatus contributes with all its components variably to LVOT dynamic obstruction thus surgical correction in addition to extended myectomy is recommended to achieve the best outcome.