Here, we report the case of a patient who presented to our institution with severe, destructive, and un-reconstructable prosthetic valve endocarditis which required the planned implantation of a total artificial heart (TAH) to function as a bridge to cardiac transplantation.

Whipple's endocarditis is a rare culture-negative endocarditis caused by Tropheryma whipplei, an intracellular gram-positive organism. Here, we present a case of a 60-year-old male who presented with transient ischemic attack and was found to have an aortic valve mass. Following successful excision, histopathologic assessment of the lesion was consistent with calcified amorphous aortic tumor, a rare non-neoplastic hamartomatous mass of the heart. However, 16s rRNA and 18s rRNA sequencing detected Tropheryma whipplei, and the diagnosis of Whipple's endocarditis was made.

Background: Left ventricular assist devices (LVAD) are standardly implanted via full sternotomy. Non-sternotomy approaches are gaining popularity, but potential benefits of this approach have not been well-studied. We hypothesized that LVAD implantation by bi-thoracotomy (BT) would demonstrate smaller and more consistent inflow cannula angles leading to improved postoperative outcomes compared to sternotomy. Methods: Charts of patients who underwent LVAD implantation between June 2018 and June 2020 at a single academic institution were retrospectively reviewed. Patient demographics, surgical approach (sternotomy vs. BT), laboratory values, and postoperative course were compared. The inflow cannula angle was measured on the first chest radiograph available postoperatively. Results: Of 40 patients studied, BT approach was used in 17 (42.5%). Mean inflow cannula angles were smaller in BT patients (23.0 vs. 37.1 degrees, p=0.018) and had a smaller standard deviation (13.8 vs. 20.3). Excluding patients who went on to receive heart transplant or died in the same hospitalization, there was no difference in median length of hospital stay after surgery (16.0 vs. 17.5 days, p=0.768). However, BT patients required fewer days of postoperative inotrope support (4.0 vs. 7.0 days, p=0.012). Conclusions: Our data suggest inflow cannula angles are smaller and more consistent with the BT approach, which leads to shorter duration of postoperative inotropic support. This finding may suggest improved right heart function following LVAD implant via BT approach. Further study is warranted to determine additional benefits of the BT approach.

COVID-19 has created challenges for society and the medical community. While the pandemic continues to unfold, the transplant community has had to pivot to keep recipients, donors, and transplant teams safe given these unprecedented times. This has resulted in a decrease in the number of transplants performed in the United States and an increased number of inactive patients on the UNOS waiting list.1 Waitlist and transplant recipients have an increased risk for acquiring COVID-19. It is speculated that this patient population is particularly vulnerable given their immunocompromised status and the high prevalence of comorbidities.2 Given the uncertainty surrounding the risk of transplant patients contracting COVID-19, there is interest in describing these cases in the literature.

With new technology comes new complications. We discuss the interesting case presented by Bjelic and colleagues regarding a missplaced TAVR valve into the inflow cannula of an LVAD, leading to hemodynamic collapse. The authors describe the pitfalls of the new technology and interesting surgical maneuvers to address these complications.

A 52-year-old man presented to our institution with a one year history of intermittent, progressive chest tightness with activity. He underwent stress test which was positive. Coronary angiography revealed a long segment myocardial bridge of the left anterior descending artery (LAD). Initially, he was trialed on maximal medical therapy, however, symptoms continued. As a result, he was brought to the operating room for unroofing of the myocardial bridge with excellent clinical and radiographic outcome. The diagnosis, medical, and surgical management of myocardial bridge is complicated. Long-term data surrounding best options for management is scarce.