Background: Frailty influences the postoperative outcomes in patients undergoing left ventricular assist device (LVAD) implantation; however, a quantitative evaluation method has not been established. The purpose of the present study was to evaluate whether preoperative ESM mass is associated with short- and long-term clinical outcomes in patients with LVAD. Methods: A total of 119 consecutive patients with LVAD were enrolled between January 2010 and October 2017 at a single heart center. The ESM index and Hounsfield units (HU) of the ESM were calculated by computed tomography for preoperative ESM mass evaluation. We then statistically evaluated the in-hospital mortality, major adverse cardiovascular events (MACE), duration of hospital stay, and long-term survival. Results: In a multivariate Cox regression analysis, ESM index and HU of the ESM indicated no effect on the in-hospital mortality, MACE, and long-term survival. In addition, the ESM index presented a weak but significant negative linear correlation only with the duration of hospital stay (r = -0.21, p < 0.05). In contrast, the model for end-stage liver disease (MELD) score and preoperative venous-arterial extracorporeal membrane oxygenation (va-ECMO) were significant predictive factors for in-hospital mortality (MELD score: p < 0.001, hazard ratio [HR] 1.1; preoperative va-ECMO: p < 0.01, HR 2.72) and MACE (MELD score: p < 0.001, HR 1.07; preoperative va-ECMO: p < 0.005, HR 2.62). Conclusion: Preoperative ESM mass might predict the length of hospital stay in patients undergoing LVAD implantation. In contrast, it had no effect on MACE, in-hospital mortality, or long-term survival in this study.

Objectives: Left ventricular assist device (LVAD) implantation is a common therapy for end-stage heart failure. LVAD patients often present with atrial fibrillation (AF). The purpose of this study was to evaluate the influence of AF in combination with vascular complications on outcome in LVAD patients. Methods: Between 01/2010 and 12/2017, 168 patients (141 male) with end-stage heart failure underwent LVAD implantation at a single center. Patient outcome was retrospectively studied using the Kaplan-Meier method for analyzing crude survival as well as Cox regression for analyzing risk factors. Results: Sixty-two patients suffered from preoperative atrial fibrillation at LVAD implantation. Mean age was 56.8±11.9 years (range: 22–79) and 141 (84%) were male. Postoperatively, vascular or visceral surgical management due to malperfusion was needed in 27 patients (16.1%) and did not correlate with postoperative mortality (p=0.121, HR=1.587, CI=0.885–2.845). Patient with AF had by trend an impaired outcome in Kaplan-Meier analysis (p=0.069). Cox regression analysis revealed postoperative AF (n=53, p=0.316, HR=1.281, CI=0.789–2.079), preoperative mechanical support (MCS) [extracorporeal membrane oxygenator (ECMO), intraaortic balloon pump, Abiomed Impella® (n=74, p=0.160, HR=1.391, CI=0.878-2.206)] as no significant risk factors for death. Conclusions: Our data suggest preoperative AF may be a potential predictor of mortality and impaired long-term outcome in LVAD patients. In contrast preoperative ECLS and vascular or visceral surgery after LVAD implantation did not represent limiting factors with regard to mortality after LVAD implantation.

Management of patients with acute type A aortic dissection (ATAAD) presenting with cerebral malperfusion due to carotid artery obstruction is still a major challenge and often associated with poor prognosis despite successful surgical aortic repair, due to prolonged cerebral perfusion deficit. Here, we present the first report regarding successful percutaneous recanalization of an internal carotid artery occlusion in the setting of an ATAAD prior to open surgical aortic repair with excellent clinical outcome after three year follow-up, including almost full neurological recovery.

Concomitant surgery on the aortic arch with hypothermic cardiac arrest in the setting of heart transplantation (HTX) is extremely rare. A 67-year-old woman who suffered from ischemic cardiomyopathy was evaluated for HTX. Computed tomography showed diffuse soft and hard atheromatous plaques of the entire aorta. Upon allocation of an appropriate donor organ, the ascending aorta and the proximal aortic arch were replaced using hypothermic cardiac arrest at 28℃ prior to arrival of the donor heart and without clamping of the diseased recipient aorta. After uncomplicated postoperative course the patient was recovered without neurological complications.

As long-term outcomes of congenital heart diseases improve, the probability of adult patients presenting for heart transplantation for late failure of congenitally corrected heart disease also increases. In patients with dextro-transposition of the great arteries (d-TGA) who were initially treated in the era of Mustard or Senning procedures and before Jatene procedure was introduced, progressive systemic right ventricular failure represents a problem in the very long-term follow-up. We report a rare case of heart transplantation as a third operation 36 years after Mustard procedure in a patient with d-TGA experiencing late failure of the systemic right ventricle.

Background: Although minimally invasive mitral valve surgery (MIMVS) has become the first choice for primary mitral regurgitation (MR) in recent years, clinical evidence in this field is yet limited. The main focus of this study was the analysis of preoperative (Pre), postoperative (Post) and 1-year follow-up (Fu) data in our series of MIMVS in order to identify factors that have an impact on the left ventricular ejection fraction (LVEF) evolution after MIMVS. Methods: We reviewed the perioperative and 1-year follow-up data from 436 patients with primary MR (338 isolated MIMVS und 98 MIMVS combined with tricuspid valve repair) to analyzed patients baseline characteristics, the change of LV size, the postoperative evolution of LVEF and its factors, and the clinical outcomes. Results: The overall mean value of EF slightly decreased at 1-year follow-up (mean change of LVEF: -2.63±9.00%). A significant correlation was observed for PreEF und EF evolution, the higher PreEF the more pronounced decreased EF evolution (in all 436 patients; r= -0.54, p<0.001, in isolated MIMVS; r= -0.54, p<0.001, in combined MIMVS; r= -0.53, p<0.001). Statistically significant differences for negative EF evolution were evident in patients with mild or greater tricuspid valve regurgitation (TR) (in all patients; p<0.05, OR=1.64, in isolated MIMVS; p<0.01, OR=1.93, respectively). Overall clinical outcome in NYHA classification at 1 year was remarkably improved. Conclusions: Our results suggest an excellent clinical outcome at 1 year, although mean LVEF slightly declined over time. TR could be a predictor of worsened FuEF in patients undergoing MIMVS.

A 61-year-old woman with acute myocardial infarction (MI), cardiogenic shock and Impella CP support underwent emergency coronary artery bypass grafting. Postoperatively venous-arterial extracorporeal membrane oxygenation (va-ECMO) became necessary, followed by Impella 5.0 insertion on 7th postoperative day (POD), addition of right ventricular support by TandemHeart due to inadequate flow of Impella system, which then allowed for va-ECMO weaning. Impella und TandemHeart were removed on 14th POD, 31st POD, respectively. Biventricular decompensation following MI was successfully treated by a sequence of different mechanical circulatory support systems allowing an adaptive weaning strategy.