Mechanical Support Devices Research Articles

Impact of type of mechanical circulatory support before transplant on postorthotopic heart transplantation infections

BackgroundInfections after orthotopic heart transplantation (OHT) cause significant morbidity and mortality. Concurrent with increased pre-OHT temporary mechanical support (MCS), there have been recent concerns of a perceived increase in infections post-OHT. We examined the association between pre-OHT temporary vs. durable MCS and post-OHT infection. MethodsWe performed a single-center retrospective review of patients who received OHT at Tufts Medical Center between January 2014 and April 2022. Information was collected on MCS device(s) in place during the admission in which the OHT occurred. Our composite outcome was the occurrence of bacteremia, invasive fungal infections, opportunistic infections, or skin/soft tissue infections of device sites within one-year post-OHT. We used Cox proportional hazards models to assess the relationship between type of pre-OHT MCS and time to first infection, treating death from other causes as a competing risk. We addressed confounding with two statistical methods: propensity score (PS) with inverse probability weighting (IPW) and an instrumental variable (IV) analysis. ResultsOf the 320 OHT recipients during the study period, 268 required MCS prior to OHT; 192 were managed with durable MCS and 76 with temporary MCS before transplant. Patients receiving pre-OHT temporary MCS had no difference in time to first infection (unadjusted HR 0.77, 95% CI 0.41-1.44), compared to durable MCS. Results were similar in the model employing PS with IPW (HR 0.61, 95% CI 0.29- 1.27) and the IV analysis (HR 0.28, 95% CI 0.26-2.36). ConclusionPre-OHT temporary MCS was not associated with the composite outcome of bacteremia, invasive fungal infections, opportunistic infections, or skin/device site infections post-transplant compared to durable MCS in this single-center cohort.

A Mock Circulatory Loop Analysis of Cardiorenal Hemodynamics With Intra-Aortic Mechanical Circulatory Support.

Type 1 cardiorenal syndrome is associated with significant excess morbidity and mortality in patients with severe acute decompensated heart failure. Previous trials of vasoactive drugs and ultrafiltration have not shown superiority over placebo or intravenous diuretics. Pilot data suggest short-term mechanical support devices may support diuresis in the cardiorenal syndrome. We evaluated the intra-aortic balloon pump (IABP) and a novel intra-aortic entrainment pump (IAEP) in a mock circulation loop (MCL) biventricular systolic heart failure model, to assess impact on renal flow and cardiac hemodynamics. Both devices produced similar and only modest increase in renal flow (IABP 3.3% vs. IAEP 4.3%) and cardiac output, with associated reduction in afterload elastance in the MCL. There were minor changes in coronary flow, increase with IABP and minor decrease with IAEP. Differences in device preload and afterload did not impact percentage change in renal flow with IABP therapy, however, there was a trend toward higher percentage flow change with IAEP in response to high baseline renal flow. The IAEP performed best in a smaller aorta and with more superior positioning within the descending aorta. Demonstrated changes in MCL flow during IAEP were of lower magnitude than previous animal studies, possibly due to lack of autoregulation and hormonal responses.

The impact of ticagrelor therapy on CABG-related bleeding in patients with STEMI managed with pPCI and following on-pump CABG.

Patients on double antiplatelet treatment who need early in-hospital coronary artery bypass grafting (CABG) are at high risk of major bleeding. In this study, we aimed to investigate the impact of ticagrelor preloading on CABG related bleeding in patients with ST-segment elevation myocardial infarction (STEMI) initially managed with primary percutaneous coronary intervention (pPCI). Patients with the diagnosis of STEMI who were managed with pPCI and underwent subsequent early (4-7days following pPCI) or delayed (> 7days following pPCI) on-pump CABG surgery were included. All study patients were preloaded with ticagrelor 180mg prior to pPCI procedure. Patients' demographics, clinical variables, and short-term cardiovascular outcomes were recorded. This is a retrospective study which included 98 patients. Fifty-four (54%) patients underwent early and 44 (45%) patients underwent delayed CABG surgery. CABG-related bleeding occurred in 22 (22.4%) patients. There was no significant difference with respect to total ticagrelor dose and timing of the surgery between patients with or without CABG-related bleeding (p: 0.165 and p: 0.142). Multivariate analyses demonstrated that only preoperative hemoglobin level < 10.9 and use of mechanical cardiac support devices were independent predictors of CABG-related bleeding [OR: 3719, p: 0.009 and OR: 11,698, p: 0.004, respectively].There were three deaths within the 30days of surgery, all occurring in patients with CABG-related bleeding. However, CABG-related bleeding was not associated with long-term cardiovascular events during the follow-up. Our results indicated that discontinuation of ticagrelor therapy 3days prior to surgery is sufficient to avoid CABG-related bleeding. Moreover, early CABG following STEMI does not increase the risk of long-term cardiovascular events.

Post-procedural Anticoagulation With Unfractionated Heparin in Acute Coronary Syndrome: Insight from the STOPDAPT-3 Trial

The current guidelines for acute coronary syndrome (ACS) discourage the use of anticoagulation after percutaneous coronary intervention (PCI) without specific indications, although the recommendation is not well supported by evidence. In this post hoc analysis of the ShorT and OPtimal Duration of Dual AntiPlatelet Therapy-3 (STOPDAPT-3) trial, 30-day outcomes were compared between the 2 groups with and without post-PCI heparin administration among patients with ACS who did not receive mechanical support devices. The co-primary end points were the bleeding end point, defined as the Bleeding Academic Research Consortium type 3 or 5 bleeding, and the cardiovascular end point, defined as a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke. Among 4,088 patients with ACS, 2,339 patients (57.2%) received post-PCI heparin. The proportion of patients receiving post-PCI heparin was higher among those with ST-elevation myocardial infarction compared with others (72.3% and 38.8%, p <0.001), and among patients with intraprocedural adverse angiographic findings compared with those without (67.6% and 47.5%, p <0.001). Post-PCI heparin compared with no post-PCI heparin was associated with a significantly increased risk of the bleeding end point (4.75% and 2.52%, adjusted hazard ratio 1.69, 95% confidence interval 1.15 to 2.46, p = 0.007) and a numerically increased risk of the cardiovascular end point (3.16% and 1.72%, adjusted hazard ratio 1.56, 95% confidence interval 0.98 to 2.46, p = 0.06). Higher hourly dose or total doses of heparin were also associated with higher incidence of both bleeding and cardiovascular events within 30 days. In conclusion, post-PCI anticoagulation with unfractionated heparin was frequently implemented in patients with ACS. Post-PCI heparin use was associated with harm in terms of increased bleeding without the benefit of reducing cardiovascular events. Trial identifier: STOPDAPT-3 ClinicalTrials.gov number, NCT04609111.

Delayed closure of ventricular septal defect with prolonged mechanical support

Introduction: Ventricular septal defect (VSD) is a severe complication following acute myocardial infarction (MI) resulting from mechanical disruption of the interventricular septum due to extensive myocardial necrosis. Despite advances in management, the mortality rate approaches 50%. We report a case of a 58-year-old male with VSD following MI who was successfully treated with a delayed surgical approach after haemodynamic support using Impella. Case description: A 58-year-old man with type 2 diabetes mellitus and hypertension presented with three days of chest pain. Testing revealed late presenting acute anterior ischaemic infarction and left-to-right shunt in the apical ventricular septum. Urgent cardiac catheterisation showed near-total occlusion of the left anterior descending artery. An Impella CP® was placed before angioplasty with a drug-eluting stent to optimise haemodynamics. After a multidisciplinary discussion, the Impella CP® was upgraded to Impella 5.5®, and surgery was delayed allowing for scar formation. The patient remained in the intensive care unit, where he underwent physical therapy, showing improvements in exercise tolerance by the time of surgery. He underwent a left ventriculotomy with a successful repair via an endocardial patch 28 days after initial presentation. Post-operative recovery was uneventful, with the patient discharged five days later, reporting no physical limitations one month post-discharge. Conclusion: The successful management of VSD post-MI relies on interdisciplinary collaboration, careful timing of surgical intervention and the strategic use of mechanical support devices such as the Impella. This case highlights the potential for favourable outcomes when tailored treatment approaches are employed.

From the Laboratory to the Clinic: Molecular Treatment of Heart Failure

Coronary and cardiovascular diseases are the leading cause of death today, with heart failure being among the primary culprits. Heart failure can occur as a result of many diseases, so research in this area is important in terms of clinical outcomes and treatment. Histopathology of heart failure includes cardiac hypertrophy, inflammation, angiogenesis, and apoptosis pathways. The issue of elucidating the pathology of heart failure is still an area of active research. In advanced heart failure, the typical management strategy is medical treatment, mechanical ventricular support devices, and heart transplantation. Heart failure, which occurs with modifiable and non-modifiable risk factors, can be controlled with both non-pharmacological and pharmacological treatment applications. It is especially important to focus on new treatment methods and introduce them to the clinic. Although they are all not yet used in clinics, many studies have yielded promising results with molecular treatment options for heart failure prevention. Studies in animals have shown that heart failure stops proceeding when angiogenesis is induced. Promising results have also been achieved with stem cell therapy, but these may not be implementable for years. It is expected that studies following phases 1 and 2, of the studies which had positive results in the treatment of heart failure, will be conducted and applied in the daily treatment practice.

Immediate inflammatory response to mechanical circulatory support in a porcine model of severe cardiogenic shock

BackgroundIn selected cases of cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is combined with trans valvular micro axial flow pumps (ECMELLA). Observational studies indicate that ECMELLA may reduce mortality but exposing the patient to two advanced mechanical support devices may affect the early inflammatory response. We aimed to explore inflammatory biomarkers in a porcine cardiogenic shock model managed with V-A ECMO or ECMELLA.MethodsFourteen landrace pigs had acute myocardial infarction-induced cardiogenic shock with minimal arterial pulsatility by microsphere embolization and were afterwards managed 1:1 with either V-A ECMO or ECMELLA for 4 h. Serial blood samples were drawn hourly and analyzed for serum concentrations of interleukin 6 (IL-6), IL-8, tumor necrosis factor alpha, and serum amyloid A (SAA).ResultsAn increase in IL-6, IL-8, and SAA levels was observed during the experiment for both groups. At 2–4 h of support, IL-6 levels were higher in ECMELLA compared to V-A ECMO animals (difference: 1416 pg/ml, 1278 pg/ml, and 1030 pg/ml). SAA levels were higher in ECMELLA animals after 3 and 4 h of support (difference: 401 ng/ml and 524 ng/ml) and a significant treatment-by-time effect of ECMELLA on SAA was identified (p = 0.04). No statistical significant between-group differences were observed in carotid artery blood flow, urine output, and lactate levels.ConclusionsLeft ventricular unloading with Impella during V-A ECMO resulted in a more extensive inflammatory reaction despite similar end-organ perfusion.

Temporal Analysis in Outcomes of Long-Term Mechanical Circulatory Support: Retrospective Study.

Mechanical assist device indications have changed in recent years. Reduced incidence of complications, better survival, and the third generation of mechanical support devices contributed to this change. In this single-center study, we focused on two time periods that are characterized by the use of different types of mechanical support devices, different patient characteristics, and change in the indications. The data were processed from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). We retrospectively defined two time intervals to reflect changes in ventricular assist device technology (period 1: 2007-2015; period 2: 2016-20222). A total of 181 patients underwent left ventricular assist device implantation. Device utilization was the following: HeartMate II = 52 (76.4%) and HeartWare = 16 (23.6%) in period 1 and HeartMate II = 2 (1.8%), HeartMate 3 = 70 (61:9%), HeartWare = 29 (25.7%), SynCardia TAH = 10 (8.8%), and BerlinHeart EXCOR = 2 (1.8%) in period 2. The outcomes of the time intervals were analyzed and evaluated. Survival was significantly higher during the second time period. Multivariate analysis revealed that age and bypass pump time are independent predictors of mortality. Idiopathic cardiomyopathy, bypass time, and the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score are independent predictors of adverse events. Furthermore, the first period was noted to be at an increased risk of the following adverse events: pump thrombosis, gastrointestinal bleeding, and bleeding events. Despite the higher risk profile of the patients and persistent challenges, during the second period, there was a significant decrease in mortality and morbidity. The use of the HeartMate 3 device may have contributed to this result.

Strategies to Minimize Access Site-related Complications in Patients Undergoing Transfemoral Artery Procedures with Large-bore Devices.

Large bore accesses refer to accesses with a diameter of 10 French or greater and are necessary for various medical devices, including those used in transcatheter aortic valve replacement, endovascular aneurysm repair stent-grafts, and percutaneous mechanical support devices. Notably, the utilization of these devices via femoral access is steadily increasing due to advancements in technology and implantation techniques, which are expanding the pool of patients suitable for percutaneous procedures. However, procedures involving large bore devices carry a high risk of bleeding and vascular complications (VCs), impacting both morbidity and long-term mortality. In this review article, we will first discuss the incidence, determinants, and prognostic impact of VCs in patients undergoing large bore access procedures. Subsequently, we will explore the strategies developed in recent years to minimize VCs, including techniques for optimizing vascular puncture through femoral cannulation, such as the use of echo-guided access cannulation and fluoroscopic guidance. Additionally, we will evaluate existing vascular closure devices designed for large bore devices. Finally, we will consider new pharmacological strategies aimed at reducing the risk of periprocedural access-related bleeding.

In vitro investigation of axial mechanical support devices implanted in the novel convergent cavopulmonary connection Fontan.

The 2 opposing inflows and 2 outflows in a total cavopulmonary connection make mechanical circulatory support (MCS) extremely challenging. We have previously reported a novel convergent cavopulmonary connection (CCPC) Fontan design that improves baseline characteristics and provides a single inflow and outflow, thus simplifying MCS. This study aims to assess the feasibility of MCS of this novel configuration using axial flow pumps in an in vitro benchtop model. Three-dimensional segmentations of 12 single-ventricle patients (body surface area 0.5-1.75 m2) were generated from cardiovascular magnetic resonance images. The CCPC models were designed by connecting the inferior vena cava and superior vena cava to a shared conduit ascending to the pulmonary arteries, optimized in silico. The 12 total cavopulmonary connection and their corresponding CCPC models underwent in vitro benchtop characterization. Two MCS devices were used, the Impella RP® and the PediPump. MCS successfully and symmetrically reduced the pressure in both vena cavae by >20 mmHg. The devices improved the hepatic flow distribution balance of all CCPC models (Impella RP®P = 0.045, PediPump P = 0.055). The CCPC Fontan design provides a feasible MCS solution for a failing Fontan by balancing hepatic flow distribution and symmetrically decompressing the central venous pressure. Cardiac index may also improve with MCS. Additional studies are needed to evaluate this concept for managing Fontan failure.

Multimodality Imaging in Advanced Heart Failure for Diagnosis, Management and Follow-Up: A Comprehensive Review.

Advanced heart failure (AHF) presents a complex landscape with challenges spanning diagnosis, management, and patient outcomes. In response, the integration of multimodality imaging techniques has emerged as a pivotal approach. This comprehensive review delves into the profound significance of these imaging strategies within AHF scenarios. Multimodality imaging, encompassing echocardiography, cardiac magnetic resonance imaging (CMR), nuclear imaging and cardiac computed tomography (CCT), stands as a cornerstone in the care of patients with both short- and long-term mechanical support devices. These techniques facilitate precise device selection, placement, and vigilant monitoring, ensuring patient safety and optimal device functionality. In the context of orthotopic cardiac transplant (OTC), the role of multimodality imaging remains indispensable. Echocardiography offers invaluable insights into allograft function and potential complications. Advanced methods, like speckle tracking echocardiography (STE), empower the detection of acute cell rejection. Nuclear imaging, CMR and CCT further enhance diagnostic precision, especially concerning allograft rejection and cardiac allograft vasculopathy. This comprehensive imaging approach goes beyond diagnosis, shaping treatment strategies and risk assessment. By harmonizing diverse imaging modalities, clinicians gain a panoramic understanding of each patient's unique condition, facilitating well-informed decisions. The aim is to highlight the novelty and unique aspects of recently published papers in the field. Thus, this review underscores the irreplaceable role of multimodality imaging in elevating patient outcomes, refining treatment precision, and propelling advancements in the evolving landscape of advanced heart failure management.

Abstract 16986: Verticalize to Mobilize: A Pilot Study

Introduction: Early mobility in critical illnesses, like acute decompensated heart failure, is essential to preserving muscle strength. However, patients on mechanical support devices such as a femoral-inserted intra-aortic balloon pump (f-IABP) have traditionally had limited mobility due to potential complications. Unfortunately, this commonly leads to prolonged ICU stay and an increased need for rehabilitation. Aim: This study evaluates the safety and feasibility of implementing a nurse-led verticalization protocol for patients with an f-IABP. Methods: A total of 36 patients with f-IABP successfully verticalized utilizing the Kreg Catalyst™ bed between May 1, 2022, to May 4, 2023, for one hour-long session. The cohort selection required patients to be ambulatory before f-IABP placement, hemodynamically stable, and free of arrhythmias within the last 24 hours. The study carefully monitored hemodynamic stability by comparing baseline averages to peak tolerated angle (PTA) data. Results: A total of 322 verticalization sessions were completed without significant complications and only nine minor complications. Minor complications included five sessions (1.55%), resulting in a catheter readjustment of over 3 centimeters. They averaged 9±7 verticalization sessions per patient, averaging 55±13 minutes. Were19/36 patients (53%) achieved a PTA greater than 70 degrees. Mean arterial pressure decreased by 4±7mmHg. Pulmonary artery systolic pressure decreased by 2±3mmHg, the cardiac index fell by 0.1± 0.5L/min/m 2 , and the heart rate increased by 4±5bpm. Of the 36 patients, 29 (81%) received heart transplants during their hospitalization and had an average post-operative ICU stay of 7 days and a total postoperative hospital stay of 18 days. Of the cohort study, 23 patients (64%) were discharged home with home health, ten patients (27%) were transferred to a rehabilitation center, two patients (5%) were transferred to an outside hospital, and one patient transitioned to comfort care. Conclusions: The result of the study indicates that it is safe and feasible to verticalize patients with f-IABP.

Abstract 18864: A Novel Technique to Improve Vector Uptake for Cardiac Gene Therapy

Introduction: Cardiac gene therapy with adeno-associated virus (AAV) has promise. However, clinical trials with intracoronary (IC) delivery have been challenged by low efficacy. Hypothesis: We predicted that AAV uptake could be enhanced using a catheter-based mechanical cardiac support device (MCS) to facilitate IC delivery with brief coronary balloon occlusions in a pig model of myocardial infarction (MI). Aims: We aimed to: 1) confirm that MCS could support hemodynamics during coronary balloon occlusions, and 2) determine whether this technique could improve vector uptake and cardiac gene expression after HF onset. Methods: A week after MI, 12 Yorkshire pigs (36.6±1.45 kg, male n=6) received AAV6 encoding for luciferase by one of four delivery methods (n=3/group) (Figure 1). Tissues were harvested 1 mo later for analysis. A similar experiment was conducted with gold nanoparticles (GNPs) in place of AAV by either continuous or CAO+CSO delivery (n=4) with same-day cardiac harvest. GNP presence was seen by electron microscopy. Results: MCS maintained blood pressure and prevented arrhythmias during coronary balloon occlusions. Application of MCS during continuous infusion did not significantly alter AAV genome uptake (vg) or luciferase expression (luc). CAO+CSO delivery increased both vg and luc across heart regions, with notable significance at the infarct-border region vs continuous delivery (vg: p=0.027; luc: p=0.032). Vg was also positively associated with luc (Figure 2). Improved uptake was further supported by greater GNP presence with CAO+CSO delivery. Conclusion: MCS can be utilized to optimize IC gene delivery in a safe and clinically-applicable way.

Abstract 127: Trends of Racial Disparities and the In-Hospital Outcomes of Patients With Pulmonary Artery Catheterization for Cardiogenic Shock

Introduction: The use of pulmonary artery catheterization (PAC) in patients with cardiogenic shock (CS) has been associated with improved outcomes in non-randomized studies. However, the racial difference in PAC utilization and outcomes in CS have not been assessed. Methods: We identified all patients with CS who had PAC from the national inpatient sample of the Health Care Utilization Project database between 2016 - 2020. Patients were classified according to ethnic groups as white, black, Hispanic, and Asians Outcomes of interest included in-hospital mortality and use mechanical circulatory support (MCS) by ethnic group. Result: From 76,815 patients who underwent PAC during CS admission 64.18% of were Whites, 24.78% Blacks, 8.19% Hispanics, and 2.85% Asians. Black patients were younger, had higher prevalence of obesity, CHF, nicotine use and oxygen dependence. Compared to whites, blacks had lower mortality (aOR: 0.79; CI: 0.69 - 099, p=0.043), respiratory failure (aOR: 0.67; CI: 0.59 - 0.81, p&lt;0.001), mechanical support device utilization (aOR: 0.73, CI; 0.67 - 0.81, p&lt;0.001), and pacemaker utilization (aOR: 0.37; CI: 0.18 - 0.78, p=0.008). Hispanics had a longer length of stay (21 days vs 17.7 days). Blacks had higher rates of PAC use than other racial minorities between and mortality rates in blacks were noted to decline significantly in patients that had PAC during hospitalizations for CS (aOR: 0.49, CI; 0.46 - 0.52, p&lt;0.001). Conclusion: The utilization of PAC in patients with CS is associated with better outcomes, including mortality and this was noted as well in the individual racial subgroups. Despite these findings, racial disparities persist. These disparities could be alleviated by equitable distribution of healthcare resources.

TCT-471 Cangrelor in Patients Undergoing Percutaneous Coronary Intervention With Mechanical Support Devices: Insights From a Swiss Registry

TCT-471 Cangrelor in Patients Undergoing Percutaneous Coronary Intervention With Mechanical Support Devices: Insights From a Swiss Registry

A Decrease in Effective Renal Perfusion Pressure Is Associated With Increased Acute Kidney Injury in Patients Undergoing Cardiac Surgery.

This study aimed to evaluate the relationship between intra-abdominal pressure (IAP), renal perfusion indices, and postoperative acute kidney injury (AKI) in cardiac patients. In a prospective cohort study conducted at a single academic institution, we collected data from adult patients undergoing open-heart operations with cardiopulmonary bypass (CPB) at our institution from February 2022 to April 2022 using the Accuryn SmartFoley system® (Potrero Medical, Hayward, CA). Patients on mechanical support devices, pregnant patients, and patients on hemodialysis were excluded. Demographics, hemodynamics, and mean airway pressure (mAir) were measured at the beginning of the cardiac operations and during the first four hours of ICU. Renal perfusion indices were then calculated (mean perfusion pressure (MPP) = mean arterial pressure (MAP) - central venous pressure (CVP); abdominal perfusion pressure (APP) = MAP - IAP; and effective renal perfusion pressure (eRPP) = MAP - (CVP + mAir + IAP)). Length of stay (LOS) was measured from the day of surgery to ICU discharge (ICU LOS) and hospital discharge (hospital LOS). During the first four hours of ICU stay, the non-AKI group had lower IAP and higher renal perfusion indices (MPP, APP, and eRPP). Logistic regression showed high perfusion pressures correlated with lower postoperative AKI (all OR <1, p<0.05). The postoperative AKI group also had significantly longer ICU LOS (7.33 vs. 4.57 days) and hospital LOS (17.0 vs. 10.2 days). Renal perfusion indices are a promising tool to predict postoperative AKI in cardiac surgery patients.

Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock.

Cardiogenic shock (CS) is a clinical condition characterized by inadequate tissue perfusion in the setting of low cardiac output. CS is the leading cause of death following acute myocardial infarction (AMI). Several temporary mechanical support devices are available for hemodynamic support in CS until clinical recovery ensues or until more definitive surgical procedures have been performed. Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) has evolved as a powerful treatment option for short-term circulatory support in refractory CS. In the absence of randomized clinical trials, the utilization of ECMO has been guided by clinical experience and based on data from registries and observational studies. Survival to hospital discharge with the use of VA-ECMO ranges from 28-67%. The initiation of ECMO requires venous and arterial cannulation, which can be performed either percutaneously or by surgical cutdown. Components of an ECMO circuit include an inflow cannula that draws blood from the venous system, a pump, an oxygenator, and an outflow cannula that returns blood to the arterial system. Management considerations post ECMO initiation include systemic anticoagulation to prevent thrombosis, left ventricle unloading strategies to augment myocardial recovery, prevention of limb ischemia with a distal perfusion catheter in cases of femoral arterial cannulation, and prevention of other complications such as hemolysis, air embolism, and Harlequin syndrome. ECMO is contraindicated in patients with uncontrolled bleeding, unrepaired aortic dissection, severe aortic insufficiency, and in futile cases such as severe neurological injury or metastatic malignancies. A multi-disciplinary shock team approach is recommended while considering patients for ECMO. Ongoing studies will evaluate whether the addition of routine ECMO improves survival in AMI patients with CS who undergo revascularization.

Аcute renal failure in patients with implanted LVAD in the early postoperative period

AKI is one of the major complications in the cardiac surgery group of patients in the world. In patients with LVAD in the short postoperative period, the situation with such a complication as AKI is associated with the state of hemodynamics and fluctuations in the parameters of the hemostasis system.&#x0D; The purpose of this scientific work is to analyze the state of the blood coagulation system and its response to therapy and complications in the early postoperative period in fifty patients with implanted devices for mechanical support of the left ventricle, left ventricle assist device, LVAD, in the Silesian Heart Disease, Poland. Patients were divided into two groups, a control group receiving classical anticoagulation targeted therapy (ATT), which included the most controlled monotherapy with heparin, after reaching the target values of APTT, the addition and transition to monotherapy with warfarin until reaching the target INR and ASA, and the main, research group, who received an alternative ATT consisting of the previous one with the addition of P2Y12-receptor blockers and Xa-factors.&#x0D; The results showed that the control group of patients with classical anticoagulant targeted therapy had greater mortality associated with AKI than the patients of the study group, and it was also demonstrated that the initially longer duration of surgery and intraoperative polyuria gave a greater percentage of AKI in the postoperative period.&#x0D; The work was carried out within the framework of a bilateral agreement on scientific cooperation between the Department of Anesthesiology &amp; Intensive Care at the National Medical Academy of Post-Graduate Education Named After P.L. Shupyk and the Silesian Center for Heart Diseases (Poland). This article is part of the analysis of the work on the analysis of the blood coagulation system in patients after implantation of the left ventricular mechanical circulatory support system with the analysis of such postoperative complication as acute kidney failure.

Novel Therapeutic Strategies in Heart Failure in Adult Congenital Heart Disease: of Medicines and Devices.

This paper reviews the latest literature on the growing field of heart failure in the adult congenital heart disease population. After highlighting the increasing prevalence and a few of the unique potential causes, including the concept of early senescence, this review begins with novel medical management strategies such as the angiotensin II receptor blocker and neprilysin inhibitors and sodium glucose cotransporter-2 inhibitors. Then, it addresses the latest applications of percutaneous techniques like implantable hemodynamic monitoring, transcatheter pulmonary and aortic valve replacement, and mitral clips. Cardiac resynchronization therapy and novel lymphatic system imaging and intervention are then described. Finally, the use of mechanical support devices, temporary and durable, is discussed as well as heart and combined heart and liver transplantation. There have been recent exciting advances in the strategies used to manage adult congenital heart disease patients with heart failure. As this population continues to grow, it is likely we will see further rapid evolution in this field.

Percutaneous Treatment of Left Main Disease: A Review of Current Status.

Percutaneous treatment of the left main coronary artery is one of the most challenging scenarios in interventional cardiology, due to the large portion of myocardium at risk the technical complexity of treating a complex bifurcation with large branches. Our aim is to provide un updated overview of the current indications for percutaneous treatment of the left main, the different techniques and the rationale underlying the choice for provisional versus upfront two-stent strategies, intravascular imaging and physiology guidance in the management of left main disease, and the role of mechanical support devices in complex high-risk PCI.