Texas Heart Institute Research Articles

Quality Assessment of Long-Term Cryopreserved Human Bone-Derived Marrow Mesenchymal Stromal Cell Samples: Experience from the Texas Heart Institute Biorepository and Biospecimen Profiling Core.

In biomedical research, biorepositories are pivotal resources that safeguard and supply clinical samples for scientific investigators. Proper long-term cryopreservation conditions are essential to maintain biospecimen quality. In this study, we analyzed the efficacy of sample cryopreservation at the Texas Heart Institute Biorepository and Biospecimen Profiling Core (THI-BRC). Our assessments included a thorough review of internal processes, quality reports, and both internal and external audit outcomes. We examined the integrity of human bone marrow-derived multipotent mesenchymal stromal cells (BM-MSCs) that were cryopreserved for over 5 years. These samples originated from randomly selected clinical trial participants or commercially sourced cell lines. Parameters such as cell viability, DNA and RNA integrity, population doubling time, sterility, and BM-MSC-specific attributes such as surface antigen expression and differentiation potential were studied. BM-MSC samples cryopreserved for ∼6 months served as our control. Our results demonstrated that the 5-year cryopreserved samples maintained their integrity compared with the shorter-term stored control samples. Moreover, THI-BRC has met accreditation agency standards and has not received any repeated deficiencies over 7 years. Collectively, our findings affirm that THI-BRC's biospecimen storage protocols align with accepted standards as confirmed by the quality assessment of long-term stored clinical samples.

Mortality in Recipients of Durable Left Ventricular Assist Devices Undergoing Ventricular Tachycardia Ablation

BackgroundLeft ventricular assist device (LVAD) recipients have a higher incidence of ventricular tachycardia (VT). However, the role of VT ablation in this population is not well-established. ObjectivesThis single-center retrospective cohort study sought to examine the impact of post-LVAD implant VT ablation on survival. MethodsThis retrospective study examined a cohort of patients that underwent LVAD implantation at Baylor St. Luke’s Medical Center and Texas Heart Institute between January 2011 and January 2021. All-cause estimated mortality was compared across LVAD recipients based on the incidence of VT, timing of VT onset, and the occurrence and timing of VT ablation utilizing Kaplan-Meier survival analysis and Cox proportional hazards models. ResultsPost-implant VT occurred in 53% of 575 LVAD recipients. Higher mortality was seen among patients with post-implant VT within a year of implantation (HR: 1.62 [95% CI: 1.15-2.27]). Among this cohort, patients who were treated with a catheter ablation had superior survival compared with patients treated with medical therapy alone for the 45 months following VT onset (HR: 0.48 [95% CI: 0.26-0.89]). Moreover, performance of an ablation in this population aligned mortality rates with those who did not experience post-implant VT (HR: 1.18 [95% CI: 0.71-1.98]). ConclusionsVT occurrence within 1 year of LVAD implantation was associated with worse survival. However, performance of VT ablation in this population was correlated with improved survival compared with medical management alone. Among patients with refractory VT, catheter ablation aligned survival with other LVAD participants without post-implant VT. Catheter ablation of VT is associated with improved survival in LVAD recipients, but further prospective randomized studies are needed to compare VT ablation to medical management in LVAD recipients.

The Texas Heart Institute and Ray C. Fish Award for Scientific Achievement in Cardiovascular Disease.

The Texas Heart Institute and Ray C. Fish Award for Scientific Achievement in Cardiovascular Disease.

Cutting-Edge Trials in Structural Heart Disease at The Texas Heart Institute.

Mitral and tricuspid valvular disease have been managed surgically; however, multiple transcatheter technologies have diversified the therapeutic arsenal and expanded the number of patients eligible for treatment. These new technologies and active trials currently being performed at The Texas Heart Institute will be highlighted.Transcatheter edge-to-edge repair (TEER) with MitraClip (Abbott Structural Heart) plays an important role in the management of degenerative and functional mitral regurgitation (MR). Despite its success, the limitations of MitraClip include challenging anatomy that may not be amenable to TEER, the common need for multiple devices, risk of device-related mitral stenosis, and a not-trivial rate of residual MR.1 Delivered via a 22F sheath, the PASCAL device (Edwards Lifesciences) offers several improvements.2 Its 3-catheter system (including a guide, steerable, and implantation catheter) offers easy maneuverability in 3 independent planes. It has a spacer that fills the interleaflet area, helping reduce regurgitation. Additionally, its relatively larger “clasps” are designed to reduce leaflet stress by better distributing tension. Similar to the latest generation of MitraClip, PASCAL has independent gripper action.The CLASP IID and CLASP IIF trials randomized patients with degenerative and functional MR, respectively, to PASCAL vs MitraClip. The CLASP IID trial, which has completed enrollment, reported noninferiority of the PASCAL device with relation to procedural safety and effectiveness.3 It also showed durable reductions in MR to ≤1+ (87.2% at discharge and 83.7% at 6 months in the PASCAL arm; 88.5% at discharge and 71.2% at 6 months in the MitraClip arm). The CLASP IIF trial is currently enrolling.Compared with TEER, transcatheter mitral valve replacement (TMVR) theoretically offers treatment for complex mitral valvular anatomies, including mixed valvular disease and the potential for lower rates of residual regurgitation.4 The Intrepid valve (Medtronic) is a promising transcatheter device being studied in the APOLLO trial. Intrepid is designed as a double stent composed of a nitinol mesh, with an inner stent containing a bovine, trileaflet valve and a larger, outer stent that fixates onto the mitral annulus. It is available in 42- and 48-mm outer diameter sizes, with a 54-mm size currently in development.5 The APOLLO trial initially began as a randomized controlled trial comparing transapical TMVR to surgery, but because of developments in TEER technology, has evolved into a single-arm trial of patients who are not candidates for TEER or conventional mitral valve surgery. More recently, a 35F transfemoral delivery platform for the Intrepid system has been developed.One particularly important complication of TMVR is left ventricular outflow tract obstruction that is caused by displacement of the anterior mitral valve leaflet. Multiple efforts have been made to prevent this complication, including sophisticated computed tomography–based prediction of the neo–left ventricular outflow tract that help guide patient selection and the use of interventional techniques including leaflet laceration and alcohol septal ablation.6Early results of the Intrepid valve show excellent procedural success (96%) with mild or less MR in 100% of patients at a median 173-day follow-up.5 Whereas the early experience with transapical delivery of the Intrepid valve in a high-risk patient cohort was associated with high mortality (14% at 1 month),5 the development of a transfemoral delivery platform promises to reduce procedural morbidity and mortality.Often labeled the “forgotten valve,” tricuspid valvular regurgitation (TVR) is common and associated with substantial morbidity and mortality—as low as 34% survival at 5 years.7 However, late patient presentation, high comorbidity burden, and a high associated surgical mortality preclude many patients from receiving surgical treatment. Additionally, whether tricuspid valve intervention can improve patient outcomes is unclear because TVR is usually secondary to right ventricular dysfunction rather than being primary valvular disease. Therefore, it may often be a marker of severe disease rather than a pathophysiologic mediator.Nonetheless, transcatheter technologies are being studied for their potential to improve clinical outcomes of patients with severe TVR. The CLASP-TR trial, in which patients are being randomized to TEER with the PASCAL device vs medical therapy, should provide insight into the natural history of TVR and the utility of intervention.8 One of the major challenges is imaging. Owing to its more anterior position, clear transesophageal windows of the tricuspid valve are more difficult to obtain than are those with the mitral valve. Whereas the tricuspid valve has traditionally been viewed as trileaflet, tricuspid anatomy is actually quite diverse, often consisting of 4 or even 5 leaflets.9 New structural imaging guidelines aid in the evaluation of tricuspid valve disease and procedural guidance.10New transcatheter valve repair devices and transcatheter valve replacement technologies hold the promise of increasing the number of patients with structural heart disease who are eligible for transcatheter technologies and may permit more complete, durable responses to treatment; this will hopefully translate into better long-term patient outcomes.

Management of Cardiogenic Shock: Present and Future.

Management of Cardiogenic Shock: Present and Future.

The Texas Heart Institute Medal and Ray C. Fish Award for Scientific Achievement in Cardiovascular Diseases

The Texas Heart Institute Medal and Ray C. Fish Award for Scientific Achievement in Cardiovascular Diseases

Transfusion thresholds in cardiac surgery: Commentary on Bracey et al., 1999.

Transfusion thresholds in cardiac surgery: Commentary on Bracey et al., 1999.

The Texas Heart Institute Anesthesia Experience in China, 1985

IN SEPTEMBER 1985, the People's Republic of China (PRC) was still recovering from the Cultural Revolution, a 10-year movement (1966-1976) that isolated it socially, economically, and medically from the rest of the world. 1 Lu J Wang W Cheng W et al. Current status of cardiovascular anesthesia in China. Anesth Analg. 2017; 125: 1855-1862 Crossref PubMed Scopus (8) Google Scholar ,2 Ramzy, Austin. Mao's Cultural Revolution. New York Times, May 14, 2016https://www.nytimes.com/2016/05/15/world/asia/china-cultural-revolution-explainer.html Google Scholar That year, an executive at an American bank, who was formerly a perfusionist at the Texas Heart Institute (THI), conceived an expedition to the PRC by a THI cardiovascular team. His goal was to demonstrate American cardiac care techniques, monitoring, prosthetics, and perfusion equipment, which he hoped would open a new market for American equipment. The THI, in Houston, Texas, remains an internationally known cardiac surgery center. By 1985 it was the nation's busiest open-heart cardiac surgery program, reaching 5,000 open heart procedures annually. 3 Cooley DA. A brief history of the Texas Heart Institute. Tex Heart Inst J. 2008; 35: 235-239 PubMed Google Scholar The THI reputation and the banking executive's prior association were responsible for the expedition's choice of THI for the clinical team. Other trip organizers had previous contacts with the Shanghai Renji (also known as “Ren-Ji”) Hospital, which was associated with the No. 2 People's Medical School. The hospital surgical team was receptive to the authors visit. This article presents the experience of the authors, the 2 cardiovascular anesthesiologists on this unusual journey.

Durability Beyond Our Wildest Dreams: The Caged-Ball Valve at 60 Years.

Knowing our surgical history does more than provide terrain for moral contemplation and a sense of identity for our cardiothoracic specialty. Probing the human endeavor also provides a window into the continuum of our collective experience. The 1950s saw the beginnings of modern cardiothoracic surgery, with nearly every segment of the aorta successfully replaced during the decade. However, treatment of diseased aortic and mitral valves was essentially limited to commissurotomy, and there was no truly curative surgical technique available at the time. It was not until 1960 that surgical replacement of cardiac valves was made possible.1–3 That year, Dwight Harken and Albert Starr first used caged-ball devices to replace the aortic and mitral valves within months of each other.2,3 The development of the caged-ball valve was one of the marvels of 20th-century medical science.When Starr (only 30 years old at the time of his innovative collaboration with 60-year-old engineer Lowell Edwards) reflected on the development of the Starr-Edwards valve, he attributed its rapid advance from bench to bedside to several factors present in 1960 but not in today's medical environment.4 One was freedom from oversight: the United States Food and Drug Administration was not focused on medical devices at the time, and there were no institutional review boards, informed consent requirements, or ethical guidelines for human subject research. As a result, Starr and Edwards were able to move rapidly through multiple iterations of the caged-ball valve—first in animals, then in humans. Surprisingly, this pioneering spirit laid the groundwork for the subsequent development of numerous iterations of cardiac valves: continued modification of the ball-and-cage valves, Alain Carpentier's use of the porcine tissue valve and the other bioprosthetic valves that followed, and the evolution of mechanical valves that eventually culminated in pyrolytic carbon bileaflet mechanical valves.5In this issue of the Texas Heart Institute Journal, De Martino and associates6 trace the history of a true milestone in cardiac surgery, the evolution of the caged-ball prosthesis. Their historical review provides valuable knowledge to everyone from nascent medical students to clinicians in the later years of their cardiovascular careers. It is also an amazing testament to the pioneering spirit of Harken and Starr that has led to the various iterations of the caged-ball and subsequent valves, provided so many patients with decades of functional life, and ultimately transformed the treatment of valvular disease in millions.Funding/support: Dr. Coselli's work is partly supported by the Cullen Foundation. Dr. Coselli consults for, receives royalties and a departmental educational grant from, and participates in clinical trials for Terumo Aortic; consults and participates in clinical trials for Medtronic, Inc., and W.L. Gore & Associates; and serves as a co-investigator for CytoSorbents.

In Memoriam: Louis L. Leatherman, Jr., MD (1937–2022)

Louis Levy Leatherman, Jr., MD, died peacefully on 11 January 2022. Born on 17 April 1937, he was the eldest son of Gertrude Leatherman and Louis Levy Leatherman, Sr. His desire to become a physician was motivated by his father's death of heart disease when Louis Jr. was 16 years old.Dr. Leatherman studied at Louisiana College, then earned his medical degree from Louisiana State University Medical School in 1962. His internship was at Martin Army Community Hospital in Fort Benning, Georgia (1962–1963), and his internal medicine residency at Confederate Memorial Medical Center in Shreveport, Louisiana (1965–1967).He moved to Houston in 1968 for his cardiology fellowship, sponsored by Baylor College of Medicine (BCM). During his training at St. Luke's Episcopal Hospital (SLEH) and the Texas Heart Institute (THI), he grew to appreciate his colleagues' aggressive management of heart and vascular disease. Their varied approaches to diseases and problems taught him to think flexibly when he evaluated his own patients. He participated in SLEH's first heart transplant program and considered it “fantastically exciting.”Cardiologists were also seeking alternatives to open heart surgery for treating blockages in coronary arteries. In the late 1970s, a new technique, percutaneous transluminal coronary angioplasty (PTCA), enabled special catheters to be threaded into coronary arteries and inflated to reopen blocked blood vessels. Dr. Leatherman, along with Dr. Paolo Angelini, brought PTCA to THI after studying under Dr. Andreas Gruentzig. In 1979, the National Heart, Lung, and Blood Institute chose THI as a test site, and, by April 1980, THI physicians had performed 100 PTCA procedures.Dr. Leatherman established a private practice at the Medical Clinic of Houston while also serving as attending physician at SLEH and THI, Clinical Associate Professor of Medicine at BCM, consulting staff member at Texas Children's Hospital, and teaching staff member at Ben Taub General Hospital and Jefferson Davis Hospital. He retired in 1995 after a 30-year career.In 1972, Dr. Leatherman purchased a ranch near Bertram, Texas, where he and his family enjoyed escaping the rigors of his medical practice. He loved nature and wildlife. In 1994, he married Mary Gail Swift, and when he retired, they moved to the ranch permanently. The couple traveled monthly to Ruston, Louisiana, to help run a corporate wellness clinic for a good friend.Dr. Leatherman was preceded in death by his parents and by his first wife and mother of his children, Charlotte Wheeler Leatherman. He is survived by his wife Mary Gail Leatherman; daughter Dr. Martha Leatherman (and husband Dr. James Moore); son Mark Leatherman (and wife Peggy); brothers Dr. Edward H. and Malcolm L. Leatherman; grandchildren Jameson, Jonathan, and Rachel Moore, and Ashley and Hunter Leatherman; stepchildren Curt Swift and Shelly Swift Roeder; and step-grandchildren Jackson and Mia Swift, and Levon and Iva Mae Roeder.Dr. Leatherman, a pioneer in advancing the treatment of heart disease, was deeply committed to his patients. They, along with his colleagues and family, will cherish his memory and contributions.

A Foot Soldier in Cardiac Metabolism: A Conversation With Heinrich Taegtmeyer, MD, DPhil.

A Foot Soldier in Cardiac Metabolism: A Conversation With Heinrich Taegtmeyer, MD, DPhil.

Texas Heart Institute Medal and the Ray C. Fish Award for Scientific Achievement in Cardiovascular Diseases.

Ray C. Fish (1902–1962) was a leading figure in Houston's natural gas industry and a philanthropist. He believed in the American dream of “opportunity for success.” The Ray C. Fish Foundation was established so that others might be encouraged to broaden man's self-knowledge and to keep the American dream alive. After its founder's death from heart disease, the Fish Foundation granted $5 million to make the Texas Heart Institute a reality. For this reason, the Institute's highest professional award is given in honor of this extraordinary man. The award recognizes those whose innovations have made significant contributions to cardiovascular medicine and surgery. The 1st Texas Heart Institute Medal and the Ray C. Fish Award for Scientific Achievement in Cardiovascular Diseases were presented in 1972 to Dr. Norman Shumway. Since 1972, 25 other highly deserving recipients have been so honored by the Institute. The complete Roll of Recipients appears at the end of this article. In 2004, the faculty and staff of the Institute were extremely pleased to honor James L. Cox, MD. Dr. Cox received his award at a dinner held in conjunction with the Fifth Symposium on Cardiac Arrhythmias (New Pharmacologic and Interventional Strategies), on 14 February 2004, at the Houstonian Hotel, Club and Spa. James L. Cox, MD Dr. James L. Cox was honored for his seminal work in atrial fibrillation, a condition that affects up to 2 million people in the United States and is responsible for about 300,000 strokes every year. This disorder is characterized by spiraling electric signals that cause the heart to beat out of control. Dr. Cox has spent his career unraveling the mechanism behind this disorder and devising surgical techniques to cure it. In 1987, Dr. Cox performed his first Maze procedure. The Maze procedure definitively curbs the electrical, atrial chaos with a maze of incisions on the surface of the atria. The incisions block the signals, stopping the atrium from fibrillating. The Cox-Maze procedure has proved highly successful in long-term follow-up of patients. In 1967, Dr. Cox received his medical degree from the University of Tennessee, where he earned the Alpha Omega Alpha Distinguished Graduate Award as the outstanding student in his graduating class. He spent the next 11 years in surgical training under Dr. David Sabiston, Jr., at Duke University, except for a 2-year stint on active duty in the U.S. Army, which earned him a personal commendation from Brigadier General George S. Patton III. Dr. Cox was appointed an NIH Scholar in Academic Surgery for the remainder of his surgical training. After completing his residency, he remained at Duke for 5 years before leaving to become chief of the Division of Cardiothoracic Surgery at Washington University School of Medicine in St. Louis. In 1997, he left St. Louis for Washington, D.C., and the chairmanship of the Department of Cardiothoracic Surgery at Georgetown University. Not long thereafter, simultaneous bilateral knee replacements forced him to give up the clinical practice of surgery, but he has remained very active in the field. Currently, he is chairman and chief executive officer of The World Heart Foundation and a member of the board of directors of The Cardiothoracic Surgery Network (CTSNet). In addition, Dr. Cox was editor-in-chief of 2 of the 3 official journals of the American Association for Thoracic Surgery. Dr. Cox has trained more than 100 residents and fellows, delivered over 150 peer-reviewed scientific presentations, given over 180 invited lectures, and served as visiting professor at 79 institutions nationally and internationally and as invited operating surgeon at 40 international institutions. Dr. Cox has been a director of the American Board of Thoracic Surgery, a board member of the Thoracic Foundation for Research and Education, a member of the NIH Study Section on Surgery and Bioengineering, and chairman of the Residency Review Committee for Thoracic Surgery; in 2001, he was president of the American Association for Thoracic Surgery.

Heterotopic Cardiac Transplantation: Long-term Results and Fate of the Native Heart

The long-term results of heterotopic cardiac transplantation have not been well defined. Patient survival rates and the fate of the native heart remain unclear. This study is a retrospective review of all 46 heterotopic cardiac transplantations performed at a single institution, the Texas Heart Institute in Houston, Texas, between 1982 and 2017. Four patients who underwent heterotopic transplantation as an emergency procedure for cardiogenic shock were excluded. Three of the procedures were repeat transplantations in patients who had previously undergone heterotopic transplantation; the 3 repeat transplantations were excluded, but the original procedures were not. Follow-up was 100% complete for mortality and 77% complete (30 of 39 patients) for assessment of preoperative indication for surgery and postoperative cardiac function. For the 39 patients, the 1-year, 5-year, and 10-year survival rates were 69%, 36%, and 21%, respectively. One patient remains alive 25 years after the transplantation procedure. The most frequent indication for heterotopic transplantation was pulmonary vascular resistance greater than 4 Wood units (n= 11), followed by weight greater than 112.5 kg (n= 7). In most patients, native heart left ventricular ejection fraction stabilized over time to between 10% and 30%. Sinus rhythm was preserved in 87% (26 of 30) of native hearts at long-term follow-up. Heterotopic cardiac transplantation is an acceptable procedure that should be considered for obese patients (especially those heavier than 112.5 kg) and patients with elevated pulmonary vascular resistance (especially those with pulmonary vascular resistance >4.0 Wood units). After heterotopic transplantation, native cardiac function appears to stabilize, and there is potential for native heart recovery.

Zero-Fluoroscopy Ablation at the Texas Heart Institute.

Zero-Fluoroscopy Ablation at the Texas Heart Institute.

In Memoriam: James T. Willerson, MD (1939-2020).

In Memoriam: James T. Willerson, MD (1939-2020).

2678 To the Heart of the Matter: A Case of Left Ventricular Assist Device Erosion at the Texas Heart Institute

INTRODUCTION: Left ventricular assist devices (LVADs) are used in patients with advanced systolic heart failure as a bridge to cardiac transplant or as destination therapy. LVADs provide a survival benefit in this population but pose a significant risk of infection, typically of the driveline. Gastrointestinal-related infectious complications of LVADs, including erosion into the GI tract, or a device-related enteric fistula are less common. Here we present a case of enteric LVAD erosion discovered while investigating unusual blood culture results. CASE DESCRIPTION/METHODS: A 52 year old man with history of alcohol-related cardiomyopathy now with LVAD and chronic driveline infections with Stenotrophomonas, E. cloacae, MRSA, and MSSA on suppressive antibiotics was admitted to our hospital after outpatient blood cultures grew C. albicans. He reported fatigue and forty-pound weight loss during the previous three months. He denied fevers, abdominal pain, nausea, vomiting, change in appetite or early satiety. On admission, the patient was afebrile. On physical exam, he was in no distress, the abdomen was soft and not tender. There was purulent drainage from the driveline site, unchanged from prior admissions. Given his unusual history of bloodstream infections with Lactobacillus, Enterobacter, E. coli, and now Candida, there was concern for a bowel connection to the LVAD. Cross-sectional imaging with PO contrast revealed expected positioning of the LVAD abutting the gastric body and significant hardware scatter artifact, limiting the examination (Figure 1). The patient therefore underwent bidirectional endoscopy and EGD revealed two areas of ulceration and exposed LVAD hardware eroding into the greater curvature of the gastric body (Figure 2). The patient underwent subsequent explant and replacement of the LVAD. Two defects in the gastric body, one near the cardia and the other near the antrum were repaired by omental flap placement and gastrorrhaphy. A peri-gastric abscess was also drained. DISCUSSION: LVADs have revolutionized the management of advanced heart failure, however one-half of patients will develop a device-related infection within nine months of implantation. Although less common, GI-related LVAD infections, including enteric erosion and fistula formation, require a high index of suspicion. Non-invasive testing is suboptimal given limitations of current imaging modalities. Therefore, these patients should undergo upper and lower endoscopy for direct visualization and timely diagnosis.

THIS TOO SHALL PASS (UNTIL IT DOESN'T): A RARE CASE OF TAKOTSUBO CARDIOMYOPATHY WITH PERSISTENT LEFT VENTRICULAR DYSFUNCTION

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Takotsubo cardiomyopathy (TCM) is characterized by acute regional dysfunction of the left ventricle (LV) triggered by emotional or physical stress. There is an absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture. TCM is usually reversible within a few weeks to months. Here, we present a rare case of TCM in which 6 months post inciting event there was not only a lack in recovery of LV function, but also new onset ventricular arrhythmias requiring AICD placement. CASE PRESENTATION: A 72-year-old male with a past medical history of hypertension, hyperlipidemia, and diabetes, presented with substernal chest pain for the last 10 days. The patient also reported increased work-related stress recently. EKG showed diffuse ST segment elevations and T wave inversions. Transthoracic echocardiogram (TTE) demonstrated a severely hypokinetic LV apical segment with a left ventricular ejection fraction (LVEF) of 45%. There was no significant atherosclerotic occlusion on coronary angiography. On follow up visit 4 months later, EKG showed persistent diffuse Q waves in anteroseptal and inferior leads with resolution of T wave inversions. The patient also developed new-onset paroxysmal atrial fibrillation. 6 months later, the patient presented with a complaint of palpitations, dizziness, and lethargy. TTE at that time showed persistent diminished LVEF to 45% with continued LV apical hypokinesis. The patient underwent an electrophysiology study that showed new-onset inducible ventricular tachycardia and lengthy sinus nodal reentrant tachycardia. He underwent successful left subclavian dual-lead AICD placement, with resolution of symptoms. DISCUSSION: TCM is generally characterized as transient LV dysfunction secondary to a stressor, with regression of wall motion abnormalities and gradual restoration of LVEF until complete recovery is achieved. Here, we describe a unique case, in which more than 6 months after the inciting event, LV function was still impaired. In approximately 20% of cases of TCM, complications may occur, including cardiogenic shock, heart failure, rhythm disorders, LV thrombus formation, free wall rupture, and death. There have been very few cases, as in this case, in which not only did LV function not recover but rhythm disorders developed months after the inciting event. Differences in the evolution of TCM may be attributed to the different pathophysiological mechanisms that have been cited to contribute to the disorder – namely, catecholamine-induced myocardial stunning, transient epicardial vasospasm, coronary microvascular dysfunction, and transient LV obstructions. CONCLUSIONS: TCM is often characterized as transient LV dysfunction. This case demonstrated the need for close monitoring post inciting event, as there is a possibility for persistent LVEF depression, as well as further complications that could significantly increase mortality. Reference #1: Virani, S. S., Khan, A. N., Mendoza, C. E., Ferreira, A. C., & de Marchena, E. (2007). Takotsubo cardiomyopathy, or broken-heart syndrome. Texas Heart Institute journal, 34(1), 76-9. Reference #2: Zalewska-Adamiec, M., Bachorzewska-Gajewska, H., Tomaszuk-Kazberuk, A., Nowak, K., Drozdowski, P., Bychowski, J., Krynicki, R., Musial, W. J., … Dobrzycki, S. (2016). Takotsubo cardiomyopathy: serious early complications and two-year mortality - a 101 case study. Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 24(9), 511-9. DISCLOSURES: no disclosure on file for Rakesh Gupta; No relevant relationships by Christina Jee Ah Rhee, source=Web Response No relevant relationships by Sharmila Sarkar, source=Web Response

The Maglev Heart

FOR MORE THAN 50 YEARS, cardiac surgeons and biomedical engineers at the Texas Heart Institute (THI) have been questing for an artificial heart that can fully replace natural ones, which are in terribly short supply for transplant. They've seen their share of metal and plastic contraptions that used a variety of pumping mechanisms, but none of these machines could match the astounding performance of the human heart.

Use of the Impella 5.0 Micro-Axial Flow Device in Refractory Cardiogenic Shock - A Single Center Experience

Introduction Patients with refractory cardiogenic shock have a mortality in excess of 80%. The use of percutaneous mechanical circulatory support devices to bridge patients with refractory cardiogenic shock to definitive therapy has steadily increased, although the benefit remains poorly defined. This study describes the Baylor St Luke's Medical Center - Texas Heart Institute institutional experience using the Impella 5.0 micro-axial flow device to treat patients with refractory cardiogenic shock. Methods A retrospective study of all consecutive Impella 5.0 devices implanted at our institution between 8/2013 - 12/2018. Results Sixty-eight patients with refractory cardiogenic shock received an Impella 5.0 as a bridge to decision or definitive therapy. The cohort mean age was 60.2±12.7 years, 85.3% were male, 51.5% were Caucasian and 50.0% had coronary artery disease. The etiology of cardiogenic shock was primarily acute on chronic decompensated systolic heart failure (89.7%). After a median of 10 days on support (range 1-83 days), thirty-five patients (51.5%) had significant improvement while on Impella 5.0 support and were successfully bridged; twenty-six patients received a durable left ventricular assist device, one received a heart transplantation and eight recovered. Thirty-three patients (48.5%) had failed to recover end-organ function and either expired or care was withdrawn. Conclusions In our single center experience, Impella 5.0 implantation allowed discrimination of a patient sub-population suitable for definitive long-term therapy and was associated with better than expected survival to hospital discharge in patients with refractory cardiogenic shock.

In Memoriam: Herbert L. Fred, MD (1929–2018)

In Memoriam: Herbert L. Fred, MD (1929–2018)