Ventricular Assist Device Implantation Research Articles

Endomyocardial biopsy: safety and prognostic utility in paediatric and adult myocarditis in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry.

Contemporary multicentre data on clinical and diagnostic spectrum and outcome in myocarditis are limited. Study aims were to describe baseline features, 1-year follow-up, and baseline predictors of outcome in clinically suspected or biopsy-proven myocarditis (2013 European Society of Cardiology criteria) in adult and paediatric patients from the EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry. Five hundred eighty-one (68.0% male) patients, 493 adults, median age 38 (27-52) years, and 88 children, aged 8 (3-13) years, were divided into 3 groups: Group 1 (n = 233), clinically suspected myocarditis with abnormal cardiac magnetic resonance; Group 2 (n = 222), biopsy-proven myocarditis; and Group 3 (n = 126) clinically suspected myocarditis with normal or inconclusive or no cardiac magnetic resonance. Baseline features were analysed overall, in adults vs. children, and among groups. One-year outcome events included death/heart transplantation, ventricular assist device (VAD) or implantable cardioverter defibrillator (ICD) implantation, and hospitalization for cardiac causes. Endomyocardial biopsy, mainly right ventricular, had a similarly low complication rate in children and adults (4.7% vs. 4.9%, P = NS), with no procedure-related death. A classical myocarditis pattern on cardiac magnetic resonance was found in 31.3% of children and in 57.9% of adults with biopsy-proven myocarditis (P < .001). At 1-year follow-up, 11/410 patients (2.7%) died, 7 (1.7%) received a heart transplant, 3 underwent VAD (0.7%), and 16 (3.9%) underwent ICD implantation. Independent predictors at diagnosis of death or heart transplantation or hospitalization or VAD implantation or ICD implantation at 1-year follow-up were lower left ventricular ejection fraction and the need for immunosuppressants for new myocarditis diagnosis refractory to non-aetiology-driven therapy. Endomyocardial biopsy was safe, and cardiac magnetic resonance using Lake Louise criteria was less sensitive, particularly in children. Virus-negative lymphocytic myocarditis was predominant both in children and adults, and use of immunosuppressive treatments was low. Lower left ventricular ejection fraction and the need for immunosuppressants at diagnosis were independent predictors of unfavourable outcome events at 1 year.

Management of aortic valve insufficiency in patients with continuous-flow left ventricular assist device: a republication of the review published in Japanese Journal of Artificial Organs.

Since 2011, implantable ventricular assist devices have been a standard treatment for severe heart failure alongside heart transplantation in Japan. However, the limited availability of donors has led to a prolonged wait for transplants, now averaging 1719days, intensifying the issue of aortic insufficiency in patients with continuous flow ventricular assist devices. These devices limit the opening of the aortic valve, leading to sustained closure and increased shear stress, which accelerates valve degradation. Risk factors for aortic insufficiency include having a smaller body surface area, being of advanced age, and the presence of mild aortic insufficiency prior to device implantation. In patients presenting with mild or moderate aortic regurgitation at the time of ventricular assist device implantation, interventions such as aortic valve repair or bioprosthetic valve replacement are performed with the aim of halting its progression. The choice of surgical procedure should be tailored to each patient's individual condition. The management of de novo aortic insufficiency in patients with continuous flow ventricular assist devices remains challenging, with no clear consensus on when to intervene. Interventions for significant aortic insufficiency typically consider the patient's symptoms and aortic insufficiency severity. De novo aortic insufficiency progression in continuous flow ventricular assist devices patients necessitates careful monitoring and intervention based on individual patient assessments and valve condition. This review was created based on a translation of the Japanese review written in the Japanese Journal of Artificial Organs in 2023 (Vol. 52, No. 1, pp. 77-80), with some modifications.

Prognosis of patients in end-stage heart failure with atrial fibrillation treated with ablation: Insights from CASTLE-HTx

BackgroundThe CASTLE-HTx trial demonstrated the benefit of atrial fibrillation (AF) ablation compared with medical therapy in decreasing mortality, need for left ventricular assist device implantation, or heart transplantation (HTx) in patients with end-stage heart failure (HF). ObjectiveThis analysis aimed to identify risk factors related to adverse outcomes in patients with end-stage HF and to assess the impact of ablation. MethodsThe CASTLE-HTx protocol randomized 194 patients with end-stage HF and AF to ablation vs medical therapy. We identified left ventricular ejection fraction <30%, New York Heart Association class ≥III, and AF burden >50% as predictors for the primary end point. The CASTLE-HTx risk score assigned weights to these risk factors. Patients with a risk score ≥3 were identified as high risk. ResultsThe patients were assigned to low-risk (89 [45.9%]) and high-risk (105 [54.1%]) groups. After a median follow-up of 18 months, a primary end point event occurred in 6 and 31 patients of the low- and high-risk groups (hazard ratio, 4.98; 95% confidence interval, 2.08–11.9). The incidence rate (IR) difference between ablation and medical therapy was much larger in high-risk patients (8/49 [IR, 11.4] vs 23/56 [IR, 36.1]) compared with low-risk patients (2/48 [IR, 2.6] vs 4/41 [IR, 6.3]). The IR difference for ablation was significantly higher in high-risk patients (24.69) compared with low-risk patients (3.70). ConclusionThe absolute benefit of ablation is more pronounced in high-risk patients, but low-risk patients may also benefit. The CASTLE-HTx risk score identifies patients with end-stage HF who will particularly benefit from ablation.

Outcomes of left ventricular assist device implantations at Karolinska University Hospital: A retrospective study

ObjectiveTo descriptively present data and outcomes of Left ventricular assist device (LVAD) implantations at Karolinska University hospital. MethodsData were collected from consecutive patients (n=44) who were implanted with HeartMate 3 (HM3) at Karolinska University Hospital between 2017 and 2022. The study presents baseline characteristics, clinical course during the inpatient hospital care after implantation, adverse events, and clinical outcomes. ResultsMedian intensive care unit stay and hospital stay after HM3 implantation was 8 (interquartile range [IQR] 6; 15) and 28 days (IQR 22; 36), respectively. In total, 73% underwent ramp test at some point after the implantation. Death from all causes within 30 days post-implantation was 5%. A total of 21 patients (48%) underwent right heart catheterization, at a median of 0.5 years (IQR 0.3;0.7) after implantation, and all exhibited optimally unloaded left ventricles. During the study period, 34% of the patients were transplanted, 5% were explanted, and 16% died with LVAD. In total, 11% and 5% suffered from early and late right ventricle failure, respectively. Acute renal failure affected 46% and 18% had drive-line infection. Spontaneous cerebral haemorrhage and cerebral infarction affected 5% and 7% of the study population, respectively. Gastrointestinal bleeding affected 16%. The median LVAD-duration was 10 months (IQR 5;22). The one-year survival rate with LVAD was 85%, and the two-year survival rate was 80%. ConclusionsThe results of this low volume single-center retrospective study on LVAD implantations align with the results of other studies and international registries.

Arrhythmic manifestations and outcomes of definite and probable cardiac sarcoidosis

BackgroundThe 2014 Heart Rhythm Society consensus statement defines histological (definite) and clinical (probable) diagnostic categories of cardiac sarcoidosis (CS), but few studies have compared their arrhythmic phenotypes and outcomes. ObjectiveThe purpose of this study was to evaluate the electrophysiological/arrhythmic phenotype and outcomes of patients with definite and probable CS. MethodsWe analyzed the arrhythmic/electrophysiological phenotype in a single-center North American cohort of 388 patients (median age 56 years; 39% female, n = 151) diagnosed with definite (n = 58) or probable (n = 330) CS (2000–2022). The primary composite outcome was survival to first ventricular tachycardia/fibrillation (VT/VF) event or sudden cardiac death. Key secondary outcomes were also assessed. ResultsAt index evaluation, in situ cardiac implantable electronic devices and antiarrhythmic drug use were more common in definite CS. At a median follow-up of 3.1 years, the primary outcome occurred in 22 patients with definite CS (38%) and 127 patients with probable CS (38%) (log-rank, P = .55). In multivariable analysis, only a higher ratio of the 18F-fluorodeoxyglucose maximum standardized uptake value of the myocardium to the maximum standardized uptake value of the blood pool (hazard ratio 1.09; 95% confidence interval 1.03–1.15; P = .003, per 1 unit increase) was associated with the primary outcome. During follow-up, patients with definite CS had a higher burden of device-treated VT/VF events (mean 2.86 events per patient-year vs 1.56 events per patient-year) and a higher rate of progression to heart transplant/left ventricular assist device implantation but no difference in all-cause mortality compared with patients with probable CS. ConclusionPatients with definite and probable CS had similarly high risks of first sustained VT/VF/sudden cardiac death and all-cause mortality, though patients with definite CS had a higher overall arrhythmia burden. Both CS diagnostic groups as defined by the 2014 Heart Rhythm Society criteria require an aggressive approach to prevent arrhythmic complications.

(1311) - Nutritional Risk Assessment and Adverse Events in Patients Undergoing Left Ventricular Assist Device Implantation - A Retrospective Cohort Study Using Hospital Information System

(1311) - Nutritional Risk Assessment and Adverse Events in Patients Undergoing Left Ventricular Assist Device Implantation - A Retrospective Cohort Study Using Hospital Information System

Pregnancy in women with dilated cardiomyopathy genetic variants

Introduction and objectivesLimited information is available on the safety of pregnancy in patients with genetic dilated cardiomyopathy (DCM) and in carriers of DCM-causing genetic variants without the DCM phenotype. We assessed cardiac, obstetric, and fetal or neonatal outcomes in this group of patients. MethodsWe studied 48 women carrying pathogenic or likely pathogenic DCM-associated variants (30 with DCM and 18 without DCM) who had 83 pregnancies. Adverse cardiac events were defined as heart failure (HF), sustained ventricular tachycardia, ventricular assist device implantation, heart transplant, and/or maternal cardiac death during pregnancy, or labor and delivery, and up to the sixth postpartum month. ResultsA total of 15 patients, all with DCM (31% of the total cohort and 50% of women with DCM) experienced adverse cardiac events. Obstetric and fetal or neonatal complications were observed in 14% of pregnancies (10 in DCM patients and 2 in genetic carriers). We analyzed the 30 women who had been evaluated before their first pregnancy (12 with overt DCM and 18 without the phenotype). Five of the 12 (42%) women with DCM had adverse cardiac events despite showing NYHA class I or II before pregnancy. Most of these women had a history of cardiac events before pregnancy (80%). Among the 18 women without phenotype, 3 (17%) developed DCM toward the end of pregnancy. ConclusionsCardiac complications during pregnancy and postpartum were common in patients with genetic DCM and were primarily related to HF. Despite apparently good tolerance of pregnancy in unaffected genetic carriers, pregnancy may act as a trigger for DCM onset in a subset of these women.

(1370) - Exploring Factors Associated with Prolonged Intubation After Ventricular Assist Device Implantation in Children

(1370) - Exploring Factors Associated with Prolonged Intubation After Ventricular Assist Device Implantation in Children

(110) - Mitral Regurgitation at the Time of Left Ventricular Assist Device Implantation - Should We Treat It or Not?

(110) - Mitral Regurgitation at the Time of Left Ventricular Assist Device Implantation - Should We Treat It or Not?

(109) - Incidence and Risk Factors for Early Stroke Following Durable Left Ventricular Assist Device (LVAD) Implantation: An STS Intermacs Analysis

(109) - Incidence and Risk Factors for Early Stroke Following Durable Left Ventricular Assist Device (LVAD) Implantation: An STS Intermacs Analysis

(837) - Trending Renal Function Pre- and Post-Left Ventricular Assist Device (LVAD) Implantation

(837) - Trending Renal Function Pre- and Post-Left Ventricular Assist Device (LVAD) Implantation

(1235) - Patient Outcomes Following Emergency Ventricular Assist Device Implantation During High-Urgency Waiting Period for Heart Transplantation

(1235) - Patient Outcomes Following Emergency Ventricular Assist Device Implantation During High-Urgency Waiting Period for Heart Transplantation

(874) - Usefulness of Established Risk Scores in Predicting Right Heart Failure Requiring Temporary Right Ventricular Assist Device Support Following Left Ventricular Assist Device Implantation

(874) - Usefulness of Established Risk Scores in Predicting Right Heart Failure Requiring Temporary Right Ventricular Assist Device Support Following Left Ventricular Assist Device Implantation

Cardiac MRI-Enriched Phenomapping Classification and Differential Treatment Outcomes in Patients With Ischemic Cardiomyopathy.

Significant controversy continues to confound patient selection and referral for revascularization and mitral valve intervention in patients with ischemic cardiomyopathy (ICM). Cardiac magnetic resonance (CMR) enables comprehensive phenotyping with gold-standard tissue characterization and volumetric/functional measures. Therefore, we sought to determine the impact of CMR-enriched phenomapping patients with ICM to identify differential outcomes following surgical revascularization and surgical mitral valve intervention (sMVi). Consecutive patients with ICM referred for CMR between 2002 and 2017 were evaluated. Latent class analysis was performed to identify phenotypes enriched by comprehensive CMR assessment. The primary end point was death, heart transplant, or left ventricular assist device implantation. A multivariable Cox survival model was developed to determine the association of phenogroups with overall survival. Subgroup analysis was performed to assess the presence of differential response to post-magnetic resonance imaging procedural interventions. A total of 787 patients were evaluated (63.0±11.2 years, 24.8% women), with 464 primary events. Subsequent surgical revascularization and sMVi occurred in 380 (48.3%) and 157 (19.9%) patients, respectively. Latent class analysis identified 3 distinct clusters of patients, which demonstrated significant differences in overall outcome (P<0.001). Latent class analysis identified differential survival benefit of revascularization in patients as well as patients who underwent revascularization with sMVi, based on phenogroup classification, with phenogroup 3 deriving the most survival benefit from revascularization and revascularization with sMVi (hazard ratio, 0.61 [0.43-0.88]; P=0.0081). CMR-enriched unsupervised phenomapping identified distinct phenogroups, which were associated with significant differential survival benefit following surgical revascularization and sMVi in patients with ICM. Phenomapping provides a novel approach for patient selection, which may enable personalized therapeutic decision-making for patients with ICM.

(188) - Right Ventriculo-Arterial Coupling Assessment by High-Fidelity Hemodynamic Measurements in Patients Undergoing Left Ventricular Assist Device Implantation

(188) - Right Ventriculo-Arterial Coupling Assessment by High-Fidelity Hemodynamic Measurements in Patients Undergoing Left Ventricular Assist Device Implantation

(846) - A Multidisciplinary Approach to Reduce Length of Stay Post Ventricular Assist Device Implant

(846) - A Multidisciplinary Approach to Reduce Length of Stay Post Ventricular Assist Device Implant

(590) - Outcome of Left Ventricular Assist Device Implantation with Concomitant Aortic Valve Procedure

(590) - Outcome of Left Ventricular Assist Device Implantation with Concomitant Aortic Valve Procedure

(1184) - Left Ventricular Assist Device Implantation in Patient with Localized Stenosis at a Distal Anastomotic Site of the Ascending Aorta After Bentall's Surgery

(1184) - Left Ventricular Assist Device Implantation in Patient with Localized Stenosis at a Distal Anastomotic Site of the Ascending Aorta After Bentall's Surgery

(814) - Pre-Implant Pulmonary Artery Pulsatility Index and Its Relationship with Early Right Ventricular Failure After Left Ventricular Assist Device Implantation: An INTERMACS Analysis

(814) - Pre-Implant Pulmonary Artery Pulsatility Index and Its Relationship with Early Right Ventricular Failure After Left Ventricular Assist Device Implantation: An INTERMACS Analysis

(1183) - Successfully Treated Gastric Cancer with Prolonged Discontinuation of Antithrombotic Therapy After Left Ventricular Assist Device Implantation

(1183) - Successfully Treated Gastric Cancer with Prolonged Discontinuation of Antithrombotic Therapy After Left Ventricular Assist Device Implantation