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Cardiac risk stratification and coronary angiography are routinely performed as part of kidney and liver transplant candidacy evaluation. There are limited data on the outcomes of surgical coronary revascularization in this patient population. This study investigated outcomes in patients with end- stage renal or hepatic disease who were undergoing coronary artery bypass grafting (CABG) to attain kidney or liver transplant candidacy. This study was a retrospective analysis of all patients who underwent isolated CABG at our institution, Indiana University School of Medicine (Indianapolis, IN), between 2010 and 2016. Patients were divided into 2 cohorts: pretransplant (those undergoing surgery to attain renal or hepatic transplant candidacy) and nontransplant (all others). Baseline characteristics and postoperative outcomes were compared between the groups. A total of 1801 patients were included: 28 in the pretransplant group (n = 22, kidney; n = 7, liver) and 1773 in the nontransplant group. Major adverse postoperative outcomes were significantly greater in the pretransplant group compared with the nontransplant group: 30-day mortality (14.3% vs 2.8%; P =.009), neurologic events (17.9% vs 4.8%; P =.011), reintubation (21.4% vs 5.8%; P =.005), and total postoperative ventilation (5.2 hours vs 5.0 hours; P =.0124). The 1- and 5-year mortality in the pretransplant group was 17.9% and 53.6%, respectively. Of the pretransplant cohort, 3 patients (10.7%) underwent organ transplantation (all kidney) at a mean 436 days after CABG. No patients underwent liver transplantation. Outcomes after CABG in pre–kidney transplant and pre–liver transplant patients are poor. Despite surgical revascularization, most patients do not ultimately undergo organ transplantation. Revascularization strategies and optimal management in this high-risk population warrant further study. [ABSTRACT FROM AUTHOR]

Blunt thoracic aortic injury treatment has evolved over the past decade particularly with respect to endovascular intervention options. We investigated the trends in blunt thoracic aortic injury management and outcomes over an 11-year span at the sole tertiary referral center in our state. We retrospectively reviewed all patients who presented to our institution with blunt traumatic aortic injury between 2007 and 2017. Baseline demographics including aortic injury grade, injury severity score, and abbreviated injury scale were collected. Outcomes were compared by type and timing of treatment, which included either nonoperative management, endovascular repair, or open surgical repair. Bivariate and multivariable analyses were performed to examine treatment group differences and factors associated with 30-day mortality. In total, 229 patients were reviewed. The distribution of injury severity was grade 1 (30%), grade 2 (8%), grade 3 (30%), and grade 4 (31%). Overall, 27% of patients underwent endovascular repair, 29% open surgery, and 44% definitive nonoperative management. Over the study period, there was a dramatic decline in open surgery and a corresponding rise in endovascular treatment. Thirty-day mortality for the entire cohort was 22%. Mortality by treatment subgroup was 30% for nonoperative management, 8.2% for endovascular treatment, and 21% for open surgery. Delaying endovascular or open surgical treatment by at least 24 hours after admission was associated with significantly improved 30-day survival. Procedural intervention, whether endovascular or surgical, is associated with improved mortality compared with nonoperative treatment. Delayed intervention, particularly in the case of high-grade injuries, may allow for initial patient stabilization and improved outcomes. [ABSTRACT FROM AUTHOR]

Ventricular tachycardia refractory to traditional therapies such as medical management and endocardial catheter ablation poses a risk for sudden cardiac death and poor quality of life. We describe a patient who was successfully treated for refractory symptomatic ventricular tachycardia using hybrid endocardial and minimally invasive epicardial ablation with a subxiphoid approach. [ABSTRACT FROM AUTHOR]

Background. Right heart failure is poorly understood and treated. In left heart failure, ventricular restraint can reverse pathologic left ventricular remodeling. The effect of restraint in right heart failure, however, is not known. We hypothesize that ventricular restraint can be applied selectively to the right ventricle (RV) to promote RV reverse remodeling. Methods. Right heart failure was induced by right coronary artery ligation in a sheep model. Eight weeks later, a saline-filled epicardial balloon was placed around the RV surface for restraint. Restraint level was defined by measuring balloon luminal pressure at end-diastole. Maximum balloon pressure was determined by the amount of balloon pressure required to decrease systemic mean arterial pressure by 10 mm Hg. We determined enddiastolic transmural myocardial pressure, indices of myocardial oxygen consumption, and RV diastolic compliance at 4 different restraint levels. Results. After coronary ligation, RV ejection fraction (EF) decreased from 0.574 ± 0.04 to 0.362 ± 0.03 (p < 0.05). End-diastolic RV volume increased from 70.8 mL/m² ± 9 to 82.2 mL/m² ± 7 (p < 0.05) by magnetic resonance imaging. After application of restraint to the RV only, RV transmural pressure decreased significantly by 27%. Greater levels of restraint also improved RV EF (0.347 ± 0.06 to 0.473 ± 0.05) but did not change RV end-diastolic volume. Conclusions. A model of ischemic right heart failure was successfully created. Selective RV restraint results in improved mechanical efficiency, decreased wall stress, and improved EF. The benefits of restraint in right heart failure warrant further investigation. [ABSTRACT FROM AUTHOR]

Background: We investigated predictive factors of postoperative recurrence of mitral regurgitation (MR) after mitral valve annuloplasty for functional ischemic MR. Methods: This study was a retrospective review of patients with functional MR who underwent mitral ring annuloplasty at our institution from 1998 to 2008. Records were reviewed for perioperative variables, including echocardiographic measurements. Recurrence was defined as MR grade moderate (3+) or greater on any postoperative echocardiogram. Results: Of 548 patients who underwent mitral annuloplasty for functional MR, echocardiogram reports were available for review for 250. These patients comprised the study cohort. There were 154 patients with concomitant coronary artery bypass grafting. The left ventricular (LV) end-diastolic (LVED) index was calculated by dividing the LVED dimension by body surface area (BSA). A high LVED index (> 3.5 cm/m2) was predictive of MR recurrence (p = 0.047): the recurrence rate was 20.3% (13 of 64) in high-index patients and 10.2% (19 of 186) in low-index (< 3.5 cm/m2) patients. Median recurrence-free survival was 35 months (range, 19 to 59 months) in high-LVED-index patients and 46.5 months (range, 22 to 75 months) in low-LVED-index patients (p = 0.048). Preoperative MR severity and LV ejection fraction were not predictive of MR recurrence. Conclusions: Careful analysis of the preoperative echocardiogram using a novel, easily calculated variable, the LVED index, may help identify patients who are at greater risk for MR recurrence and reduced survival. Such information could prompt consideration of alternative or additional interventions in these patients. [ABSTRACT FROM AUTHOR]