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There is a paucity of data evaluating the effect of performing a concomitant cardiac procedure (CCP) on peri-operative survival in patients undergoing implantation of long-term left ventricular assist devices (LVADs). The objective of this study was to review our single-institutional experience with patients who underwent a CCP during implantation of a long-term continuous-flow LVAD.From March 2006 through June 2012, 130 patients underwent implantation of a LVAD. Of these, 76 (58.5%) were implanted as bridge-to-transplant and 54 (41.5%) as destination therapy. The LVAD implantation was isolated in 95 patients and with CCP in 35. This included 19 tricuspid valve repairs, 14 aortic valve repair/replacements, and 2 patent foramen ovale closures. The LVAD only and LVAD+CCP groups were compared regarding pre-operative demographics, peri-operative and midterm survival, and the incidence of post-operative complications.Pre-operative central venous pressure (p = 0.047), moderate to severe tricuspid regurgitation (p = 0.011), cardiopulmonary bypass time (p0.0001), cross-clamp time (p0.0001), and right ventricular end diastolic diameter (p = 0.039) were higher in the CCP group. Body mass index (p = 0.01) and body surface area (p = 0.037) were higher in the LVAD-only group. Peri-operative and midterm survival at 30 days, 6 months, 1 year, and 2 years was 94%, 87%, 80%, and 73%, respectively, for isolated LVAD implants vs. 97%, 90%, 86%, and 86%, respectively, for LVAD+CCP (p = NS). Survival was similar for LVAD patients with tricuspid valve repairs, with aortic valve repair, and with patent foramen ovale repair (p = NS). Cox proportional hazard models showed a CCP was not an independent predictor of outcome (p = NS).CCPs performed during implantation of a long-term continuous-flow LVADs does not increase peri-operative or mid-term mortality. In addition, unlike previous reports, there was no additive procedural risk for patients undergoing concomitant aortic valve repair or replacement.

Continuous-flow (CF) pumps have yielded improvements in short- and long-term survival and quality of life, and have reduced the number of left ventricular assist device (LVAD)-related complications. However, their ability to unload the right ventricle (RV) and improve RV function has not been as clearly defined. We evaluated the short- and mid-term effects of CF-LVADs on central venous pressure (CVP), pulmonary artery pressures (PAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), RV ejection fraction (RVEF), RV end-diastolic dimension (RVEDD), RV stroke work index (RVSWI), tricuspid annular plane systolic excursion (TAPSE) and severity of tricuspid regurgitation (TR).From March 2006 through June 2012, 130 patients with chronic heart failure underwent implantation of a CF-LVAD (122 HeartMate II and 8 HeartWare devices) as a bridge to transplant (n = 76) or as destination therapy (n = 54). Patients with pre-operative long-term LVADs (n = 4) and patients who underwent concomitant tricuspid valve repairs during their LVAD implant (n = 21) were excluded from the analysis. Echocardiograms and right heart catheterizations of the remaining 105 patients were reviewed pre-operatively and at 1 and 6 months post-LVAD implantation.At 1 month post-LVAD implantation, CVP decreased from 12.4 ± 5.9 mm Hg to 8.7 ± 4.5 mm Hg (p0.001), systolic PAP decreased from 52.3 ± 14.1 mm Hg to 36.8 ± 11.3 mm Hg (p0.001), PCWP decreased from 23.0 ± 9.4 mm Hg to 12.9 ± 8.0 mm Hg (p0.001), CI index increased from 1.8 ± 0.5 liters/min m2 to 2.4 ± 0.5 liters/min m2 (p0.001), RVEF increased from 33.1 ± 4.9% to 40.4 ± 6.2% (p0.001), RVEDD decreased from 36 mm to 31 mm (p = 0.020), RVSWI improved from 408.6 ± 144.6 mm Hg ml m2 to 614.4 ± 196.2 mm Hg ml m2 (p0.001), and mean TAPSE increased from 1.1 ± 0.4 cm to 1.9 ± 0.4 cm (p = 0.004). Similarly, qualitative RV function on echocardiography improved from 57.1% moderately or severely reduced pre-operatively to 38.1% at 1 month (p = 0.008). Severity of TR decreased from 11.4% moderate or severe pre-operatively to 4.8% at 1 month (p0.001). These improvements were maintained at 6 months post-LVAD.CF-LVAD support significantly decreased CVP and RVEDD, with concomitant improvement in RV function, as measured by increases in RVEF, RVSWI and TAPSE, as well as improvements in the qualitative echocardiographic appearance of RV contractility and a reduction in TR.

Background There is a paucity of data assessing racial disparities in outcomes after left ventricular assist device (LVAD) implantation. This may be due to the relatively low percentage of African American (AA) patients at a given center. Given the high proportion of AAs in our patient population, we sought to evaluate outcomes of LVAD implantation in AAs vs Caucasians. Methods We stratified 88 LVAD patients by AA or Caucasian race. Variables were compared using 2-sided t -tests, chi-square tests, Cox proportional hazards models, and log-rank tests to determine whether a difference existed between AAs and Caucasians and whether race was a significant independent predictor of outcome. Results AAs represented 36.4% (32 of 88) of our LVAD patients. The two groups did not differ significantly in the incidence of hypertension, diabetes, or chronic renal insufficiency, reoperation rates, pre-operative body mass index, left ventricular ejection fraction, central venous pressure, pulmonary capillary wedge pressure, pulmonary artery pressure, or right ventricular function. Compared with Caucasians, AAs were significantly younger (48.6 vs 54.8 years, p = 0.019), and had a significantly higher mean body surface area ( p = 0.009) and a higher rate of non-ischemic dilated cardiomyopathy (61% vs 39%, p = 0.008). No significant difference was found in 30-day ( p = 0.12), 180-day ( p = 0.166), or 360-day ( p = 0.18) survival. Analysis by univariate Cox proportional hazard models (hazard ratio [95% confidence interval]) showed race was not an independent predictor of 30-day (4.5 [0.56–35.94], p = 0.157), 180-day (3.9 [0.48–31.95], p = 0.2), or 360-day survival (1.8 [0.6–5.71], p = 0.286). Age and pre-operative renal failure were the only independent predictors of survival at 30 days (1.1 [1.02–1.19], p = 0.019; 4.99 [1.24–20], p = 0.023, respectively), 180 days (1.09 [1–1.18], p = 0.041; 4.14 [0.99–17.39], p = 0.05), and 360 days (1.05 [1–1.1], p = 0.044; 2.52 [0.94–6.75], p = 0.05). Analysis by a multivariate logistic regression model showed age and chronic renal failure were no longer statistically significant for survival at 30, 180, and 360 days. Conclusions Although multiple studies have demonstrated that AAs experience worse outcomes after coronary artery bypass grafting, heart transplantation, and valve surgery, we did not find similar results in our LVAD population. More rigorous pre-operative LVAD workup, including an evaluation by a multidisciplinary team, along with more intense post-operative follow-up, may explain improved outcomes in AAs after LVAD implantation compared with other cardiac surgical procedures, although additional analysis is required.

evidence of higher LTx morbidity-mortality with lungs providing by suicidal hanging. Methods: All lung transplantation performed at Foch hospital between January 2010 and July 2015 were analyzed outcomes of LTx to compare hanging donors (Hanging group) with donors having other cause of death (Control group). Results: During this period 299 LT were performed and divided in 2 groups: Hanging group (N= 20) and Control group (N= 279). Donor characteristics did not differ in age, sex, time on mechanical ventilation before retrieval, PO2/FIO2 ratio, smoking history, chest Xray or bronchial secretion. Recipient diagnoses did not differ significantly between the both groups. Primary graft dysfunction (PGD) at 72 hours was no statistically significant between Hanging group (PGD 0-1 70%, PGD 2 20% and PGD 3 10%) and Control group (PGD 0-1 61%, PGD 2 23% and PGD 3 16%) Median of post-operative mechanical ventilation duration (1 [range, 0-84] vs 1 [range, 0-435] days), intensive care unit stays (7 [range, 2-66] vs 7 [range, 2-91] days), and total hospital lengths of stay (31 [range, 20-84] vs 32 [range, 12-410] days) did not differ significantly between the two groups. The percentage predicted forced expiratory volume in 1 second at 6 months and 12 months were comparable in both groups (6 months, p= 0,94; 12 months, p= 0,05). No statistically significant differences were found on the survival between Hanging group and the Control group with respectively at 1 year (83% and 85%) and 2 years (75% and 80%) (p= 0,76). Conclusion: The LT outcomes are not different between hanging donors and the others cause of death. Hanging donors should be considered as conventional donors.

Purpose Advanced age is viewed by some programs as a relative contraindication for long-term mechanical circulatory support. The purpose of this study was to review our results with long-term left ventricular assist devices (LVADs) in patients 65 years or greater in age. Methods and Materials From March 2006 through June 2012, 130 patients underwent implantation of a HeartMate II or HeartWare LVAD at our institution. Four patients who underwent device exchanges were removed from the study. Of the remaining 126 patients, 24 (19.1%) were 65 years or greater. Results Mean age was 68.1 + 2.9 (65-75) years for the older group and 50.4 + 10.6 (18-64) years for the younger group (p figure 1 ] There was no significant difference in the incidence of diabetes, hypertension, chronic renal insufficiency, or hepatic function between the groups (p=NS). A greater proportion of older patients had previous cardiac surgery (50.0% vs. 26.5%; p=0.047). There was no significant difference in survival between the groups with survival at 6 months, 1 year, and 2 years of 77.4%, 77.4%, 64.5%, respectively for the older groups versus 91.9%, 83.6%, 78.4% for the younger group (p=0.319). There was no significant difference in postoperative driveline infections, strokes, pneumonia, right ventricular failure, gastrointestinal bleeding, or readmissions within thirty days (p=NS). Using Cox Proportional Hazard Models, age ≥ 65 was not an independent predictor of mortality (p=NS). Conclusions These data demonstrate similar short and long-term results for elderly and young LVAD recipients. This supports proceeding with long-term mechanical circulatory support in carefully selected elderly patients.

Purpose The purpose of this study was to separate out patients with right ventricular (RV) failure after left ventricular assist device (LVAD) implantation into those who required prolonged Milrinone therapy versus right ventricular assist device (RVAD) and to analyze outcomes in each of these subgroups. Methods and Materials From March 2006 through July 2011, one hundred patients underwent implantation of a continuous flow LVAD (93 HeartMate II and 7 HeartWare devices) as a bridge to transplant (n=68) and destination therapy (n=32). Postoperative RV failure occurred in eleven patients - six who were treated with prolonged Milrinone and five who underwent RVAD placement. Results Patients with RV failure had significantly reduced survival compared to patients without RV failure (p=0.007). However, this was only for patients who required RVADs who had a 1-month, 6-month, and 12-month survival of 40.0%, 20.0%, and 20.0%, respectively, versus 97.0%, 91.0%, and 85.0% for patients without RV failure (p figure 1 ] All patients on Milrinone were successfully discharged from the hospital. Milrinone was weaned off in five patients at 17 days, 18 days, 3 months in two patients, and 4.5 months. One patient on Milrinone was transplanted at 9 months. Conclusions Patients with post-LVAD RV failure requiring prolonged Milrinone have similar outcomes as non-RV failure LVAD patients. However, as LVADs become a more widely used therapy for refractory, end-stage heart failure, it will be important to reduce the incidence of RV failure, as it yields significant morbidity and increases cost.