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A single-center continuous-flow left ventricular assist device (LVAD) cohort (n = 503) was reviewed for patients with information on cardiac rehabilitation (CR) participation (n = 273) over a 13-year period. The analysis was then limited LVAD recipients who fit into three main CR categories: those who graduated CR (n = 138), those who were able to but declined participation (n = 61), and those who were too sick to complete or start CR (n = 28). To assess the association between CR categories and mortality and hospitalizations on LVAD support, multivariate cox regression and negative binomial regression analyses were performed, respectively. Among those who started CR and had the opportunity to finish (enough follow-up time, insurance coverage), 79% graduated. Those who graduated CR had a 96% survival at 1 year (95% confidence interval [CI], 91–98). Compared with the graduated group, those in the too sick group had an increased hazards rate of mortality (hazard ratio, 2.85; 95% CI, 1.49–5.44; p< 0.01) and an increase in the incidence rate of hospitalizations (incidence rate ratio, 1.74; 95% CI, 1.14–2.66, p= 0.01). This study is the largest to date to report outcomes of LVAD recipients referred for CR. The lower readmission rates and high survival in the group that graduated CR provides further evidence for the safety of CR in LVAD recipients.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2010.03.006 Byline: Ranjit John (a), Kenneth Liao (a), Forum Kamdar (b), Peter Eckman (b), Andrew Boyle (b), Monica Colvin-Adams (b) Abbreviations: BTT, bridge to transplant; DPAP, diastolic pulmonary artery pressure; LVAD, left ventricular assist device; PH, pulmonary hypertension; PVR, pulmonary vascular resistance; SPAP, systolic pulmonary artery pressure; TPG, transpulmonary gradient Abstract: Pulsatile left ventricular assist devices have been shown to effectively reduce pulmonary hypertension in patients with end-stage heart failure. However, it remains to be seen whether newer continuous-flow left ventricular assist devices have a similar effect on pulmonary hypertension. The objective of this study was to determine whether the HeartMate II (Thoratec Corp, Pleasanton, Calif), a continuous-flow left ventricular assist device, is effective in improving pulmonary hemodynamics in the period after left ventricular assist device support and posttransplant. Author Affiliation: (a) Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minn (b) Department of Surgery and Division of Cardiology, University of Minnesota, Minneapolis, Minn Article History: Received 30 November 2009; Revised 8 February 2010; Accepted 9 March 2010 Article Note: (footnote) Disclosures: None.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2007.12.077 Byline: Ranjit John (a), Forum Kamdar (a), Kenneth Liao (a), Monica Colvin-Adams (b), Leslie Miller (b), Lyle Joyce (a), Andrew Boyle (b) Abbreviations: INR, international normalized ratio; LVAD, left ventricular assist device; PTT, partial thromboplastin time; TIA, transient ischemic attack Abstract: Thromboembolic events can occur in up to 20% of patients with a left ventricular assist device. The aggressive use of anticoagulation with newer continuous-flow devices has potentially increased the risk of postoperative bleeding. The predecessor of the HeartMate II left ventricular assist device, the HeartMate XVE (Thoratec Corp, Pleasanton, Calif), was associated with an extremely low thromboembolic risk, even without anticoagulation, because of its unique textured surfaces. Even though several areas of the HeartMate II are textured, a protocol was adopted for this new axial flow pump requiring long-term anticoagulation with warfarin. In our study, we investigated whether the HeartMate II left ventricular assist device is associated with a similarly low thromboembolic risk as the HeartMate XVE. Author Affiliation: (a) Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minn (b) Department of Surgery and Division of Cardiology, University of Minnesota, Minneapolis, Minn Article History: Received 31 July 2007; Revised 14 November 2007; Accepted 18 December 2007 Article Note: (footnote) This study was part of the multicenter study supported by Thoratec Corp, Pleasanton, Calif.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2007.01.085 Byline: Ranjit John (a), Kenneth Liao (a), Katherine Lietz (b), Forum Kamdar (a), Monica Colvin-Adams (b), Andrew Boyle (b), Leslie Miller (b), Lyle Joyce (a) Abbreviations: ACT, activated clotting time; ECMO, extracorporeal membrane oxygenation; GCS, Glasgow Coma Scale; IABP, intraaortic balloon pump; LVAD, left ventricular assist device; MSOF, multisystem organ failure; RVAD, right ventricular assist device; SCr, serum creatinine; VAD, ventricular assist device Abstract: Patients with refractory acute cardiogenic shock and multisystem organ failure have a poor outcome with implantation of permanent ventricular assist devices. We review our experience with the use of the CentriMag (Levitronix LLC, Waltham, Mass) circulatory support system in such patients whose neurologic status was uncertain. Author Affiliation: (a) Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn (b) Division of Cardiology, University of Minnesota, Minneapolis, Minn. Article History: Received 26 September 2006; Revised 22 January 2007; Accepted 29 January 2007 Article Note: (footnote) Monica Colvin-Adams reports lecture fees from Medtronic; Andrew Boyle reports consulting and lecture fees from Thoratec; Leslie Miller reports consulting fees and grant support from Thoratec.

Myocardial fibrosis identified by apical core pathology at the time of left ventricular assist device (LVAD) implantation may add information regarding myocardial recovery potential. In this analysis, we report the prevalence of myocardial fibrosis by cardiomyopathy type and its association with other known markers of left ventricular recovery. Left ventricular assist device core pathology was reviewed on 332 patients who underwent LVAD implantation at a single institution between 2005 and 2016. Baseline clinical and echocardiographic characteristics were compared among patients with and without myocardial fibrosis by cardiomyopathy type. Among the 332 LVAD core specimens, myocardial fibrosis was present in 79%. Myocardial fibrosis was more common in ischemic than in nonischemic patients (90% vs. 66%; p< 0.001). Patients with fibrosis were older than those without (58 ± 12 vs. 55 ± 19; p< 0.05). Among the nonischemic cardiomyopathy cases, those with fibrosis were more likely to have an implantable cardioverter defibrillator (ICD) 81% and to be diabetic 81%. Fibrosis was not associated with left ventricular end-diastolic diameter (LVEDD), creatinine, or N-terminal prohormone of brain natriuretic peptide (NT-pro BNP). Myocardial fibrosis by apical core biopsy correlated with several known markers of left ventricular recovery including cardiomyopathy type, age, and presence of an ICD. In nonischemic cardiomyopathy patients, the degree of myocardial fibrosis may add information regarding recovery potential.

Background A major problem in procurement of donor hearts is the limited time a donor heart remains viable. After cardiectomy, ischemic hypoxia is the main cause of donor heart degradation. The global myocardial ischemia causes a cascade of oxygen radical formation that cumulates in an elevation in hydrogen ions (decrease in pH), irreversible cellular injury, and potential microvascular changes in perfusion.Objective To determine the changes of prolonged storage times on donor heart microvasculature and the effects of intermittent antegrade perfusion.Materials and Methods Using porcine hearts flushed with a Ribosol-based cardioplegic solution, we examined how storage time affects microvascular myocardial perfusion by using contrast-enhanced magnetic resonance imaging at a mean (SD) of 6.1 (0.6) hours (n=13) or 15.6 (0.6) hours (n=11) after cardiectomy. Finally, to determine if administration of cardioplegic solution affects pH and microvascular perfusion, isolated hearts (group 1, n=9) given a single antegrade dose, were compared with hearts (group 2, n=8) given intermittent antegrade cardioplegia (150 mL, every 30 min, 150 mL/min) by a heart preservation device. Khuri pH probes in left and right ventricular tissue continuously measured hydrogen ion levels, and perfusion intensity on magnetic resonance images was plotted against time.Results Myocardial perfusion measured via magnetic resonance imaging at 6.1 hours was significantly greater than at 15.6 hours (67% vs 30%, P=.00008). In group 1 hearts, the mean (SD) for pH at the end of 6 hours decreased to 6.2 (0.2). In group 2, hearts that received intermittent antegrade cardioplegia, pH at the end of 6 hours was higher at 6.7 (0.3) (P=.0005). Magnetic resonance imaging showed no significant differences between the 2 groups in contrast enhancement (group 1, 62%; group 2, 40%) or in the wet/dry weight ratio.Conclusion Intermittent perfusion maintains a significantly higher myocardial pH than does a conventional single antegrade dose. This difference may translate into an improved quality of donor hearts procured for transplantation, allowing longer distance procurement, tissue matching, improved outcomes for transplant recipients, and ideally a decrease in transplant-related costs.

Despite significant advances in the science of resuscitation, survival to discharge after an in-hospital cardiac arrest in the catheterization laboratory remains poor. Clinicians face the challenges of performing CPR during procedures to address the cause of the arrest and the limitations of prolonged manual CPR. In this article we describe the first case of a patient presenting in cardiogenic shock caused by acute coronary syndrome secondary to bypass graft failure who developed cardiac arrest and survived 80 minutes of resuscitation in the catheterization lab, allowing for revascularization of a vein graft. The patient experienced complete neurological and hemodynamic recovery. This case demonstrates the importance of prompt high-quality, uninterrupted CPR using an automated chest compression device to facilitate early emergent revascularization of a vein graft. [ABSTRACT FROM AUTHOR]

Background:Cardiomyopathy has emerged as a leading cause of death in DMD although limited therapies have been developed for dystrophic heart failure.Methods:We used DMD patient-specific hiPSC-derived cardiomyocytes as a model to assess physiological responses to adrenergic agonist and antagonist treatments. These agents were further examined in vivousing wildtype and mdxmouse models.Results:DMD hiPSC-derived cardiomyocytes displayed a significant increase in arrhythmic calcium traces, both at baseline and in response to adrenergic stimulation, when compared to isogenic controls. These arrhythmias were significantly decreased with the addition of the beta-blocker propranolol. Using telemetric monitoring, we observed that mdxmice experienced arrhythmic death in response to isoproterenol stimulation and that these lethal arrhythmias were rescued, in part, by propranolol pretreatment. Using single cell and bulk RNA-Seq in DMD derived hiPSCs and mdx mice, we have identified important pathways that are perturbed under baseline and evoked conditions and normalized following the delivery of propranolol. We further determined that relatively few DMD patients see a cardiovascular specialist or receive ?-blocker therapy.Conclusions:In these studies, we have identified important mechanisms and potential therapeutic targets in the dystrophic heart. Importantly, these results may serve as a prelude for clinical studies that examine the impact of ?-blocker therapy in patients with dystrophinopathies.