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Right ventricular failure (RVF) is a major cause of early mortality after heart transplantation (HT). Isoproterenol (Iso) has chronotropic, inotropic, and vasodilatory properties, which might improve right ventricle function in this setting. We aimed to investigate the hemodynamic effects of isoproterenol on patients with post-HT RVF. We conducted a 1-yr retrospective observational study including patients receiving isoproterenol (Iso) and dobutamine for early RVF after HT. A comprehensive multiparametric hemodynamic evaluation was performed successively three times: no isoproterenol, low doses: 0.025 µg/kg/min, and high doses: 0.05 µg/kg/min (henceforth, respectively, called no Iso, low Iso, and high Iso). From June 2022 to June 2023, 25 patients, median [interquartile range (IQR) 25–75] age 54 [38–61] yr, were included. Before isoproterenol was introduced, all patients received dobutamine, and 15 (60%) were on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Isoproterenol significantly increased heart rate from 84 [77–99] (no Iso) to 91 [88–106] (low Iso) and 102 [90–122] beats/min (high Iso, P < 0.001). Similarly, cardiac index rose from 2.3 [1.4–3.1] to 2.7 [1.8–3.4] and 3 [1.9–3.7] L/min/m2 (P < 0.001) with a concomitant increase in indexed stroke volume (28 [17–34] to 31 [20–34] and 33 [23–35] mL/m2, P < 0.05). Effective pulmonary arterial elastance and pressures were not modified by isoproterenol. Pulmonary vascular resistance (PVR) tended to decrease from 2.9 [1.4–3.6] to 2.3 [1.3–3.5] wood units (WU), P = 0.06. Right ventricular ejection fraction/systolic pulmonary artery pressure (sPAP) evaluating right ventricle-pulmonary artery (RV-PA) coupling increased after isoproterenol from 0.8 to 0.9 and 1%·mmHg−1 (P = 0.001). In conclusion, in post-HT RVF, isoproterenol exhibits chronotropic and inotropic effects, thereby improving RV-PA coupling and resulting in a clinically relevant increase in the cardiac index. NEW & NOTEWORTHY: This study offers a detailed and comprehensive hemodynamic investigation at the bedside, illustrating the favorable impact of isoproterenol on right ventricular-pulmonary arterial coupling and global hemodynamics. It elucidates the physiological effects of an underused inotropic strategy in a critical clinical scenario. By enhancing cardiac hemodynamics, isoproterenol has the potential to expedite right ventricular recovery and mitigate primary graft dysfunction, thereby reducing the duration of mechanical support and intensive care unit stay posttransplantation. [ABSTRACT FROM AUTHOR]

Background: In the last years, the Cor-Knot ® device has been increasingly used in heart valve surgery. Our aim was to investigate the incidence of valvular complications in patients who underwent valvular surgery using the Cor-Knot ® device in multicentric cohorts at one-year follow-up., Methods: Three hundred and sixty-eight patient underwent heart valve repair or replacement surgery using automated titanium suture fasteners in four cardiothoracic surgery departments between September 2018 and January 2020., Results: The mean age was 66.3±10.2 years. The mean Euroscore II was 3.14±5.65. Procedures were performed by right anterior mini-thoracotomy for 264 patients (71.7%) and by conventional sternotomy for 76 (20.7%). Isolated single valve surgery was most common (285 patients, 77.4%), 31 patients (8.4%) underwent isolated double valve surgery and 6 patients isolated triple valve surgery (1.6%). An associated procedure was performed in 46 patients (12.5%). Sixteen patients (4.3%) required permanent pacemaker implantation in the postoperative period. Eighteen patients died postoperatively (4.9%). Two patients had paravalvular leak ≥2 (0.5%). Mean follow-up was 14.7±7.1 months. Eight patients died during the follow-up (2.2%). Four patients had infectious endocarditis. The rate of valvular leak ≥2 was 1.5% and four patients underwent valve-related reoperation (1.2%), no reoperation was related to a valve lesion due to Cor-Knot ® . There were three pacemaker implantation (0.9%) and 12 patients had NYHA>2 (3.7%). No case of metallic embolization, prosthesis thrombosis or leaflet perforation was reported during follow-up., Conclusions: The use of the Cor-Knot ® automated knotting system in valve surgery is not associated with an increase in the rate of paravalvular leakage, permanent pacemaker implantation or mortality postoperatively or during follow-up.