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Background Bicuspid aortic valve (BAV) is the most common congenital heart defect (reported incidence of 0.5%–2%) and is commonly associated with proximal aortic dilation. Patients with severe aortic stenosis (AS) of BAV have been shown to have worse pre-operative left ventricular (LV) function as well as a higher incidence of post-operative heart failure hospitalization when compared with analogous patients with tri-leaflet aortic valve disease. While surgical aortic valve replacement (SAVR) may be favoured over transcatheter aortic valve implantation (TAVI) due to anatomical factors or concomitant aortopathy and coronary artery disease, surgical candidacy is often limited by prohibitive operative risk. Case summary We report on three cases of severe AS in BAV with concomitant aortopathy and severe left ventricular dysfunction in whom we proceeded with SAVR with a priori planned venoarterial extracorporeal membrane oxygenation (VA-ECMO) support and inotrope-assisted wean. All patients had severe LV dysfunction (ejection fraction < 25%) at baseline with gradual substantial improvement or normalization after successful SAVR. Discussion These cases demonstrate the utility of planned VA-ECMO with SAVR and aortic root replacement as an integral component of the operative strategy for high surgical risk patients with severe BAV AS not amenable to TAVI. Appropriate pre-operative planning and consent for VA-ECMO as well as a multi-disciplinary approach involving anaesthesia, intensive care, and heart failure cardiology are the key to offering this option as an alternative to palliative medical therapy to a selected group of patients. [ABSTRACT FROM AUTHOR]

Aims: Clinical pathways have been shown to improve outcomes in patients with heart failure (HF). Although patients with HF often have a cardiac implantable electronic device, few studies have reported the utility of device‐derived risk scores to augment and organize care. TriageHF Plus is a device‐based HF clinical pathway (DHFP) that uses remote monitoring alerts to trigger structured telephone assessment for HF stability and optimization. We aimed to evaluate the impact of TriageHF Plus on hospitalizations and describe the associated workforce burden. Methods and results: TriageHF Plus was a multi‐site, prospective study that compared outcomes for patients recruited between April 2019 and February 2021. All alert‐triggered assessments were analysed to determine the appropriateness of the alert and the workload burden. A negative‐binomial regression with inverse probability treatment weighting using a time‐matched usual care cohort was applied to estimate the effect of TriageHF Plus on non‐elective hospitalizations. A post hoc pre‐COVID‐19 sensitivity analysis was also performed. The TriageHF Plus cohort (n = 443) had a mean age of 68.8 ± 11.2 years, 77% male (usual care cohort: n = 315, mean age of 66.2 ± 14.5 years, 65% male). In the TriageHF Plus cohort, an acute medical issue was identified following an alert in 79/182 (43%) cases. Fifty assessments indicated acute HF, requiring clinical action in 44 cases. At 30 day follow‐up, 39/66 (59%) of initially symptomatic patients reported improvement, and 20 (19%) initially asymptomatic patients had developed new symptoms. On average, each assessment took 10 min. The TriageHF Plus group had a 58% lower rate of hospitalizations across full follow‐up [incidence relative ratio: 0.42, 95% confidence interval (CI): 0.23–0.76, P = 0.004]. Across the pre‐COVID‐19 window, hospitalizations were 31% lower (0.69, 95% CI: 0.46–1.04, P = 0.077). Conclusions: These data represent the largest real‐world evaluation of a DHFP based on multi‐parametric risk stratification. The TriageHF Plus clinical pathway was associated with an improvement in HF symptoms and reduced all‐cause hospitalizations. [ABSTRACT FROM AUTHOR]

This article, published in the Oxford Medical Case Reports, presents a case of a 49-year-old White male with left ventricular noncompaction cardiomyopathy (LVNC). The patient had severe left ventricular dilation and dysfunction, leading to a referral for transplant assessment. However, as he was asymptomatic on medical therapy, he was discharged to local heart failure services. The patient later developed a large left ventricular thrombus, which led to multi-organ failure and an embolic stroke. Treatment was ultimately withdrawn due to the contraindication for transplant. The article discusses the clinical sequalae of LVNC and the controversy surrounding prophylactic anticoagulation. [Extracted from the article]

Cytomegalovirus (CMV) disease caused by genetically resistant CMV poses a major challenge in solid organ transplant recipients, and the development of resistance is associated with increased morbidity and mortality. Antiviral resistance affects 5%–12% of patients following ganciclovir (GCV) therapy, but is more common in individuals with specific underlying risk factors. These include the CMV D+R‐ serostatus, type of transplanted organ, dose and duration of (Val)GCV ([V]GCV) prophylaxis, peak viral loads, and the intensity of immunosuppressive therapy. Guideline recommendations for the management of GCV resistance (GanR) in solid organ transplant recipients are based on expert opinion as there is a lack of data from controlled trials. Second‐line options to treat GanR include foscarnet (FOS) and cidofovir (CDV), but these drugs are often poorly tolerated due to high rates of toxicity, such as renal dysfunction and neutropenia. Here, we report seven cardiothoracic transplant recipients with GCV resistance CMV infection from our centre treated with CMV immunoglobulin (CMVIG) +/‐ leflunomide (LEF) and reviewed the literature on the use of these agents in this therapeutic setting. [ABSTRACT FROM AUTHOR]