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In patients with ischemic cardiomyopathy and left ventricular aneurysm formation who are symptomatic despite optimal medical therapy, it is challenging to determine whether surgical ventricular reconstruction, heart transplantation, or left ventricular assist device (LVAD) implantation is the treatment of choice. This report describes the concept of surgical ventricular reconstruction with a specially prepared LVAD fixation ring to facilitate subsequent LVAD implantation if required. In the patient reported in this case, endoventricular circular LVAD ring plasty sufficiently reduced the ventricular volume, normalized the left ventricular geometry, and subsequently led to an improvement of left ventricular ejection fraction. [ABSTRACT FROM AUTHOR]

Impella 5.0 and 5.5 (summarized as Impella 5+) are microaxial, catheter-based left ventricular assist devices (LVAD) that are implanted via a vascular graft sutured to the axillary artery and provide blood flow of up to 5.5 liter/min. This study aims to investigate the incidence of long-term complications following circulatory support with Impella 5+. A single-center retrospective analysis of 203 consecutive adult patients treated between January 2017 and September 2021 with a surgically implanted Impella 5.0 or 5.5 via a vascular graft sutured to the axillary artery. The median Impella support duration was 8 days. Of 203 patients, 78 (38.4%) died while on temporary mechanical circulatory support. Fifty-five (27.1%) were successfully weaned from Impella 5+ and 70 (34.5%) were bridged to a durable LVAD with a median follow-up time of 232 (IQR 68.5, 597) days after Impella 5+ explantation. In 119 of these patients, the Impella was explanted and the vascular graft was shortened, ligated, and pushed under the pectoralis muscle; in 6 patients early graft infection prompted complete graft removal during explantation. In addition, 13 patients (10.9%) developed a late-onset graft infection after a median of 86 days, requiring complete (n = 10) or partial (n = 2) explantation of the retained graft. In 1 patient, the graft infection was successfully treated by conservative therapy. Our analysis identified no specific risk factors for graft infections. Of the 203 patients, 5 (2.5%) developed a brachial plexus injury resulting in neurological dysfunction. In 10.9% of patients, retaining the vascular graft was complicated by a late graft infection. Complete explantation of the graft prosthesis may decrease the infection rate, but may in turn increase the risk of brachial plexus injury. On the other hand, this method offers the possibility of bedside explantation. [ABSTRACT FROM AUTHOR]

Recently, temporary mechanical circulatory support (tMCS) has been increasingly used for cardiogenic shock therapy. Originally designed as a bail-out option for patients who could not be weaned from cardiopulmonary bypass, the indications for tMCS have been expended and now enable us to support a wide range of patients with various cardiac pathologies. Modern tMCS devices include microaxial flow pumps (mAFP) which are small, versatile systems that can provide both acute cardiac support and cardiac protection for high-risk interventions. In this paper, we review different surgical implantation techniques with modern mAFP as well as specific aspects of preoperative indications and patient evaluation.

Objectives: Due to the limited longevity of endovascular leads, children require thoughtful lifetime lead management strategies including conservation of access vessel patency. Consequently, there is an increasing interest in transvenous lead extraction (TLE) in children, however, data on TLE and the use of powered mechanical dissection sheaths is limited., Methods: We performed a retrospective cohort study analyzing all children <18 years that underwent TLE in our institution from 2015 to 2022. Procedural complexity, results and complications were defined as recommended by recent consensus statements., Results: Twenty-eight children [median age 12.8 (interquartile range 11.3-14.6) years] were included. Forty-one leads were extracted [median dwell time 85 (interquartile range 52-102) months]. Extractions of 31 leads (76%) in 22 patients (79%) were complex, requiring advanced extraction tools including powered bidirectional rotational dissection sheaths in 14 children. There were no major complications. Complete procedural success was achieved in 18 (64%) and clinical success in 27 patients (96%), respectively. Procedural success and complexity varied between lead types. The Medtronic SelectSecure™ lead was associated with increased odds of extraction by simple traction ( p  = 0.006) and complete procedural success ( p  < 0.001) while the Boston Scientific Fineline™ II lead family had increased odds of partial procedural failure ( p  = 0.017)., Conclusions: TLE with the use of mechanical powered rotational dissection sheaths is feasible and safe in pediatric patients. In light of rare complications and excellent overall clinical success, TLE should be considered an important cornerstone in lifetime lead management in children. Particular lead types might be more challenging and less successful to extract., Competing Interests: VF, CS and FB declare relevant financial activities unrelated to the submitted work with several commercial entities. VF has relevant financial activities with Medtronic, Biotronik, Abbott, Boston Scientific, Edwards Lifesciences, Berlin Heart, Novartis Pharma, JOTEC and Zurich Heart in relation to educational grants (including travel support), fees for lectures and speeches, fees for professional consultation and research and study funds. CS has received consulting fees and travel expenses from Medtronic; consulting fees and research support from Biotronik; research support from Abbott; workshop fees, consulting fees, educational grants, and research support from Cook Medical; consulting fees from Spectranetics/Philips; consulting fees from Angiodynamics. FB has received consulting fees and travel expenses from Medtronic; consulting fees, travel expenses and research support from Abbott; consulting fees from Venus Medtech Europe. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Heck, Peters, Lanmüller, Photiadis, Berger, Falk, Starck and Kramer.)

Aims: Several large studies have documented the outcome of transvenous lead extraction (TLE), focusing on laser and mechanical methods. To date there has been no large series addressing the results obtained with rotational lead extraction tools. This retrospective multicentre study was designed to investigate the outcomes of mechanical and rotational techniques., Methods and Results: Data were collected on a total of 2205 patients (age 66.0 ± 15.7 years) with 3849 leads targeted for extraction in six European lead extraction centres. The commonest indication was infection (46%). The targeted leads included 2879 pacemaker leads (74.8%), 949 implantable cardioverter-defibrillator leads (24.6%), and 21 leads for which details were unknown; 46.6% of leads were passive fixation leads. The median lead dwell time was 74 months [interquartile range (IQR) 41-112]. Clinical success was obtained in 97.0% of procedures, and complete extraction was achieved for 96.5% of leads. Major complications occurred in 22/2205 procedures (1%), with a peri-operative or procedure-related mortality rate of 4/2205 (0.18%). Minor complications occurred in 3.1% of procedures. A total of 1552 leads (in 992 patients) with a median dwell time of 106 months (IQR 66-145) were extracted using the Evolution rotational TLE tool. In this subgroup, complete success was obtained for 95.2% of leads with a procedural mortality rate of 0.4%., Conclusion: Patient outcomes in the PROMET study compare favourably with other large TLE trials, underlining the capability of rotational TLE tools and techniques to match laser methods in efficacy and surpass them in safety., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)