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Objectives: Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has been increasingly used in cardiopulmonary resuscitation (ECPR) in select patients. Few centers have published their experience or outcomes with ECPR. The aim of our study was to evaluate outcomes of adult patients in cardiac arrest placed on VA ECMO in the catheterization laboratory. Methods: We performed a retrospective analysis of adult patients in refractory cardiac arrest who underwent ECPR at the Minneapolis Heart Institute (MHI) at Abbott Northwestern Hospital from January 2012 to December 2017. Relevant data were obtained from electronic medical records, including arrest to ECMO flow time, total ECMO support time, and outcomes. Results: Twenty-six adult patients underwent ECPR at the study site during the defined time period. Seven patients (27%) sustained cardiac arrest out of hospital, 19 patients arrested in-hospital with eight of those occurring in the catheterization laboratory. Seventeen (65%) patients had initial rhythm of ventricular fibrillation or tachycardia (VF/VT). All patients underwent mechanical CPR with LUCAS device. Overall 30 day and 6 month survival was 69%. Median time from arrest to ECMO flow was 46 mins (21,68) vs 61 mins (36,71) in survivors and non-survivors, respectively. Sixteen of 18 survivors discharged with a CPC score of 1 or 2. Conclusions: We demonstrate that adult patients in cardiac arrest initiated on VA ECMO in the cardiac catheterization laboratory and cared for by a multidisciplinary shock team in the critical care unit have superior long-term survival and functionally favorable neurologic recovery when compared to current literature.

Surveillance for environmental contamination of antineoplastic drugs has been recommended by authoritative bodies such as the United States Pharmacopeia and the National Association of Pharmacy Regulatory Authorities. Clear guidance is needed on how to develop sampling strategies that align with surveillance objectives efficiently and effectively. We conducted a series of simulations using previously collected surveillance data from nine cancer treatment centers to evaluate different sampling strategies. We evaluated the impact of sampling 2, 5, 10, or 20 surfaces, at monthly, quarterly, semi-annual, and annual frequencies, while employing either a random or sentinel surface selection strategy to assess contamination by a single antineoplastic drug (AD) or by a panel of three ADs. We applied two different benchmarks: a binary benchmark of above or below the limit of detection and AD-specific hygienic guidance values, based on 90th percentile values as quantitative benchmarks. The use of sentinel surfaces to evaluate a three-drug panel relative to 90th percentile hygienic guidance values (HGVs) resulted in the most efficient and effective surveillance strategy.

BACKGROUND: Cardiac computed tomography (CT) is increasingly used in pediatric patients with congenital heart disease (CHD). Variability of practice and of comprehensive diagnostic risk across institutions is not known. METHODS: Four centers prospectively enrolled consecutive pediatric CHD patients

OBJECTIVE To investigate the long-term outcomes of patients with severe comorbidities (sCM) undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND The benefit of TAVR may be limited among patients with sCM due to a lack of mortality- or quality-of-life-benefit. METHODS All TAVR patients in the Allina Health System between January 1, 2011 and August 7, 2018 were included (n = 890, 82 ± 8 years, 55% men). sCM included: severe lung disease, severe liver disease, end-stage renal disease, severe, severe dementia, severe dilated cardiomyopathy, and frailty. Outcomes between patients with (n = 215, 24%) and without (n = 675, 76%) sCM were compared. RESULTS At baseline, patients with sCM had worse symptoms, higher STS-PROM and a lower Kansas City Cardiomyopathy Questionnaire (KCCQ) score compared to those without. During a median follow-up of 15 months (IQR, 7-29 months), there were 208 (23%) deaths. Patients with sCM had a lower 3-year survival free from all-cause mortality (40% vs. 79%, p

Although rare in the general population, genetic arrhythmia syndromes have a significant public health impact due to their contribution to the incidence of sudden cardiac death, particularly in children and young adults. When sudden cardiac death occurs in the absence of ischemic heart disease, a genetic cardiac condition may be suspected and clinical and genetic screening of family members is recommended. The Genetic Arrhythmia Center at the Minneapolis Heart Institute collaborates with local partners in the Sudden Cardiac Arrest network to connect patients and their family members with interdisciplinary care for diagnosis and treatment of these conditions. The most common conditions seen in the Genetic Arrhythmia Center include arrhythmogenic right ventricular cardiomyopathy, left ventricular noncompaction, long QT syndrome, and Brugada syndrome. In addition to providing clinical care and genetic testing and counseling services, the Genetic Arrhythmia Center is working to advance the scientific understanding of the clinical presentation and natural history of these rare conditions.

To prevent type A aortic dissection (AD), patients with aortic diameters ≥ 5.5 cm are recommended to undergo elective aortic repair, yet AD may occur at smaller sizes. This study aimed to identify results of aortic imaging prior to AD. In a retrospective cohort of 200 patients with AD at our

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is characterized by replacement of the myocardium with fibrous and fatty tissue that may lead to increased risk of ventricular arrhythmias and heart failure. Although left ventricular (LV) and biventricular involvement have been recognized with

Pulmonary hypertension (PH) with aortic stenosis impacts 1- and 2-year survival following transcatheter aortic valve replacement (TAVR). Most PH patients who undergo TAVR normalize right ventricular systolic pressure (RVSP), yet a subset have residual PH. Retrospective review of patients with

Purpose With growing use of Left ventricular assist devices (LVAD) and a limited donor supply, it is imperative to understand the impact LVADs may have on a young and potentially working population, where psychological morbidity predicts poor health related to compliance, self-care, hospitalizations and worse outcomes. Methods The Quality of Life with a Left Ventricular Assist Device (QOLVAD) questionnaire is a valid and reliable measure of overall QOL and includes 5 domain specific scores, including Emotional and Meaning/Spiritual Domains. As part of a prospective, cross-sectional multi-site study evaluating QOL, we examined age for a significant difference in the emotional and spiritual domains. We also compared age with depressive symptoms (PHQ9). anxiety (PROMIS), and spiritual wellbeing (FACIT-Sp). Two-sample T-tests were conducted using STATA®. Results The QOLVAD tool was used on a sample of 186 patients from 7 centers across the United States, including 68 (37%) with age ≤ 55 years. The mean age was 58.5±13.8; 82.7% were male, 77.3% were White and 21.5% Black, 50% were a bridge to transplant, 30.1% destination therapy, and most common LVAD types included HeartMate II (69.1%) and HeartMate 3 (20.6%). Scores for emotional and spiritual wellbeing stratified by age are reported in the table below. Conclusion LVAD patients ≤ 55 years had lower Emotional and Meaning/Spiritual Domain QOLVAD scores compared to patients >55 years. Results also suggest that faith may be a strong resource in older patients. Further research may help delineate whether low emotional wellbeing in younger patients is influenced to a greater degree by anxiety than depression. The QOLVAD tool may help clinicians identify patients at risk of poor emotional and spiritual wellbeing earlier and assist in offering support before it compromises functioning. Limitations to this study include a population that is predominantly White and male and a lower number of responses associated with the PROMIS.

Purpose The Quality of Life with an LVAD (QOLVAD) questionnaire is a valid, reliable assessment for QoL in LVAD patients. The final 5 summary items evaluate patient perceptions of overall QoL, adjustment to a VAD and degree of agreement for replacing the VAD if it failed. In our last analysis, we noted that while females rated higher adjustment to living with a VAD, they were less likely to opt for a replacement VAD if it failed and less likely to repeat the entire process again. Our current analysis investigates if these findings can be explained by characteristics of the female cohort. Methods A prospective, cross-sectional, ongoing 7-site study of adult patients with durable LVADs completing a questionnaire bundle including the QOLVAD and Functional Assessment of Chronic Illness Therapy (FACIT-Sp) surveys. Results The overall sample included 186 patients (83% male and average age 58 years). Patient responses to the question of opting for a VAD again if they had to repeat the entire process were analyzed (n=178). No statistically significant difference was found based on patients’ marital status (p=0.971), duration of heart failure (p=0.445), education level (p=0.712) and indication for VAD (p=0.702) in patients who responded yes or no. Female patients were analyzed for this same question with respect to indication for VAD with 50% of females responding no being Bridge to Transplant (BTT) (p=0.448). For females responding no to opting for a replacement VAD for VAD failure, 25% were BTT and 50% were Destination Therapy (p=0.338). The FACIT-Sp faith subscale revealed females tended to have more faith than male patients (p=0.0378). Conclusion The responses of the QOLVAD provide helpful insight into perceptions on VAD adjustment and reimplantation. Our prior study demonstrated differences in responses based on gender. Current findings show higher faith in women compared to men, which has not previously been considered in the differences noted. Other factors like financial or caregiver burden may also contribute to the differences noted. A larger sample of females may have detected statistically significant differences in the select summary questions analyzed based on indication for VAD. This emphasizes the necessity for improved representation of female patients within LVAD studies in order to gain an accurate and insightful understanding on true patient perceptions regarding LVADs.

Purpose A valid and reliable quality of life (QOL) measure designed for left ventricular assist device (LVAD) patients has not been established. We report second stage preliminary psychometrics for the QOLVAD Questionnaire. Methods Prospective, cross-sectional study at 7 sites. QOLVAD construct validity (overall, physical, emotional, social, cognitive and meaning/spiritual QOL) was tested using confirmatory factor analysis. Convergent validity was tested using correlations between QOLVAD scores and well-established measures of subjective health status (KCCQ12), depressive symptoms (PHQ9) anxiety (PROMIS), meaning/peace and faith (FACIT). Reliability was quantified using Cronbach's alpha (for domain scores) and factor determinacy score (multidimensional reliability). Test re-test reliability was quantified using correlations and Bland-Altman tests (enrollment vs. 1 week later). Results There were 186 LVAD patients in the overall sample: 58.5±13.8 years; 82.7% male, 77.3% white, 50% bridge to transplant. Surveys were completed at median time (25th, 75th percentile) of 44 weeks (17.5±115.5) post-VAD. The five domains of the QOLVAD had good construct validity (RMSEA = 0.07, Comparative and Tucker Lewis fit indices = 0.90, weighted and standardized root mean square residual = 1.348 and 0.09, respectively). QOLVAD scores were standardized to range from 0-100 with higher values indicating better QOL. The overall and domain specific scores were significant correlated with the various other tools to which they were compared (Table). Additionally, with the exception of the cognitive domain (α=0.60), reliability was high among all areas (range 0.79 to 0.93) as was test re-test reliability (range 0.71 to 0.94; p Conclusion While a subsequent version will focus on strengthening reliability of the cognitive domain, the existing QOLVAD is a valid, reliable measure of overall QOL with an LVAD and of physical, emotional, social and meaning/spiritual domains.

Purpose Although quality of life (QOL) has been widely reported in patients receiving LVADs, spiritual wellbeing among LVAD recipients is rarely included in these reports. Methods Prospective, multi-site, cross-sectional, descriptive study of patient-reported outcomes. Depressive symptoms were measured by PHQ9 (lower = fewer symptoms). Spiritual wellbeing was measured through two different questionnaires. The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-Sp) (12-items) is an established independent measure (possible score 0-48, higher better) with a faith subscale (score 0-16) and a meaning/peace subscale (score 0-32). The QOLVAD Meaning/Spirituality subscale (5-items) is one of five domains for QOL included in the new, valid and reliable Quality of Life with an LVAD (QOLVAD) questionnaire (domain possible score 0-100, higher better). Results There were 186 LVAD patients in the overall sample: 83% male, 77% white, 22% African American, 90% HeartMate II and 3, 50% bridge to transplant, 30% destination therapy, with average age of 58.5±13.8 years. We report preliminary findings from surveys completed at median time (25th, 75th percentile) of 44 weeks (17.5±115.5) post-VAD. Faith affiliation was 69% Protestant, 19% Catholic, 6% Agnostic/Atheist, and 6% other. The mean PHQ9 score was 3.97±4.16 and FACIT-Sp 38.7±8.8. Meaning/Peace and Faith subscale scores were 26.1±5.5 and 13.0±4.0, respectively. The PHQ9 and the faith subscale of the FACIT-Sp had a significant inverse relationship (r = -0.2166, p=0.004), suggesting that patients with higher faith had fewer depressive symptoms. Similarly, scores for the PHQ and the Meaning/Spirituality subscale of the QOLVAD had a significant inverse relationship (r = -0.3121; p Conclusion Spiritual wellbeing is an important facet of assessing patient-reported outcomes in LVAD patients. Given the strong inverse correlation between spiritual wellbeing and depressive symptoms, some patients may benefit from interventions targeted at improving spiritual wellbeing during LVAD support. Findings may suggest a role for institutional support of resources to promote patient spiritual wellbeing.

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is characterized by life-threatening ventricular arrhythmias and fibrous or fatty replacement of the myocardium, which can lead to congestive heart failure. Although there are recommendations based on high-risk characteristics, there

Patients with single ventricle heart disease often have advanced diagnostic imaging performed prior to superior cavopulmonary connection (Glenn) for visualization of cardiac anatomy and thoracic vasculature. Cardiac catheterization (CC) is the standard, but newer modalities of cardiac magnetic