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This Editorial comments on the article by Jauffret et al. in this issue. [ABSTRACT FROM AUTHOR]

The Ross procedure allows replacement of a diseased aortic valve with pulmonary root autograft, possibly avoiding the highly thrombotic mechanical valves and immunologic deterioration of tissue valves in antiphospholipid syndrome (APS). Here, we present the use of the Ross procedure in a 42‐year‐old woman with mild intellectual disability, APS, and a complex anticoagulation history after she presented with thrombosis of her mechanical On‐X aortic valve previously implanted for non‐bacterial thrombotic endocarditis. [ABSTRACT FROM AUTHOR]

Sarcopenia refers to a reduction in skeletal muscle mass and strength. Despite the known association between single-slice muscle measurements on lumbar computed tomography and poor outcomes in various clinical settings, studies using thoracic muscle measurements on cardiac magnetic resonance imaging (CMR) have been limited. Patients undergoing surgical aortic valve replacement (SAVR) between 2010 and 2020 were included if they were ≥ 50 years of age with preoperative CMR. Manual unilateral pectoralis major and minor skeletal muscle area measurements were made at the carina and normalized for body size by height to obtain skeletal muscle index (SMI). Sarcopenia was defined as the lowest sex-stratified SMI tertile and higher-risk as the highest fiftieth percentile Society of Thoracic Surgeons' (STS) mortality score. A total of 133 patients were included, 35 (26.3%) females. The average age was 64 ± 9 years, with most Caucasian (93.2%). Compared to non-sarcopenic patients, sarcopenic patients were older with lower body mass index. During a median follow-up of 27.3 (7.6–60.4) months, 10 (22.2%) deaths occurred in the sarcopenic group and 8 (9.1%) in the non-sarcopenic group (p = 0.039 by log-rank test). On subgroup analysis (66 patients), higher-risk sarcopenic patients had 10 (37.0%) deaths compared to 8 (20.5%) in higher-risk non-sarcopenic patients (p = 0.011 by log-rank test). Simple unilateral pectoralis muscle measurements on preoperative CMR can be used as an adjunct to traditional risk scores for predicting mortality post-SAVR. • Lower unilateral pectoralis muscle measurements on cardiac magnetic resonance imaging predict higher post-operative mortality in patients undergoing surgical aortic valve replacement. • Sarcopenia assessment with imaging can improve outcomes prediction when combined with traditional risk stratification scores, which typically evaluate comorbidities without incorporating frailty. • Patients with sarcopenia based on imaging evaluation would likely benefit from further optimization from a nutrition and exercise standpoint before and after surgery. [ABSTRACT FROM AUTHOR]

Pasteurella multocida is an aerobic gram-negative coccobacillus usually found in the oral cavities of most healthy cats and dogs as part of their natural oral flora. This zoonotic pathogen can cause a variety of infections in humans through bites, scratches, or licking. Infections range from less severe cases, such as infected animal bites and cellulitis, to more severe cases of pneumonia, septic arthritis, osteomyelitis, sepsis, and meningitis. However, the number of reported cases of peritoneal dialysis-associated peritonitis caused by P. multocida has been limited worldwide. Here, we report the case of a 59-year-old man undergoing continuous cycling peritoneal dialysis who developed P. multocida peritonitis, believed to be secondary to domestic cat exposure to dialysis equipment. Due to the increasing trend of pet ownership, patients maintained on peritoneal dialysis should be educated on the importance of strict hygiene and avoiding pet contact with the dialysis equipment, especially in bag exchange areas. Although the best means of preventing such infections is to avoid having pets at home, the positive psychological effects of pet ownership should also be considered. Thus, patients in such situations should be continuously educated and encouraged to be mindful of the importance of environmental hygiene. [ABSTRACT FROM AUTHOR]

Patients with severe tricuspid regurgitation (TR) exhibit high morbidity and mortality. Tricuspid transcatheter edge-to-edge repair (T-TEER) is a rapidly evolving strategy to address the unmet clinical need of severe TR therapies. Organize the current body of evidence on outcomes following use of the PASCAL (Edwards Lifesciences) system for T-TEER. For this meta-analysis, we searched the MEDLINE/PubMed, Embase, and Cochrane databases for keywords ["tricuspid"] and ["transcatheter" or "edge-to-edge"] and ["PASCAL" or "leaflet repair" or "valve repair"] from the database inception until January 11, 2023. Primary outcomes of interest were procedural success, mortality, New York Heart Association (NYHA) functional class, 6-min walking distance (6MWD), and TR severity. A total of 549 patients undergoing PASCAL or PASCAL Ace T-TEER were included. The mean age ranged from 71.0 to 80.3 years, with 25.0 to 63.6% females. The follow-up duration ranged from 30 days to 1 year. The success rate was 83.5% (409/490). There was improvement in symptoms based on NYHA classification (at 1- to 6-months; NYHA ≥3 RR 0.27 [95% CI 0.19–0.39]; p < 0.001) and 6MWD (at 1-month; 50.96 [95% CI 32.34–69.59]; p < 0.001) post-procedure. On imaging, there was improvement in TR severity post-procedure (at 1- to 12-months; ≥ severe TR 0.21 [95% CI 0.14–0.31]; p < 0.001), which remained significant with each study removed. PASCAL for T-TEER is associated with high procedural success rates along with improvements in NYHA functional class, TR severity, 6MWD, and patient-reported outcomes. • PASCAL for T-TEER is associated with high procedural success rates along with improvements in NYHA functional class, TR severity, and 6MWD. • Patient-reported health status and quality of life post-procedure also improved based on the KCCQ and MLHFQ. • PASCAL and MitraClip XTR have similar procedural outcomes, including similar procedural success and times, short-term mortality, NYHA functional class improvement, and TR severity improvement. [ABSTRACT FROM AUTHOR]

Introduction: Self‐reported measures of immunosuppression adherence have been largely examined in research settings. Methods: In this single center study of 610 kidney transplant recipients, we examined if a voluntary, non‐anonymous self‐report measure could identify non‐adherence in a routine clinic setting and how patients perceived such a measure. Non‐adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) and patient perception was elicited using a customized questionnaire. Results: Non‐responders to the survey (15%) were younger, more likely to be black, and less likely to have had a pre‐emptive transplant. Among complete responders (n = 485), 38% reported non‐adherence with non‐adherent patients being younger (54 y vs. 60 y; p =.01), less likely to have been on dialysis pre‐transplant (59% vs. 68%; p =.04), further out from transplant (37 vs. 22 months; p <.001) and had more rejections in the preceding year (8% vs. 3%; p =.02). Self‐reported non‐adherence was associated with higher calcineurin inhibitor intra‐patient variability (27.4% vs. 24.5%; p =.02), but not with donor‐specific antibody detection (27.8% vs. 21.2%, p =.15). Of patients providing feedback (n = 500), the majority of patients felt comfortable reporting adherence (92%), that the survey was relevant to their visit (71%), and that the survey did not interfere with their clinic visit (88%). Conclusion: In summary, a self‐reported questionnaire during clinic visits identified immunosuppression non‐adherence in a significant proportion of patients and was well received by patients. Integrating self‐report measures into routine post‐transplant care may enable early identification of non‐adherence. [ABSTRACT FROM AUTHOR]

Myocardial bridge occurs when the myocardium courses external to an intramyocardial coronary artery, most commonly, the left anterior descending artery. The presentation can range from an asymptomatic, incidental finding to myocardial infarction, and sudden cardiac death. We report two cases of symptomatic MBs, which were treated with surgical unroofing, using a totally endoscopic robotic-assisted off-pump approach. [ABSTRACT FROM AUTHOR]

Aim: Viral causes of acute respiratory distress syndrome (ARDS) are mostly limited to influenza A; however, adenovirus has been emerging as a cause of fulminant ARDS with a high mortality rate and no consensus on its management. Here we present a series of five patients with confirmed adenovirus infection treated for ARDS at our quaternary referral institution. Materials and methods: All patients were above 18 years old, had confirmed adenovirus infection, and were treated for acute hypoxic respiratory failure requiring mechanical ventilation in our medical intensive care unit (MICU). Demographic and clinical data were collected and analyzed. Results: Among these patients, the median age was 28 years, median BMI 28 kg/m2, median sequential organ failure assessment (SOFA) score 9, and median acute physiology and chronic health evaluation (APACHE) III score 74. All patients received lung-protective mechanical ventilation with high positive end-expiratory pressure and low plateau pressures. Three patients developed severe ARDS, two received prone position ventilation, and one was placed on extracorporeal membrane oxygenation. The median duration of mechanical ventilation, MICU length of stay, and hospital length of stay were 24, 19, and 27 days, respectively. One out of five patients died in our study. Conclusion: The mortality rate for adenovirus-associated pneumonia in the literature is estimated to be 40% in those requiring mechanical ventilation. The lower mortality at our institution could be attributed to the use of standardized protocols, which include low tidal volume ventilation, early use of neuromuscular blockade, targeting low plateau pressures, conservative fluid management, and comfort and familiarity with the use of adjunctive and rescue therapies. We recommend testing for adenovirus as part of a routine respiratory viral panel in ARDS patients, and if tested positive, transfer to tertiary or quaternary centers with the experience and rescue modalities needed to manage complicated ARDS patients. [ABSTRACT FROM AUTHOR]

Summary: Selective patients with multiple myeloma (MM) receiving immunomodulatory drugs (IMiD) are at high risk for venous thromboembolism (VTE). The SAVED score is a VTE risk prediction model recently incorporated into the National Comprehensive Cancer Network (NCCN) guidelines. Using retrospective data from 501 MM patients with new IMiD initiation between 2010 and 2019, we performed the first independent external validation of this model. The cumulative incidence of VTE after IMiD initiation at 6 and 12 months was 32% and 42% in the high‐risk group, versus 6% and 9% in the low‐risk group respectively. The C‐statistic of the SAVED score to predict VTE within 12 months of IMiD‐based treatment start was 0.74 [95% confidence interval (CI): 0.69–0.78], which outperformed several other VTE risk models in MM patients. Our findings suggest that the SAVED score is an accurate risk assessment tool for VTE stratification in patients initiating IMiD‐containing regimens. [ABSTRACT FROM AUTHOR]

• Heart transplant (HT) patients with COVID-19 did not show worse outcomes than matched controls. • Mortality in HT patients with COVID-19 may be more influenced by chronic comorbidities. • Changes in immunosuppression doses did not change HT mortality. • Mortality in HT patients with COVID-19 was not higher in the first year of transplantation. Heart transplantation (HT) recipients infected with COVID-19 may be at an increased risk of severe illness due to chronic immunosuppression. Adult HT patients hospitalized with COVID-19 at the Cleveland Clinic between March 2020 and March 2021 were included in this retrospective cohort analysis. Twenty-four HT cases were matched to 96 non-HT controls, similarly hospitalized with COVID-19, out of 11,481 patients based on different baseline characteristics. Primary outcome was all-cause mortality; secondary outcomes included mechanical ventilation, intensive care unit admission, vasopressor need, dialysis, pneumonia, and 90-day readmission. Subgroup analysis was performed based on the time from transplantation (within 1 year of transplantation and greater than 1 year since transplantation). Both primary and secondary outcomes were not significant. Subgroup analysis did not show a significant difference in mortality (P =.355) or 30-day readmission (P =.841) between patients who were within 1 year of transplantation and remote transplantation beyond 1 year. Univariable analysis of immunosuppressant continuation, dose-reduction, or discontinuation did not significantly affect HT mortality. Despite limited sample size, our results suggest that HT patients do not show worse outcomes after acquiring COVID-19, whether in the first year of transplantation or after a remote transplantation procedure. Future studies with multicenter data that incorporate the subsequent COVID-19 variants (eg, Delta and Omicron), the impact of long COVID-19, and assessing full vs reduced immunosuppression regimens would add insights to this patient population. [ABSTRACT FROM AUTHOR]

Worsening systemic congestion is often the central trigger of hospitalization in patients with heart failure. However, accurate assessment of congestion is challenging. The prognostic impact of systemic congestion following durable continuous‐flow left ventricular assist device (LVAD) implantation remains unknown. Consecutive patients who received durable continuous‐flow LVAD implantation between January 2014 and June 2017 and were followed for 1 year were included. The association of preoperative plasma volume status, which was calculated using patients' body weight and hematocrit and expressed as a deviation from ideal plasma volume, with 1‐year mortality following LVAD implantation was investigated. In total, 186 patients (median 57 years and 138 males) were included. Baseline plasma volume status was −30.1% (−37.1%, −19.4%) on median. Eighty‐eight patients (47%) had higher plasma volume status (>−29.8%), and their 1‐year survival was significantly lower than those without (67% vs. 87%, P =.001). High plasma volume status was an independent predictor of 1‐year death with an adjusted hazard ratio of 4.52 (95% confidence interval 1.52‐13.5). Baseline systemic congestion, as defined by the high plasma volume status, was associated with higher mortality following durable continuous‐flow LVAD implantation. The implication of improving preoperative plasma volume remains an area of needed investigation. [ABSTRACT FROM AUTHOR]

Background: The negative impact of baseline hypoalbuminemia on clinical outcome following left ventricular assist device (LVAD) implantation is well known. However, the implications of perioperative change in serum albumin levels on post‐LVAD outcomes remain uninvestigated. Methods: Among consecutive patients with baseline serum albumin <3.5 g/dl who received durable LVAD implantation between April 2014 and August 2017 and were followed for 1 year, the impact of perioperative change in serum albumin level from baseline to 3 months post‐LVAD on the incidence of adverse events was investigated. Results: Sixty‐eight patients (median 60 years and 69% male) were included. Serum albumin change was an independent predictor of the occurrence of adverse events with an adjusted hazard ratio of 0.32 (95% confidence interval, 0.13–0.78) and a cutoff change of 0.7 g/dl. Those with albumin increase >0.7 g/dl had higher 1‐year freedom from adverse events (45% vs. 14%, p = .008), dominantly due to lower incidence of death or sepsis compared with those without (p < .05 for both). Conclusion: Among those with baseline hypoalbuminemia, a considerable perioperative increase in serum albumin levels following LVAD implantation was associated with lower mortality and morbidity. The implication of aggressive nutrition intervention on LVAD patients is the next concern. [ABSTRACT FROM AUTHOR]

Background: The negative impact of baseline hypoalbuminemia on clinical outcome following left ventricular assist device (LVAD) implantation is well known. However, the implications of perioperative change in serum albumin levels on post-LVAD outcomes remain uninvestigated.Methods: Among consecutive patients with baseline serum albumin <3.5 g/dl who received durable LVAD implantation between April 2014 and August 2017 and were followed for 1 year, the impact of perioperative change in serum albumin level from baseline to 3 months post-LVAD on the incidence of adverse events was investigated.Results: Sixty-eight patients (median 60 years and 69% male) were included. Serum albumin change was an independent predictor of the occurrence of adverse events with an adjusted hazard ratio of 0.32 (95% confidence interval, 0.13-0.78) and a cutoff change of 0.7 g/dl. Those with albumin increase >0.7 g/dl had higher 1-year freedom from adverse events (45% vs. 14%, p = .008), dominantly due to lower incidence of death or sepsis compared with those without (p < .05 for both).Conclusion: Among those with baseline hypoalbuminemia, a considerable perioperative increase in serum albumin levels following LVAD implantation was associated with lower mortality and morbidity. The implication of aggressive nutrition intervention on LVAD patients is the next concern. [ABSTRACT FROM AUTHOR]

Background: Active smoking is associated with worse clinical outcomes following left ventricular assist device (LVAD) implantation. However, the effect of sex differences in conjunction with smoking status remains uninvestigated.Methods: Consecutive patients who underwent LVAD implantation between January 2013 and September 2018 were included. Clinical outcomes were retrospectively compared between the current smokers and never smokers among male cohorts and female cohorts separately.Results: About 130 patients, with a median age of 56 years, were included. Among the male cohort (N = 85), the current smokers (N = 25/85) had a higher total readmission rate than the never smokers (N = 60/85) with an adjusted incidence rate ratio of 2.38 (95% confidence interval, 1.16-3.85, P = .014), dominantly due to higher rates of gastrointestinal bleeding, stroke, and hemolysis. Among the female cohorts (N = 45), never smokers (N = 36/45) had a statistically comparable total readmission rate (2.80 vs 2.50 events per year; P = .37) compared with current smokers (N = 9/45).Conclusion: Among male patients with LVAD, active smoking was associated with higher rates of adverse events. Female patients with LVAD had a high rate of adverse events irrespective of smoking status. Gender-specific therapeutic approaches might be required to prevent LVAD-related comorbidities. [ABSTRACT FROM AUTHOR]

Despite the well‐established correlation between the tobacco use and cardiovascular disease, little is known about postoperative outcomes following the left ventricular assist device (LVAD) implantation. We aimed to elucidate the effect of tobacco smoking on post‐LVAD implant outcomes. Patients who received LVADs from 2013 to 2018 were retrospectively characterized as current, former, or never smokers at the time of implant. We examined 1‐year survival, total hospital readmissions, and specific hospital readmissions for LVAD‐related adverse events based on patient's smoking status. Of the enrolled patients (n = 292), 55% were former smokers, 33% were never smokers, and 11% were current smokers. The majority of patients were African‐American (48%) with a median age of 58 years. Never smokers were younger and less likely to be Caucasian compared to former or current smokers (P <.05, for both). The category of former smokers had statistically comparable total readmission rates with never smokers (2.49 vs. 2.13 event/year), whereas current smokers had significantly higher rates compared to never smokers (2.81 events/year, P <.05), with odds ratio 2.12 (95% CI = 1.35‐3.32) adjusted for age and Caucasian race for >5 times of total readmissions per year. The rates of driveline infection, stroke, and hemolysis were statistically comparable between the never smokers and former smokers, while current smokers had significantly higher rates compared to never smokers (P <.05 for all). [ABSTRACT FROM AUTHOR]