Search

Patients with left ventricular assist devices (LVAD) often tolerate ventricular arrhythmias (VA). We aim to assess the frequency and outcomes of ICD therapies averted by ultraconservative ICD programming (UCP) in LVAD patients.This single center, retrospective cohort study included patients with LVADs and ICDs implanted from 2015 to 2019 that had UCP. The aim for UCP was to maximally delay VA treatments and maximize anti-tachycardia pacing (ATP) prior to ICD shocks. VA events were reviewed after UCP and evaluated under prior conservative programming to assess for potentially averted events (that would have resulted in either ATP or defibrillation with prior programming).Fifty patients were included in the study with follow-up of median 16 ± 10.2 months after UCP. The median time from LVAD implantation to reprogramming was 7 days (IQR 5-9 days). Fourteen patients (28%) had potentially averted VA events that would have been treated with their prior ICD programming (82 total events, median two events per patient, IQR 1-10 events). Treated VA events occurred in 15 patients (30%). Eleven of the 14 patients with potentially averted VAs had treated events as well. Only one patient reported definitive symptoms of self-limited "dizziness" during a potentially averted event that did not result in hospitalization. No patients died of complications from or needed emergent care/hospitalization due a potentially averted VA.UCP in LVAD patients likely prevented unnecessary VA treatments in many patients with minimal reported symptoms during these potentially averted events. Prospective studies are necessary to confirm these findings.

Introduction Electromagnetic interference (EMI) from left ventricular assist devices (LVADs) can cause implantable cardioverter-defibrillator (ICD) oversensing. We sought to assess the frequency of inappropriate shocks/oversensing due to LVAD-related EMI and prospectively compare integrated (IB) versus dedicated bipolar (DB) sensing in patients with LVADs. Methods Single-center study in LVAD patients with Medtronic or Abbott ICDs between September 2017 and March 2020. We excluded patients that were pacemaker dependent. Measurements were obtained of IB and DB sensing and noise to calculate a signal-to-noise ratio (SNR). Device checks were reviewed to assess appropriate and inappropriate sensing events. Results Forty patients (age 52 ± 14 years, 75% men, 38% ischemic cardiomyopathy) were included with the median time between LVAD implantation and enrollment of 6.7 months [2.3, 11.4 months]. LVAD subtypes included: HeartWare (n=22, 55%), Heartmate II (n=10, 25%), and Heartmate III (n=8, 20%). Over a follow-up duration of 21.6 ± 12.9 months after LVAD implantation, 5% of patients (n=2) had oversensing of EMI from the LVAD (both with HeartWare LVADs and Abbott ICDs) at 4 days and 10.8 months after LVAD implantation. Both patients underwent adjustment of ventricular sensing with resolution of oversensing and no further events over 5 and 15 months of further follow-up. The SNR was similar between IB and DB sensing (50 [29-67] and 57 [41-69], p=0.89). Conclusion ICD oversensing of EMI from LVADs is infrequent and can be managed with reprogramming the sensitivity. There was no significant difference in the R-wave SNR with IB versus DB ICD leads. This article is protected by copyright. All rights reserved.

Left ventricular assist devices (LVADs) use in treatment of stage D heart failure (HF) has evolved and expanded in the past decade. There is paucity of data on LVAD utilization in patients with age ≥65 years with multiple co-morbidities. We aimed to investigate utilization trends, outcomes, and rates and predictors of readmissions in patients receiving LVADs with age ≥65 years (AO) and comparing them with patient age65 years (AY). We analyzed hospitalization data from the Nationwide Inpatient Sample from 2007 to 2015 to evaluate LVAD utilization trends and outcomes between the 2 patient cohorts. We also queried the Nationwide Readmission Database from 2014 to third quarter of 2015 to identify trends and compare etiologies of readmissions. Implants in AO patients increased from 20% (154) of the total LVADs implanted in 2007 to 33.2% (1,215) in 2014 and 31.8% (910) through September 2015 (p0.01). Over the study period there was a steady and significant increase in the mean Elixhauser scores in elderly patients who underwent LVAD implantation from 15.4 in 2007 to 24.54 in 2015 (p0.01). Despite this finding, the mean LOS in the AO cohort decreased from 56.0 days in 2007 to 33.8 days in 2015 (p0.001). Furthermore, the in-hospital mortality associated with LVAD implantation among the AO group gradually decreased over the study time period (39% in 2007 to 12.2% in 2015, p0.001). The overall readmission rate was not significantly different between AO versus AY group (28% vs 33%, p = 0.2). The most common cause in both groups was gastrointestinal bleed but it was significantly higher in AO group (24.3% vs 11.3%, p = 0.01). In conclusion, patients age ≥65 years with multiple co-morbidities are receiving increasing number of LVADs with improved survival outcomes. Their 30-day readmissions are comparable to the younger patients.

Background The usefulness of right heart catherization (RHC) has long been debated, and thus, we aimed to study the real‐world impact of the use of RHC in cardiogenic shock. Methods and Results In the Nationwide Readmissions Database using International Classification of Diseases, Tenth Revision ( ICD‐1 0 ), we identified 236 156 patient hospitalizations with cardiogenic shock between 2016 and 2017. We sought to evaluate the impact of RHC during index hospitalization on management strategies, complications, and outcomes as well as on 30‐day readmission rate. A total 25 840 patients (9.6%) received RHC on index admission. The RHC group had significantly more comorbidities compared with the non‐RHC group. During the index admission, the RHC group had lower death (25.8% versus 39.5%, P P P =0.04) and death on readmission (7.9% versus 9.3%, P =0.03) were also lower in the RHC group. After adjustment, RHC was associated with lower index admission mortality (odds ratio, 0.69; 95% CI, 0.66–0.72), lower stroke rate (odds ratio, 0.81; 95% CI, 0.72–0.90), lower 30‐day readmission (odds ratio, 0.83; 95% CI, 0.78–0.88), and higher left ventricular assist device implantations/orthotopic heart transplants (odds ratio, 6.05; 95% CI, 4.43–8.28) during rehospitalization. Results were not meaningfully different after excluding patients with cardiac arrest. Conclusions RHC use in cardiogenic shock is associated with improved outcomes and increased use of downstream advanced heart failure therapies. Further blinded randomized studies are required to confirm our findings.

Various risk models with differing discriminatory power and predictive accuracy have been used to predict right ventricular failure (RVF) after left ventricular assist device (LVAD) placement. There remains an unmet need for a contemporary risk score for continuous flow (CF)-LVADs. We sought to independently validate and compare existing risk models in a large cohort of patients and develop a simple, yet highly predictive risk score for acute, severe RVF. Data from the Mechanical Circulatory Support Research Network (MCSRN) registry, consisting of patients who underwent CF-LVAD implantation, were randomly divided into equal-sized derivation and validation samples. RVF scores were calculated for the entire sample, and the need for a right ventricular assist device (RVAD) was the primary endpoint. Candidate predictors from the derivation sample were subjected to backward stepwise logistic regression until the model with lowest Akaike information criterion value was identified. A risk score was developed based on the identified variables and their respective regression coefficients. Between May 2004 and September 2014, 734 patients underwent implantation of CF-LVADs [HeartMate II LVAD, 76% (n = 560), HeartWare HVAD, 24% (n = 174)]. A RVAD was required in 4.5% (n = 33) of the patients [Derivation cohort, n = 15 (4.3%); Validation cohort, n = 18 (5.2%); P = 0.68)]. 19.5% of the patients (n = 143) were female, median age at implant was 59 years (IQR, 49.4-65.3), and median INTERMACS profile was 3 (IQR, 2-3). RVAD was required in 4.5% (n = 33) of the patients. Correlates of acute, severe RVF in the final model included heart rate, albumin, BUN, WBC, cardiac index, and TR severity. Areas under the curves (AUC) for most commonly used risk predictors ranged from 0.61 to 0.78. The AUC for the new model was 0.89 in the derivation and 0.92 in the validation cohort. Proposed risk model provides very high discriminatory power predicting acute severe right ventricular failure and can be reliably applied to patients undergoing placement of contemporary continuous flow left ventricular assist devices.

Although seen in ∼5% of sarcoidosis patients, cardiac sarcoidosis (CS) accounts for nearly 25% of disease-related deaths. This study aimed to describe characteristics and outcomes among CS patients. Patients diagnosed with CS in 2016-2017 in the US National Inpatient Sample Database were evaluated to study patient characteristics, reasons ascribed to admission, in-hospital outcomes, and complications. A total of 2420 patients (median age 56 years) were included in the analysis. Most admissions occurred due to ventricular tachycardia (12.8%), followed by myocarditis (9.9%) with a mean length of stay of 7 ± 7 days. The overall incidence of in-hospital mortality was 2.5%.

Left ventricular assist devices (LVAD) have been increasingly used in the treatment of end-stage heart failure. While warfarin has been uniformly recommended in the long-term as anticoagulation strategy, no clear recommendation exists for the post-operative period. We sought to evaluate the feasibility of enoxaparin in the immediate and early postoperative period after LVAD implantation.This is a two-center, retrospective analysis of 250 consecutive patients undergoing LVAD implantation between January 2017 and December 2018. Patients were bridged postoperatively to therapeutic INR by either receiving unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Patients were followed while inpatient and for 3 months after LVAD implantation. The efficacy outcome was occurrence of first and subsequent cerebrovascular accident while safety outcome was the occurrence of bleeding events. Length of stay (LOS) was also assessed.Two hundred fifty and 246 patients were analyzed for index admission and 3-month follow up respectively. No statistically significant differences were found between the two groups in CVA (OR = 0.67; CI = 0.07-6.39, P = 0.73) or bleeding events (OR = 0.91; CI = 0.27-3.04, P = 0.88) during index admission. Similarly, there were no differences at 3 months in either CVAs or bleeding events (OR = 0.85; 0.31-2.34; p = 0.76). No fatal events occurred during the study follow-up period. Median LOS was significantly lower (4 days; p = 0.03) in the LMWH group.LMWH in the immediate and early postoperative period after LVAD implantation appears to be a concurrently safe and efficacious option allowing earlier postoperative discharge and avoidance of recurrent hospitalizations due to sub-therapeutic INR.

Background Sudden cardiac arrest (SCA) remains a significant cause of morbidity and mortality. Current evidence on readmission rates and causes after SCA are scarce. Purpose To describe patient characteristics, predictors of readmission and outcomes patients with history of sudden cardiac arrest and 30-day readmission Methods We analyzed the National Readmission Database for years 2016 and 2017 to identify all patients with initial diagnosis of SCA and 30 days readmission after the initial event. We analyzed baseline characteristics and looked into predictors, outcomes and diagnoses of re-admission. Results We identified 79,844 patients with an initial diagnosis of SCA that were discharged alive after index admission. Of those 14,387 (18.01%) had one readmission and 3,978 (4.99%) had more than one readmission. The mean age was 64 years and 41.3% were females. Hypertension, dyslipidemia, diabetes, CAD, CHF and CKD were present in 76.5%, 42.4%, 46.3%, 50.4%, 62.3% and 43.5% respectively. Overall mortality was 9.1% and length of stay 7.8 days. (Table 1). Congestive heart failure was the predominant diagnosis for readmission (Figure). Female sex (HR=0.93; p=0.004) was the only independent risk factor for all cause readmission. Conclusions Patients with history of SCA that have a 30-day readmission have significantly more comorbidities and length of day. Congestive heart failure is the predominant diagnosis for readmission Funding Acknowledgement Type of funding source: None

Background Left ventricular assist devices (LVAD) have been increasingly used in the treatment of end-stage heart failure. While warfarin has been uniformly recommended in the long-term as anticoagulation strategy, no clear recommendation exists for the post-operative period. We sought to evaluate the feasibility of enoxaparin in the immediate and early postoperative period after LVAD implantation. Methods This is a two-center, retrospective analysis of 250 consecutive patients undergoing LVAD implantation between January 2017 and December 2018. Patients were bridged postoperatively to therapeutic INR by either receiving unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Patients were followed while inpatient and for 3 months after LVAD implantation. The efficacy outcome was occurrence of first and subsequent cerebrovascular accident while safety outcome was the occurrence of bleeding events. Length of stay (LOS) was also assessed. Results Two hundred fifty and 246 patients were analyzed for index admission and 3-month follow up respectively. No statistically significant differences were found between the two groups in CVA (OR = 0.67; CI = 0.07–6.39, P = 0.73) or bleeding events (OR = 0.91; CI = 0.27–3.04, P = 0.88) during index admission. Similarly, there were no differences at 3 months in either CVAs or bleeding events (OR = 0.85; 0.31–2.34; p = 0.76). No fatal events occurred during the study follow-up period. Median LOS was significantly lower (4 days; p = 0.03) in the LMWH group. Conclusions LMWH in the immediate and early postoperative period after LVAD implantation appears to be a concurrently safe and efficacious option allowing earlier postoperative discharge and avoidance of recurrent hospitalizations due to sub-therapeutic INR.

Objective This prospective observational study was undertaken to evaluate the utility of a miniature transesophageal echocardiography probe (ImaCor hemodynamic [hTEE]) in the management of hemodynamically unstable intensive care unit patients with and without various forms of mechanical circulatory support. Design A prospective observational study. Setting A single tertiary care cardiothoracic and surgical intensive care unit. Participants Fifty-three cardiothoracic and surgical intensive care unit patients undergoing miniature transesophageal echocardiography examinations. All patients had hemodynamic instability as defined by necessity of mechanical circulatory support (MCS) devices or vasoactive medications. Interventions From April 2012 to February 2014, 53 hemodynamically unstable intensive care unit patients received an examination with the miniature transesophageal echocardiography probe when deemed necessary by the intensivist for rapid and/or ongoing transesophageal echocardiographic examinations. Twenty-eight of the examinations were performed in patients with MCS devices (53%). The remainder of examinations (n = 25, 47%) were performed in patients after other cardiothoracic surgery or noncardiac surgery with cardiac complications. Measurements and Main Results The measured endpoint was determination of usefulness of management guidance due to the miniature transesophageal echocardiographic examination as assessed by the intensivist caring for the patient. The incidence of hTEE imaging provoking a change in management also was recorded. Overall, of the 53 examinations, 77% (n = 41) provided useful information to the management. Of the 25 examinations in patients without MCS, 92% (n = 23) of the examinations were useful in guiding management. Among the 28 examinations in patients with MCS devices, 64% (n = 18) of examinations were useful in guiding management (odds ratio = 0.156; 95% confidence interval, 0.015-0.899; p = 0.022). Eight of the 53 examinations (15%) were deemed to have “poor image quality” by the echocardiographer. Age, sex, and body mass index did not significantly affect the usefulness of the hTEE examinations. Conclusion Examination of a heterogeneous hemodynamically unstable intensive care population with a miniature transesophageal echocardiography probe provided useful information beyond standard intensive care unit monitoring data, which influenced post-hTEE medical decision making. The examinations were more useful in patients without MCS devices than in those with MCS. Of the patients with MCS, patients with durable ventricular assist devices had the lowest rate of useful examinations.

We compared maximal plasma concentrations (Cmax) of sildenafil and metabolite n-desmethyl sildenafil in 12 inpatients with left ventricular assist devices (LVADs) on sildenafil (60 mg/day) to the reference range. Sildenafil Cmax (156.8 ± 124.5 ng/ml) was elevated in 66% of patients, with a two to fivefold increase over the upper limit of the reference range in 25% of patients. Metabolite Cmax (133.3 ± 102.0 ng/ml) was elevated in 75% of patients, with a three to sevenfold increase over the upper limit of the reference range in 40% of patients. Patients with heart failure and LVADs are at increased risk of concentrated-related sildenafil adverse events.

Introduction: Tricuspid valve (TV) regurgitation is the most common valvular pathology after orthotopic heart transplant (OHT). The number of transplants being performed is increasing with patients living longer after heart transplant. Data on TV surgery in OHT recipients is limited. Methods: We sought to analyze the outcomes of patients undergoing TV surgery from a large diverse, multicentric, nationwide cohort using the Nationwide Inpatient Sample (NIS) database. Results:A total of 42,766 TV repair or replacement (bioprosthetic and mechanical) involving adult patients (age ≥18 years) between 2007 and September 2015 were identified. Of these, 366 were performed in patients with OHT. TV repair was the most common surgery performed in both groups (OHT group and native heart group). Compared to the native group, patients with OHT had a significantly higher incidence of cardiogenic shock (20 vs. 11%, p = 0.024), acute kidney injury (AKI) (59 vs. 30%, p < 0.001), and AKI requiring hemodialysis (13 vs. 4%, p < 0.001). Also, the mean length of stay for the index admission was significantly longer in the OHT group (27 vs. 17 days, p = 0.008). The mortality rate was similar between the two groups (7 vs. 8%, p = 0.753). The number of TV surgeries performed in OHT patients from 2007 to 2014 have remained stable (p = 0.803) compared to those in native heart patients which showed a significantly increasing trend (p = 0.019) during the same time period. Conclusions: TV surgery remains an important treatment modality among the OHT population and carries a similar mortality during index hospitalization as that in native heart patients undergoing TV surgery.

Background Real world experience of treatment of female patient with history of breast cancer suffering from STEMI is lacking Purpose To study the trends, utilization of therapies and outcomes of STEMI in females with history of breast cancer from a large, national, multicenter US database. Methods We analyzed Nationwide Inpatient Sample from years 2007 to 2014 to identify all females with primary discharge diagnosis of STEMI and secondary diagnosis of breast cancer. We then analyzed the use of various therapies and outcomes. Results Of 476,462 females with STEMI hospitalizations, 17, 357 (3.65%) had history of breast cancer. In this patient cohort the mean age was 75.81±11.82 years and 85% were Caucasians, hypertension, diabetes mellitus, chronic kidney disease and peripheral vascular disease was present in 29.5%, 70.3%, 12.4% and 8.3% respectively. 50% of the patients underwent percutaneous coronary intervention (PCI) and 3% underwent coronary artery bypass surgery (CABG). Intra-aortic balloon pump was used in 5.2% and percutaneous LVAD (PLVAD) in 0.5%. 15.3% patients developed cardiogenic shock (CS) and 6.2% had ventricular fibrillation/cardiac arrest (Vfib/CA). The in-hospital mortality was 12.3%. Comparison of female patients for STEMI with and without history of breast cancer Group Patients No Age (mean) PCI CABG IABP PLVAD CS Vfib/CA Mortality STEMI / Breast cancer − 495,105 69±14 54% 4.5% 6.5% 3% 9.42% 8.1% 9.7% STEMI / Breast cancer + 17,357 75.8±11.8* 50%* 3%* 5.2%* 0.5%* 15.3%* 6.2%* 12.3%* *P Conclusion The STEMI/breast cancer cohort is significantly older with underutilization of PCI, CABG, and mechanical circulatory support. This population exhibits higher mortality rates. Acknowledgement/Funding None

Background Sudden cardiac arrest (SCA) is a leading cause of death in the United States (US), claiming up to 450,000 lives annually and accounting for ∼25% of deaths following orthotopic heart transplantation (OHT), Purpose We sought to characterize OHT patients suffering SCA and their subsequent management, in comparison to the general, native heart (NH) population, using a large national inpatient database. Methods A cross-sectional analysis was performed among US OHT & NH patients hospitalized with incident SCA or ventricular fibrillation/flutter. We analyzed demographics, baseline characteristics, procedural utilization and outcomes. Groups were compared with standard statistical techniques. A P-value Results From 2007–2015, 920 SCA admissions were identified among 121,083 (0.8%) OHT hospitalizations, compared to 1,731,658 (0.6%) in the general population (P Table 1. SCA in OHT & general populations Orthotopic Heart Transplant General Population P-value (N=121,083) (N=278,463,550) Sudden cardiac arrest (SCA) events, n (%) 920 (0.8%) 1,731,658 (0.6%) Conclusions SCA hospitalizations occur more often and with higher mortality in OHT patients compared to the general population. Earlier recognition of at-risk patients may result in improved utilization of potentially life-saving therapies.

Background The bioreactance technique is a relatively new, totally noninvasive technique that is used to measure cardiac output (CO) and is easy to use. The Non-Invasive Cardiac Output Monitor (NICOM) is 1 such system. Although approved by the Food and Drug Administration for measurement of stroke volume, there is a paucity of literature validating this technology in decompensated heart failure and cardiogenic shock. Methods and Results Fifty patients admitted to our cardiac intensive care unit for cardiogenic shock and Swan-Ganz catheter-guided therapy were prospectively enrolled in the study after informed consent. Simultaneous measurements of CO were obtained using NICOM, indirect Fick and bolus thermodilution. The intraclass correlation coefficient (ICC) was used to assess the precision of NICOM for CO using the 3 repeated measurements of CO over the pooled data. The agreement of the NICOM device in the defined clinical population, compared to indirect Fick and thermodilution, was evaluated by comparing the Pearson correlation coefficient, the Bland-Altman plot and the Lin concordance correlation coefficient. The ICC for cardiac output measured by NICOM showed excellent repeatability (ICC = 0.93, 95% CI = 0.92–0.94, n = 262) in the pooled data. The Pearson correlation coefficient for cardiac output measured by NICOM was poor when compared to indirect Fick (n = 263, r = 0.132, P = 0.033) and TD (n = 258, r = 0.275, P Conclusions NICOM technology is not a reliable method of measuring CO in patients with decompensated heart failure and cardiogenic shock.

Pregnancy is contraindicated in patients with Left Ventricular Assist Device (LVAD). A 24 year old female with history of substance abuse and LVAD implantation presented to the ER with chest pain. Urine pregnancy test was positive and obstetric ultrasound confirmed pregnancy with gestational age (

Precise diagnosis and troubleshooting of LVAD complications require thorough and careful evaluation of imaging, lab testing and LVAD parameters. A 60 yo man with NICM and HM3 implant presented with dizziness and low flow alarms. ECG showed VT at 160 bpm. Labs showed AKI, normal plasma free

Academic medical centers are commonly referred challenging cases from the community. Fragmented and ultra-specialized care may introduce biases in medical decision-making. A 64-year-old white male with a history of heart failure with preserved ejection fraction, severe diastolic dysfunction

Background: Owing to this improved technology and peri-implantation care around 90% of patients being considered for mechanical circulatory support receive an LVAD. Although LVAD support is associated with improved survival and quality of life, infectious complications remain a major limitation. The exact incidence of LVAD-related and non-VAD related infections among patients with VADs is unknown. Several potential factors make patients with VADs more prone to infectious complications, most obvious being the presence of an implanted device. Temporary alterations in the host immune system, including changes in T-cell function and quantity, have been observed after VAD implantation and may contribute to development of VAD-related infections. The optimal approach to empiric antibiotic therapy and duration of treatment has yet to be fully elucidated. Current treatment recommendations are based on observational studies and expert opinion, as no randomized controlled trials have evaluated empiric treatment of VAD infections. In the past several years we have expanded our understanding of driveline infections in VAD patients. However, information about non-drive line infections in VAD patients remains limited. Study Objectives: This is a quality-improvement (QI) project to look for preventable causes of driveline as well as non-driveline infections (i.e. VAD related and non-VAD related infections) among LVAD patients cared for at University of Kansas Medical Center. Primary Objectives a) Investigate the incidence and types of non-driveline infections among LVAD patients within the first six months of their VAD implantation. b) Investigate the incidence of driveline infections among LVAD patients within the first six months of their VAD implantation. c) Identify potentially preventable causes of driveline and non-driveline infections and propose interventions to reduce the future incidence of such infections. Secondary Objective a) Share our findings with our leadership with the ultimate goal of developing recommendations on empiric antibiotic treatments based on patient-specific risk factors Study Methods: We will perform retrospective chart review of LVAD patients to establish the incidence and types of infections among these patients within the first six months of LVAD implantation. Study will only include patients who received their LVAD implantations at University of Kansas Medical Center between October 2015 and October 2017. Data collection will include patient demographics, co-morbidities and risk factors for infections, as well as infection-focused information including site of acquisition and time to onset, causative organism, and microbiological data (e.g., cultures and sensitivities, viral panels, MIC, MRSA screen) and duration of therapy.

Although milrinone infusion is reported to benefit left ventricular function in chronic left heart failure, few insights exist regarding its effects on pulmonary circulation and right ventricular function. We retrospectively reviewed right heart catheterization data at baseline and during continuous infusion of milrinone in 69 patients with advanced heart failure and analyzed the effects on ventricular stroke work indices, pulmonary vascular resistance and pulmonary arterial compliance. Compared to baseline, milrinone infusion after a mean 58 ± 61 days improved mean left ventricular stroke work index (1540 ± 656 vs. 2079 ± 919 mmHg·mL/m2, p = 0.0007) to a much greater extent than right ventricular stroke work index (616 ± 346 vs. 654 ± 332, p = 0.053); however, patients with below median stroke work indices experienced a significant improvement in both left and right ventricular stroke work performance. Overall, milrinone reduced left and right ventricular filling pressures and pulmonary and systemic vascular resistance by approximately 20%. Despite an increase in pulmonary artery capacitance (2.3 ± 1.6 to 3.0 ± 2.0, p = 0.013) and a reduction in pulmonary vascular resistance (3.8 ± 2.3 to 3.0 ± 1.7 Wood units), milrinone did not reduce the transpulmonary gradient (13 ± 7 vs. 12 ± 6 mmHg, p = 0.252), the pulmonary artery pulse pressure (25 ± 10 vs. 24 ± 10, p = 0.64) or the pulmonary artery diastolic to pulmonary capillary wedge gradient (2.0 ± 6.5 vs. 2.4 ± 6.0, p = 0.353). Milrinone improved left ventricular stroke work indices to a greater extent than right ventricular stroke work indices and had beneficial effects on right ventricular net input impedance, predominantly via augmentation of left ventricular stroke volume and passive unloading of the pulmonary circuit. Patients who had the worst biventricular performance benefited the most from chronic milrinone infusion.

Introduction Obesity paradox has been described in heart failure but data on in-hospital outcomes and readmission rates in Heart Failure with Preserved Ejection Fraction (HFpEF) in relation to body mass index (BMI) is limited. Hypothesis We hypothesized that mortality and readmissions would be lower in an obese population. Methods National Readmission Database 2016 was queried for adult patients with principal discharge diagnosis of HFpEF (I50.30-I50.33) and also had ICD 10 codes for BMI listed. Patients who died during index hospitalization were excluded from readmission analysis. Results 87041 patients met inclusion criteria and were divided in 3 groups: Non-Obese (BMI Conclusions HFpEF related readmissions were significantly higher in the morbidly obese group and obesity paradox was not observed for readmission rate in this cohort. In-hospital mortality was significantly high in non-obese group but length of stay (LOS) and total hospitalization charges were similar in non-obese and morbidly obese groups. In-hospital complications of AKI and readmissions due to AKI were significantly high in the obese and morbidly obese groups and needs further investigation.

Introduction The national data on trends, patient characteristics, utilization of therapies and outcomes in patients with sudden cardiac arrest (SCA) are lacking. Methods Using the National Inpatient Sample (NIS) database we identified yearly trends, patient characteristics, utilization of therapies and differences of in-hospital outcomes among patients with in-hospital vs out-of-hospital CA between years 2007-2015 Results A total of 1018541 patients (87% in-hospital) were identified with SCA between 2007 and 2015 with an increasing yearly trend. Of those, 201231 (20%) had AMI and 112104 (11%) cardiogenic shock and 64886 (7%) of patients underwent revascularization during same hospitalization (Table 1). Overall, 37590 (3.5%), 38489 (0.3%) and 2969 (0.3%) of patients underwent IABP, percutaneous LVAD (pLVAD) and ECMO placements respectively. While pLVAD and ECMO use has been increasing steadily in recent years, IABP use is consistently decreasing. 190 (0.05%) of patients underwent durable LVAD implantation and 225 (0.02%) underwent orthotropic heart transplant (OHT) during same hospitalization (Table 2). The length of stay (LOS) for entire cohort was 8.1(±12.4) days and the mortality for entire cohort was 68% with decreasing trend over the study period (Figure 1). The mortality in patients who underwent ECMO, durable LVAD and OHT was lower than the overall cohort (p Conclusions There has been an increase in the number of SCA patients with a concomitant decreasing mortality trend in the recent era. The mortality in patients who underwent ECMO, durable LVAD and OHT was lower than the overall cohort.

Cardiac output (CO) and cardiac index (CI) measured by pulmonary artery catheter (PAC) are used to diagnose cardiogenic shock (CS) and monitor response to therapies. Indirect Fick and Thermodilution are generally considered the “gold standard” for measurements of CO and CI. Non-invasive Cardiac

Evaluate safety and efficacy of enoxaparin for bridging sub-therapeutic INR in first 3 months of discharge after LVAD implantation. All patients who received LVAD at our institution were followed for period of 3 months after discharge or study end date whichever came earlier. Total duration on

Acute Coronary Syndrome (ACS) complicated by Cardiogenic Shock (CS) is associated with high mortality. There is paucity of data from large national studies on the trends and outcomes of ECMO use in patients with CS due to Acute Myocardial Infarction. Nationwide Inpatient Sample database was

To evaluate outcomes in patients with myocarditis who undergo endomyocardial biopsy (EMB) from a large national multicentric database. We analyzed data from the Nationwide Inpatient Sample from years 2007-2014 to identify patients with primary discharge diagnosis of myocarditis and analyzed

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides cardiopulmonary support in cardiogenic shock (CS) as a bridge to recovery, durable left ventricular assist device (LVAD) or orthotopic heart transplant (OHT). Over the past decade, there has been an increase in the use of VA-ECMO in

As ventricular-assist devices (VADs) are increasingly employed in heart failure management, a leading cause of mortality, new literature is consistently published on less-invasive implantation techniques. Although early perioperative outcomes have been shown to be favorable with minimally invasive left thoracotomy (LT) approaches compared with conventional sternotomy (CS), studies comparing long-term outcomes are lacking. We set out to evaluate long-term follow up between LT and CS approach. In a single center, retrospective review, data on patients with similar demographic profiles were collected. HeartWare (HVAD) implantation was performed by either CS or LT. Analysis was performed on perioperative adverse outcomes, and 6 month postoperative adverse events. Primary objectives of the study included comparative outcomes of morbidity and mortality between both groups at 180 days postimplantation. Eighty-one (n = 81) bridge to transplant (BTT) patients underwent CS or LT HVAD implantation. Perioperative transfusion (p = 0.04) favored the LT cohort compared with CS, with a median of 6 units and 8 units transfused for each group, respectively. No survival difference was observed between both groups at 6 months postimplantation (p = 0.52). Clinical outcomes at an average of 6 month follow up showed no difference in adverse events, including common postoperative VAD complications such as infection and right heart failure. Miniaturization of LVAD size and improvement in technology has allowed expansion of interest in alternative surgical approaches for HVAD implantation. For BTT patients, no difference in early outcome was observed 6 months after implantation using a left LT versus CS technique.