In this trial, patients with advanced heart failure were assigned to an intrapericardial centrifugal-flow LVAD or an axial-flow LVAD. The intrapericardial device was noninferior to the axial-flow ...device with respect to survival free from disabling stroke or device malfunction.
Advanced heart failure is characterized by profound limitations in survival, functional status, and quality of life despite treatment with evidence-based therapies.
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Left ventricular assist devices (LVADs) offer patients with this condition a therapeutic option that provides circulatory support while they are awaiting heart transplantation or that can serve as a permanent alternative to transplantation (i.e., “destination therapy”).
The Food and Drug Administration (FDA) approved one continuous-flow LVAD with an axial-flow design for destination therapy after outcomes with the device were shown to be superior to those with older, pulsatile LVAD technology.
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Despite the efficacy of the approved axial-flow LVAD, adverse . . .
We report a case of heart transplantation in a 68-year-old Jehovah's Witness patient with congenitally corrected transposition of the great arteries (ccTGA) who developed heart failure due to right ...ventricular dysfunction. The patient underwent successful heart transplantation without the use of blood products, employing meticulous hemostasis and careful surgical planning. This case highlights the anatomical considerations and challenges in transplanting a heart in a patient with ccTGA, including the reversed positions of the pulmonary artery and the ascending aorta. It also emphasizes the importance of tailored surgical strategies to achieve hemostasis and avoid blood transfusion in Jehovah's Witness patients. This case adds to the limited literature on heart transplantation in patients with ccTGA and demonstrates that heart transplantation can be successfully performed without blood transfusion in Jehovah's Witness patients.
The rising preference for percutaneous mitral valve-in-valve replacement (ViV TMVR) over redo surgical mitral valve replacement (MVR) is primarily due to its reduced bleeding risk. This report ...details a bloodless redo MVR performed for mitral stenosis post-ViV TMVR. We present detailed intraoperative findings, including images of the extracted bioprosthetic valves and cardiac anatomy, providing valuable insights into the surgical complexities encountered. The case underscores the importance of meticulous planning and execution in redo MVR, especially in patients with a history of multiple valve interventions. Additionally, this report discusses the potential complications associated with ViV TMVR, contributing to the evolving understanding of this procedure's long-term outcomes. Our findings highlight the need for careful consideration of patient-specific factors and the inherent risks of redo valve surgeries, aiming to improve patient outcomes in complex cardiac cases.
The WATCHMAN device offers a viable alternative to long-term oral anticoagulation for stroke prevention in nonvalvular atrial fibrillation, particularly for high-risk patients. Despite its success, ...device-related thrombosis (DRT) remains a concern, potentially restricting its wider use. We present an 83-year-old female Jehovah's Witness with atrial fibrillation who, after successful WATCHMAN device implantation, suffered multiple transient ischemic attacks six months later. Initial investigation revealed a thrombus on a slightly exposed strut of the almost completely endothelialized device. Despite treatment with warfarin and rivaroxaban, urgent surgical intervention was ultimately required to remove the thrombus completely. This case illustrates the risk of thrombus formation even with minimal strut exposure and the challenges in managing DRT. It also highlights the necessity for diligent monitoring and potential reassessment of post-implantation anticoagulation protocols. Our report adds to the limited literature regarding surgical thrombectomy following WATCHMAN implantation and provides valuable insights for clinicians managing similar scenarios.
Myocardial bridging (MB), a common anatomical variation where a segment of a coronary artery is covered by myocardium, poses a relative contraindication in heart transplantation due to the risk of ...post-transplant ischemia. This report presents a case of successful transplantation of a donor heart with MB, where unroofing (removal) of the myocardial bridge was performed. The donor was a 42-year-old male with mild nonobstructive coronary artery stenosis and MB. The recipient, a 55-year-old male, suffered from ischemic cardiomyopathy and severe heart failure. During transplantation, unroofing of the donor heart's MB was executed to mitigate the risk of myocardial ischemia. The transplantation was successful with preserved postoperative cardiac function. The unroofing procedure did not significantly extend ischemic or operative time. Postoperative electrocardiogram (ECG) and echocardiography showed no signs of myocardial ischemia. Donor hearts with MB can be utilized for transplantation with appropriate surgical intervention. This case demonstrates the potential of unroofing procedures in expanding the suitability of donor hearts for transplantation, without increasing the risk of postoperative complications or mortality.
Abnormal activation of insulin-like growth factor (IGF)-Akt signaling is implicated in the development of various diseases, including heart failure. However, the molecular mechanisms that regulate ...activation of this signaling pathway are not completely understood. Here we show that sirtuin 6 (SIRT6), a nuclear histone deacetylase, functions at the level of chromatin to directly attenuate IGF-Akt signaling. SIRT6-deficient mice developed cardiac hypertrophy and heart failure, whereas SIRT6 transgenic mice were protected from hypertrophic stimuli, indicating that SIRT6 acts as a negative regulator of cardiac hypertrophy. SIRT6-deficient mouse hearts showed hyperactivation of IGF signaling-related genes and their downstream targets. Mechanistically, SIRT6 binds to and suppresses the promoter of IGF signaling-related genes by interacting with c-Jun and deacetylating histone 3 at Lys9 (H3K9). We also found reduced SIRT6 expression in human failing hearts. These findings disclose a new link between SIRT6 and IGF-Akt signaling and implicate SIRT6 in the development of cardiac hypertrophy and failure.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Commentary: Warm ischemic injury to human donor hearts—when is it too much? Jeevanandam, Valluvan
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
April 2024, 2024-Apr, 2024-04-00, 20240401, Volume:
167, Issue:
4
Journal Article
Commentary: Redo heart transplantation: Lessons learned over the past 20 years Jeevanandam, Valluvan
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
August 2023, 2023-Aug, 2023-08-00, 20230801, Volume:
166, Issue:
2
Journal Article
Contemporary ventricular assist device therapy results in a high rate of successful heart transplantation but is associated with bleeding, infections, and other complications. Further reductions in ...pump size, centrifugal design, and intrapericardial positioning may reduce complications and improve outcomes.
We studied a small, intrapericardially positioned, continuous-flow centrifugal pump in patients requiring an implanted ventricular assist device as a bridge to heart transplantation. The course of investigational pump recipients was compared with that of patients implanted contemporaneously with commercially available devices. The primary outcome, success, was defined as survival on the originally implanted device, transplantation, or explantation for ventricular recovery at 180 days and was evaluated for both noninferiority and superiority. Secondary outcomes included a comparison of survival between groups and functional and quality-of-life outcomes and adverse events in the investigational device group. A total of 140 patients received the investigational pump, and 499 patients received a commercially available pump implanted contemporaneously. Success occurred in 90.7% of investigational pump patients and 90.1% of controls, establishing the noninferiority of the investigational pump (P<0.001; 15% noninferiority margin). At 6 months, median 6-minute walk distance improved by 128.5 m, and both disease-specific and global quality-of-life scores improved significantly.
A small, intrapericardially positioned, continuous-flow, centrifugal pump was noninferior to contemporaneously implanted, commercially available ventricular assist devices. Functional capacity and quality of life improved markedly, and the adverse event profile was favorable.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00751972.
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