Background
Despite clear clinical benefits, there is limited evidence regarding possible complications of the novel mechanical support device Impella. Aortic and mitral valve regurgitation or injury ...are rare but potential complications following implantation of the Impella device.
Methods
To evaluate valvular complications after the Impella device implantation, we have performed a comprehensive search of literature on multiple sites on this topic.
Results and Conclusion
Ten case reports and one observational retrospective study were identified, with a total number of 19 patients identified. This article aims to draw attention to potential periprocedural complications relating to the Impella, in particular iatrogenic aortic and mitral valve injuries. Moreover, we have summarized our recommendations emphasizing the need for careful management and meticulous follow‐up of these patients to avoid such potentially devastating complications.
Oehler et al. described an interesting finding, stating that length of stay (LOS) of the donors in the intensive care unit (ICU) did not have an impact on the outcomes and survival of recipients up ...to 5 years after heart transplantation (HTx) ....
Background and Objectives: This is a propensity-matched, single-center study of limited versus extended resection for type A acute aortic dissection (AAAD). Materials and Methods: This study ...collected retrospective data for 440 patients with acute type A aortic dissection repairs (limited resection, LR-215; extended resection, ER-225), of which 109 pairs were propensity-matched to LR versus ER. Multivariate analysis was performed for inpatient death, long-term survival and the composite outcome of inpatient death/TIA/stroke. Kaplan–Meier survival curves were compared at 1, 3, 5, 10 and 15 years using the log-rank test. Results: Mean age was 66.9 ± 13 years and mean follow-up was 5.3 ± 4.7 years. A total of 48.9% had LR. In-hospital mortality was 10% (LR: 6% vs. ER: 13.8%, p < 0.01). ER, NYHA class, salvage surgery and additional procedures were predictors of increased mortality in unmatched data. Propensity-matched data showed no difference in TIA/stroke rates, LOS, inpatient mortality or composite outcomes. LR had better survival (LR: 77.1% vs. ER: 51.4%, p < 0.001). ER (OR: 1.97, 95% CI: 1.27, 3.08, p = 0.003) was a significant predictor of worse long-term survival. At 15 years, aortic re-operation was 17% and freedom from re-operation and death was 42%. Conclusions: Type A aortic dissection repair has high mortality and morbidity, although results have improved over two decades. ER was a predictor of worse perioperative results and long-term survival.
This study compared perioperative outcomes and long-term survival of saphenous vein grafts (SVGs) versus left internal thoracic artery (LITA) to left anterior descending artery (LAD) in isolated ...coronary artery bypass graft surgery (CABG).
In this retrospective, single-centre study, we included patients with primary isolated CABG from January 2001 to July 2022. Baseline demographics were compared between SVG-LAD and LITA-LAD. Univariable and multivariable regressions were performed for predictors of in-hospital death. Propensity score matching was performed for LITA-LAD vs. SVG-LAD. Kaplan-Meier survival curves were generated for comparison of survival. Cox proportional hazards model was used for predictors of survival.
A total of 8237 patients (1602 SVG-LAD/6725 LITA-LAD) were included. Median age was 67.9 years (LITA-LAD; 67.1 years vs. SVG-LAD; 71.7 years,
< 0.01). A total of 1270 pairs of SVG-LAD were propensity-matched to LITA-LAD. In matched cohorts, in-hospital mortality (0.8% vs. 1.6%, LITA-LAD and SVG-LAD respectively;
= 0.07), deep sternal wound infection, new cerebrovascular events, renal replacement therapy and hospital stay >30 days were similar. SVG-LAD did not adversely affect in-hospital mortality (OR; 2.03, CI; 0.91, 4.54,
= 0.08). Median long-term survival was similar between the groups (13.7 years vs. 13.1 years for LITA-LAD and SVG-LAD respectively, log rank
< 0.31). SVG-LAD was not a predictor of adverse long-term survival. (HR; 1.06, 95% CI; 0.92, 1.22,
< 0.40). Long-term survival was better with LITA-LAD for LVEF <30% (log rank
< 0.03).
There was no difference in the propensity-matched cohorts for use of SVG vs. LITA to the LAD. Further contemporary long-term studies are needed for substantiation.
SAŽETAK
CiljUređaj za kratkotrajnu cirkulacijsku potporu klijetkama CentriMag™ može se primijeniti u kritično bolesnih bolesnika u zadnjem stadiju srčanog zatajivanja radi kandidature ili premoštenja ...do transplantacije srca. U ovom istraživanju analizirali smo posttransplantacijske ishode bolesnika kod kojih je korišten uređaj CentriMag™ radi premoštenja do transplantacije srca ili kandidature za transplantaciju srca.
Materijali i metodeAnalizirani su svi bolesnici u zadnjem stadiju srčanog zatajivanja kojima je ugrađen uređaj CentriMag™ u svrhu premoštenja do transplantacije srca ili do kandidature za transplantaciju u razdoblju od 2004. do 2019. godine. Primarni ciljevi studije bili su jednomjesečno i jednogodišnje preživljenje nakon transplantacije srca.
RezultatiUređaj CentriMag™ je korišten u 29 bolesnika (37,2 ± 13,8 godina) u svrhu premoštenja do transplantacije (18 bolesnika, 62%) ili kandidature za transplantaciju (11 pacijenata, 38%) tijekom 15-godišnjeg razdoblja istraživanja. Uređaj je korišten kao potpora lijevoj klijetki u 9 (31%), desnoj klijetki u 6 (21%) i kao potpora objema klijetkama srca u 14 bolesnika (48%). Prije implantacije uređaja CentriMag™, 4 bolesnika (17%) su mehanički ventilirana, 4 (14%) imala su nejasan neurološki status, njih 9 (31%) imalo je ugrađenu intraaortalnu balonsku pumpu, 26 bolesnika (90%) imalo je umjerenu do tešku insuficijenciju desne klijetke, 14 (48%) imalo je zatajivanje bubrega, 5 (17%) imalo je zatajivanje više organa, a 6 (21%) imalo je prethodnu sternotomiju. Jednomjesečni mortalitet nakon implantacije uređaja CentriMag™ iznosio je 7%. Prosječno trajanje potpore bilo je 38 ± 44 dana. Nije bilo komplikacija u smislu kvara uređaja. Tridesetodnevno i jednogodišnje preživljavanje nakon transplantacije srca iznosilo je 90%, odnosno 83%.
ZaključakUređaj CentriMag™ može biti učinkovit u spašavanju bolesnika sa zatajivanjem srca koji su potencijalni kandidati za transplantaciju srca, a nisu kandidati za ugradnju uređaja za dugotrajnu potporu lijevoj klijetki. CentriMag™ se može koristiti radi premoštenja ili kandidature za transplantaciju sa zadovoljavajućim rezultatima nakon transplantacije.
Components of carotid atherosclerotic plaque can be analysed preoperatively by non-invasive advanced imaging modalities such as magnetic resonance imaging (MRI). The expression of matrix ...metalloproteinase-9 protein (MMP-9), which has a potential role in remodelling of atherosclerotic plaques, can be analysed immunohistochemically. The aim of the present prospective pilot study is to analyse histological characteristics and expression of MMP-9 in carotid plaques of patients undergoing carotid endarterectomy (CEA) and to investigate the correlation with preoperative clinical symptoms and MRI features. Preoperative clinical assessment, MRI imaging, postoperative histological and immunohistochemical analyses were performed. Fifteen patients with symptomatic (7/15; 47%) and asymptomatic carotid artery stenosis undergoing CEA were included. Among symptomatic patients, 5 (71%) had recent stroke and 2 (29%) had recent transient ischaemic attack with a median timing of 6 weeks (IQR: 1, 18) before the surgery. Both groups did not significantly differ in respect to preoperative characteristics. Prevalence of unstable plaque was higher in symptomatic than asymptomatic patients, although it was not significant (63% vs. 37%,
= 0.077). The expression of MMP-9 in CD68 cells within the plaque by semiquantitative analysis was found to be significantly higher in symptomatic as compared to asymptomatic patients (86% vs. 25% with the highest expression,
= 0.014). The average microvascular density was found to be higher and lipid core area larger among both symptomatic patients and unstable carotid plaque specimens, although this did not reach statistical significance (
= 0.064 and
= 0.132,
= 0.360 and
= 0.569, respectively). Our results demonstrate that MRI is reliable in classifying carotid lesions and differentiating unstable from stable plaques. We have also shown that the expression of MMP-9 is significantly higher among symptomatic patients undergoing CEA.
The aim of this study was to identify the reliability of carotid artery stump pressure (SP) in predicting the neurologic changes and correlation with contralateral internal carotid artery (ICA) ...occlusion in patients undergoing eversion carotid endarterectomy (CEA). The optimal method for monitoring cerebral perfusion during CEA, performed under either local or general anesthesia, is still controversial.
We prospectively analyzed 118 consecutive patients undergoing eversion CEA under local anesthesia. We had 78 symptomatic (66%) and 40 asymptomatic patients (33.9%). Selective shunting was performed in patients who developed neurologic changes after carotid clamping regardless of SP. Correlation of preoperative symptom status, a degree of stenosis, status of contralateral ICA, arterial blood pressure, SP value, and the intraoperative need for shunting due to neurologic changes was evaluated for both groups: shunted and nonshunted.
Selective shunting was performed in 12 patients (10%). There was no significant difference among the groups regarding the demographic characteristics. Mean carotid clamping time was 14.57 minutes. We had no perioperative mortality, stroke, or myocardial infarction. None of the patients required conversion to general anesthesia. We found a mean SP of 31 mm Hg as a reliable threshold for shunting (P < .001; sensitivity 92.3%; specificity 91.3%). Contralateral carotid occlusion was correlated with the significantly lower SP (27 ± 13 mm Hg; P = .001) and the higher need for shunt (50%).
SP measurement is a reliable and simple method for monitoring the collateral cerebral perfusion and can predict the need for shunting during CEA. Patients with the contralateral ICA occlusion showed significantly lower SP, although it did not have impact on the outcome.
The impact of concomitant coronary artery bypass grafting (CABG) on aortic valve replacement (AVR) in octogenarians is still debated. We analyzed the characteristics and long-term survival of ...octogenarians undergoing isolated AVR and AVR + CABG.
All octogenarians who consecutively underwent AVR with or without concomitant CABG at our tertiary cardiac center between 2000 and 2022 were included. Patients with redo, emergent, or any other concomitant procedures were excluded. The primary endpoints were 30-day and long-term survival. The secondary endpoints were early postoperative outcomes and determinants of long-term survival. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of 30-day mortality, and Cox regression analysis was performed for predictors of adverse long-term survival.
A total of 1011 patients who underwent AVR (83.0 81.0-85.0 years, 42.0% males) and 1055 with AVR + CABG (83.0 81.2-85.4 years, 66.1% males) were included in our study. Survival at 30 days and at 1, 3, and 5 years in the AVR group was 97.9%, 91.5%, 80.5%, and 66.2%, respectively, while in the AVR + CABG group it was 96.2%, 89.6%, 77.7%, and 64.7%, respectively. There was no significant difference in median postoperative survival between the AVR and AVR + CABG groups (7.1 years IQR: 6.7-7.5 vs. 6.6 years IQR: 6.3-7.2, respectively,
= 0.21). Significant predictors of adverse long-term survival in the AVR group included age (hazard ratio (HR): 1.09; 95% CI: 1.06-1.12,
< 0.001), previous MI (HR: 2.08; 95% CI: 1.32-3.28,
= 0.002), and chronic kidney disease (HR 2.07; 95% CI: 1.33-3.23,
= 0.001), while in the AVR + CABG group they included age (HR: 1.06; 95% CI: 1.04-1.10,
< 0.001) and diabetes mellitus (HR: 1.48; 95% CI: 1.15-1.89,
= 0.002). Concomitant CABG was not an independent risk factor for adverse long-term survival (HR: 0.89; 95% CI: 0.77-1.02,
= 0.09).
The long-term survival of octogenarians who underwent AVR or AVR + CABG was similar and was not affected by adding concomitant CABG. However, octogenarians who underwent concomitant CABG with AVR had significantly higher in-hospital mortality. Each decision should be discussed within the heart team.
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