Chris Malaisrie

Clinical experience and patient outcomes associated with the TandemHeart percutaneous transseptal assist device among a heterogeneous patient population.

There is a paucity of literature describing the outcomes associated with the use of TandemHeart percutaneous ventricular assist device (PVAD). The literature is limited by analyzing only subsets of patients. We present the clinical outcomes and safety associated with the use of TandemHeart among a series of heterogeneous patients requiring PVAD support. We reviewed the clinical experience, hemodynamic variables, survival outcomes, and complications associated with the implantation of TandemHeart support device among 25 patients presenting to our institution. Indications for PVAD implantation were cardiogenic shock (56%), ST-segment elevation myocardial infarction (STEMI) (20%), postpericardiotomy (16%), and high-risk percutaneous coronary interventions (PCI) or ventricular tachycardia (VT) ablation (8%). TandemHeart was used for an average of 4.8 ± 2.1 days and demonstrated significant hemodynamic improvements (pre- and postimplantation left ventricular ejection fractions were 21.5% ± 15% and 24.5% ± 10.5%, respectively [p = 0.06]). The cardiac index improved from a mean 2.04 ± 075 L/min/m2 to 2.45 ± 073 L/min/m2 (p = 0.09). The mixed venous oxygen saturation (SVO2) increased from 55.14 ± 13.34 to 66.43 ± 7.43 (p = 0.008) after implantation. TandemHeart was used as a bridge to left ventricular assist device implantation (44%) or recovery (20%). Thirty-six percent of patients died on support or shortly after PVAD removal. Thirty, 90-day, and long-term (>90 days) survival rates were 56%, 52%, and 36%, respectively. Procedure-related complications were reported in 13 patients (56%), and the majority (90%) was related to vascular access (bleeding or pseudoaneurysm). The TandemHeart device is a safe therapeutic option as a bridge-to-recovery or bridge-to-bridge for patients with hemodynamic compromise regardless of the etiology. The favorable hemodynamic profile, postimplantation survival rates, and manageable complications support its use to assist hemodynamic recovery in patients refractory to conventional therapy.

Single-Center Experience Using AngioVac with Extracorporeal Bypass for Mechanical Thrombectomy of Atrial and Central Vein Thrombi

The AngioVac device (AngioDynamics, Inc, Queensbury, New York), a commercially available large-diameter aspiration cannula using extracorporeal venovenous bypass, is designed to facilitate en bloc mechanical thrombectomy of massive thrombi of the central vasculature. Between February 2014 and January 2015, seven consecutive patients, each presenting with large central thrombi of the iliac veins, vena cava, right atrium, or pulmonary artery, underwent thrombectomy. Partial or complete clot abatement was achieved in all instances. All patients survived the procedure. One case was complicated by embolization of septic thrombi. At most recent follow-up, one patient had died of causes unrelated to venous thrombosis; all other patients were living (median follow-up time 8 mo). Several technical and therapeutic insights were gained from our centers early experience.

From unicuspid to quadricuspid: influence of aortic valve morphology on aortic three-dimensional hemodynamics.

To assess the impact of aortic valve morphology on aortic hemodynamics between normal tricuspid and congenitally anomalous aortic valves ranging from unicuspid to quadricuspid morphology.

Evolution of Precision Medicine and Surgical Strategies for Bicuspid Aortic Valve-Associated Aortopathy

Bicuspid aortic valve (BAV) is a common congenital cardiac malformation affecting 1–2% of people. BAV results from fusion of two adjacent aortic valve cusps, and is associated with dilatation of the aorta, known as bicuspid valve associated aortopathy. Bicuspid valve aortopathy is progressive and associated with catastrophic clinical events, such as aortic dissection and rupture. Therefore, frequent monitoring and early intervention with prophylactic surgical resection of the proximal aorta is often recommended. However, the specific pattern of aortopathy is highly variable among patients, with different segments of the ascending aorta being affected. Individual patient risks are sometimes difficult to predict. Resection strategies are informed by current surgical guidelines which are primarily based on aortic size and growth criteria. These criteria may not optimally reflect the risk of important aortic events. To address these issues in the care of patients with bicuspid valve aortopathy, our translational research group has focused on validating use of novel imaging techniques to establish non-invasive hemodynamic biomarkers for risk-stratifying BAV patients. In this article, we review recent efforts, successes, and ongoing challenges in the development of more precise and individualized surgical approaches for patients with bicuspid aortic valves and associated aortic disease.

An unusual case of a large cavernous hemangioma invading the left ventricular apex.

Cardiac hemangiomas are extremely rare benign vascular tumors of the heart. We present the unusual case of a 60-year-old man with a large cavernous hemangioma involving the left ventricular apex. The tumor was completely excised under cardiopulmonary bypass. The pertinent literature is reviewed and the technical steps, clinical presentation, and histopathologic findings are discussed.

Viscous Energy Loss in Aortic Valve Disease Patients

Purpose: Aortic valve disease (AVD) in the form of stenosis, insufficiency, or congenital defect will disrupt normal function beyond the valve itself. This includes an increase in cardiac afterload and a drastic alteration in post-valvular 3D blood flow patterns1, 2. The current AHA/ACC standard-of-care guidelines, however, assess disease severity based on simplified measurements local to the valve, such as: peak velocity, effective orifice area, regurgitation, aortic diameter and transvalvular pressure gradient3. Paradoxically, it is known that similarly classified AVD patients under these guideline metrics can exhibit radically divergent outcomes — implying an incomplete characterization of the disease4. For this reason, functional assessment and risk-stratification may benefit from a robust methodology capable of quantifying the energetic load placed on the left ventricle (LV) due to the presence of AVD. The measurement of viscous energy loss, a parameter which is directly responsible for increased cardiac afterload and is independent of pressure recovery effects, is a promising candidate to quantify LV loading. With this in mind, the 4D flow technique (time-resolved 3D phase-contrast MRI with all principal velocity directions encoded) provides the necessary information to calculate this parameter. Therefore, we present a theoretical basis for the use of 4D flow MRI to characterize in-vivo energy loss and apply the technique in a pilot study of patients with aortic valve stenosis (n = 13) or aortic dilation (n = 17) as compared to normal controls (n = 12).© 2013 ASME

From Unicuspid to Quadricuspid: Influence of Aortic Valve Morphology on Aortic 3D Hemodynamics

To assess the impact of aortic valve morphology on aortic hemodynamics between normal tricuspid and congenitally anomalous aortic valves ranging from unicuspid to quadricuspid morphology.

From unicuspid to quadricuspid: Influence of aortic valve morphology on aortic three-dimensional hemodynamics: Aortic Valve Morphology on 3D Hemodynamics

To assess the impact of aortic valve morphology on aortic hemodynamics between normal tricuspid and congenitally anomalous aortic valves ranging from unicuspid to quadricuspid morphology.