Hiroto Kitahara

Preoperative Right-Sided Cardiac Congestion Is Associated with Gastrointestinal Bleeding in Patients with Continuous-Flow Left Ventricular Assist Devices

BackgroundLarge scale data on preoperative risk stratification for gastrointestinal bleeding (GIB) following continuous-flow left ventricular assist device (CF-LVAD) implantation are scarce.AimsTo identify independent predictors for GIB following CF-LVAD implantation.MethodsWe conducted a retrospective cohort study of consecutive 243 patients who underwent CF-LVAD implantation (HeartMateII) from January 2009 to March 2015 at the University of Chicago Medical Center. GIB was defined as the presence of overt bleeding or occult GIB with ≥xa02xa0g/dl drop in hemoglobin (Hgb) from recorded baseline values and hemoccult-positive stool. The preoperative and postoperative data were reviewed.ResultsWithin a median follow-up duration of 408 (IQR 113–954) days, 83 (34%) patients developed GIB after a median of 149 (IQR 27–615) days after implantation of CF-LVAD. There were no significant differences between the groups of GIB and non-GIB with respect to preoperative demographics and comorbidity except for ethnicity. The source of bleeding was identified in 39 (47%) patients and arteriovenous malformation or submucosal streaming vessel was the most frequent cause of bleeding (18/39, 46%). Multivariate-adjusted analysis demonstrated preoperative central venous pressure (CVP)xa0≥xa018xa0mmHg (HR 3.56; 95% CI 1.16–10.9; pxa0=xa00.026), mean pulmonary artery pressure (mPA)xa0≥xa036xa0mmHg (HR 4.14; 95% CI 1.35–12.7; pxa0=xa00.013), and the presence of moderate/severe tricuspid valve disease (HR 1.01; 95% CI 1.01–3.86; pxa0=xa00.046) were associated with the risk of GIB.ConclusionsIn this study, preoperative right-sided cardiac congestion (i.e., increased CVP, mPA and the presence of moderate/severe tricuspid valve disease) was associated with GIB in patients with CF-LVAD.

Impact of Residual Valve Disease on Survival after Implantation of Left Ventricular Assist Devices

BACKGROUNDnThis retrospective single-institutional study investigated the effect of significant valvular regurgitation after left ventricular assist device (LVAD) implantation and the role of concomitant valve surgery during LVAD surgery.nnnMETHODSnAll patients receiving an LVAD (HeartMate II; Abbott, Abbott Park, IL) during 2008 and 2015 were enrolled. The cohort was divided into two groups based on the valve status at the end of the operation: patients without significant valvular regurgitation (no-VR) and those with significant valvular regurgitation (residual-VR).nnnRESULTSnAn LVAD was implanted in 270 patients. Of these, 233 had significant preoperative valve disease(s), and 180 (66.6%) received concomitant valve interventions (35 aortic, 90 mitral, 138 tricuspid). At the completion of the LVAD operation, 204 had no-VR and 66 had residual-VR. Short-term outcomes were similar in two groups, except for longer cardiopulmonary bypass time in the no-VR group (149 minutes) than in the residual-VR group (132 minutes, pxa0= 0.038). During follow-up, mean pulmonary artery pressure (24 mm Hg in no-VR vs 27 mm Hg in residual-VR; pxa0= 0.018) and pulmonary vascular resistance (1.8 Wood units in no-VR vs 2.7 Wood units in residual-VR, pxa0= 0.008) significantly improved in no-VR group compared with the residual-VR group. Survival and heart failure admission-free rates at 1 year were significantly superior in the no-VR group compared with the residual-VR group (1-year survival: 72% ± 3% No-VR vs 55% ± 6% residual-VR; log-rank pxa0= 0.026; admission-free survival: 91% ± 2% no-VR vs 74% ± 7% residual-VR; log-rank pxa0= 0.026). Concomitant valve intervention was not an independent predictor of in-hospital death and morbidity.nnnCONCLUSIONSnAbsence of valvular lesion after LVAD implantation was associated with improved midterm hemodynamics and survival in the current study. Aggressive surgical intervention for significant valve disease(s) at the time of LVAD implant may be beneficial to selected patients.

Is robotic beating heart totally endoscopic coronary artery bypass feasible for BMI > 35 morbidly obese patients?

We investigated the outcomes of morbidly obese patients after robotic beating heart totally endoscopic coronary artery bypass (BH‐TECAB).

Robot-assisted aortic valve surgery: State of the art and challenges for the future

Robotic cardiac surgery was FDA‐approved in 2002 and since then several different procedures have been performed to facilitate a truly minimally invasive approach. The use of robotics in aortic valve surgery, however, is still in its infancy. In this article, we report our clinical experience and chronological development with robot‐assisted aortic valve surgery. This includes a description of how robotic assistance was gradually integrated during right mini‐thoracotomy aortic valve replacement, a series of cases in which the robot was docked for parts of the procedure, a single case of a totally endoscopic robot‐assisted aortic valve replacement with a stentless valve, and three cases of aortic valve papillary fibroelastoma resections. All of these were performed safely with early postoperative recovery and excellent clinical results. Additionally, we review the latest literature describing robot‐assisted aortic valve surgery. Finally, we describe current issues, and challenges for robot‐assisted aortic valve surgery.

Left ventricular assist device explant versus decommission for myocardial recovery

From the Section of Cardiac and Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, Ill. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication March 27, 2017; accepted for publication March 28, 2017; available ahead of print April 21, 2017. Address for reprints: Takeyoshi Ota, MD, PhD, Section of Cardiac and Thoracic Surgery, Department of Surgery, The University of Chicago, 5841 S Maryland Ave, MC5040, Chicago, IL 60637 (E-mail: tota@bsd.uchicago. edu). J Thorac Cardiovasc Surg 2017;154:171-2 0022-5223/

Extracorporeal membrane oxygenation therapy for postcardiotomy cardiogenic shock

36.00 Copyright 2017 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2017.03.123

Papillary muscle rupture after myocardial infarction during left ventricular assist device support

From the Section of Cardiac and Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, Ill. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication March 13, 2017; accepted for publication March 17, 2017. Address for reprints: Takeyoshi Ota, MD, PhD, Center for Aortic Diseases, Department of Surgery, Section of Cardiac and Thoracic Surgery, The University of Chicago, 5841 S Maryland Ave, MC5040, Chicago, IL 60637 (E-mail: tota@bsd.uchicago.edu). J Thorac Cardiovasc Surg 2017;-:1-2 0022-5223/

Multicenter Assessment of Grafts in Coronaries: Midterm Evaluation of the C-Port Device (the MAGIC Study)

36.00 Copyright 2017 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2017.03.065

Does Robotic Beating Heart Connector Totally Endoscopic Coronary Artery Bypass Bridge the Sex Gap in Coronary Bypass Surgery

We report a rare case of papillary muscle rupture due to myocardial infarction during left ventricular assist device support. A 69-year-old woman with cardiogenic shock due to acute myocardial infarction requiring venoarterial extracorporeal membrane oxygenation support was transferred for further surgical intervention. Six days after the event, extracorporeal membrane oxygenation was decannulated, and an extracorporeal left ventricular assist device was implanted. On postoperative day 11, she suffered from sudden onset hypoxia due to pulmonary edema. Transesophageal echocardiography showed new onset severe mitral regurgitation. No further surgical intervention was performed according to the family’s wishes, and she passed away on the 22nd postoperative day. Autopsy findings revealed papillary muscle rupture. Although the left ventricle is unloaded by the left ventricular assist device, papillary muscle rupture should be recognized as a possible complication after myocardial infarction.