J.E. Rame

Management of ventricular arrhythmias in patients with ventricular assist devices.

Purpose of review To summarize the available evidence concerning the occurrence and treatment of ventricular arrhythmias in patients supported with long-term ventricular assist devices (VADs). Recent findings Approximately one-third of left ventricular assist device-supported patients experience significant ventricular arrhythmias, with higher rates in certain patient subsets. Ventricular arrhythmias are associated with both increased mortality and morbidity in VAD-supported patients. Mechanical factors, myocardial fibrosis and alterations in cardiac myocyte physiology because of myocardial unloading are contributors to ventricular arrhythmias in this population. In the absence of definitive trials, current evidence supports implanted cardioverter defibrillators (ICDs) in long-term VAD patients to mitigate the risks associated with ventricular arrhythmias. Though antiarrhythmic therapies have limited efficacy, amelioration of inflow cannula contact with the endocardium and suction events or ablation of specific anatomic origins of ventricular arrhythmias, when present, are also efficacious in VAD-supported hearts. Summary As the application of long-term VAD support continues to grow, it will be increasingly important to clarify and target the mechanisms contributing to ventricular arrhythmias in this population. Prospective trials assessing the benefits of de-novo ICD placement, ablative strategies and other prophylactic and therapeutic interventions will be increasingly important to further improve the survival and quality of life among VAD-supported patients.

Complete Spontaneous Left Heart and Aortic Thromboses on Extracorporeal Membrane Oxygenation Support

nosed 3-vessel coronary artery disease and ischemic cardiomyopathy. The patient underwent emergent TandemHeart cannulation (left atrium to femoral artery bypass). A transthoracic echocardiogram revealed worsening biventricular failure without echo dense material or intracardiac thrombosis. Worsening cardiac function and recurrent VT prompted arterial– venous extracorporeal membrane oxygenation with insertion of a Quadrox oxygenator and an additional right atrial cannula. Therapeutic anticoagulation was maintained on intravenous heparin with a partial thromboplastin time of 79.9 seconds. Figure 1. Deep transgastric short-axis view.

Transfemoral transcatheter aortic valve replacement with a self-expanding valve for severe aortic regurgitation in a patient with left ventricular assist device

Aortic insufficiency following left ventricular assist device implantation (LVAD) has been reported in up to 40% of patients and is associated with a worse prognosis. We describe the case of a successful transfemoral transcatheter aortic valve replacement with a self‐expanding bioprosthesis for aortic insufficiency following destination LVAD implantation.

RV FRACTIONAL AREA CHANGE AT 6 MONTHS BUT NOT AT PRE-IMPLANT IS ASSOCIATED WITH LATE INDICES OF FUNCTIONAL CAPACITY AND RENAL FUNCTION: A CASE FOR THE IMPORTANCE OF LATE RV DYSFUNCTION IN LONG TERM MCS

Right heart failure (RHF) post – LVAD implantation continues to present a great challenge in the perioperative period. However few studies address the importance of right ventricular function (RVF) in the later phases of mechanical support. We hypothesized that late RVF, as measured by RV