What Did We Learn about VADs in 2023?

This is our 10th annual literature review on mechanical circulatory support (MCS) devices. All of our previous reports were well received by the readers.1-9 In this paper, we summarized the most interesting and important, from our standpoint, publications from 2023. There may be some slight overlap with the end of 2022, because some papers were published online first, and the year of publication changed when they became available in print. For the seventh time this year, we wrote a section on extracorporeal membrane oxygenation (ECMO), which primarily addresses new developments in veno-arterial ECMO. Readers who wish to supplement this review, argue with the author’s statements, or express their opinions are encouraged to do so by sending letters to the editor at [email protected]

Key role of congestion in natural history of heart failure

The natural course of heart failure with decreased and preserved systolic function is almost identical. The current concept of heart failure where decreased cardiac output plays the major role does not explain this similarity. We suggest a revised concept of heart failure where congestion plays the leading role. While congestion is almost invariably present in heart failure with normal and with reduced systolic function, the low output syndrome is only present in heart failure with reduced systolic function. The small difference in morbidity and mortality in favor of heart failure with preserved systolic function reflects the contribution of low output syndrome to the natural course of the disease. Congestion can result from low output or from multiple other conditions, but severity of congestion is the major determinant of progression of heart failure

What Did We Learn about VADs in 2022?

This is our 9th annual literature review on mechanical circulatory support devices. Our previous reports were well received by the readers. In this paper, we summarized the most interesting and important, from our standpoint, publications from 2022. There may be some slight overlap with the end of 2021 because some papers were published online first, and the year of the publication changed when they became available in print. For the sixth time, we wrote a section on extracorporeal membrane oxygenation (ECMO) which primarily addresses new developments in veno-arterial ECMO. Readers who wish to supplement this review, argue with the author’s statements or express their opinions are encouraged to do so by sending letters to the editor at [email protected]

Diuretics as pathogenetic treatment for heart failure

Increased intracardiac filling pressure or congestion causes symptoms and leads to hospital admissions in patients with heart failure, regardless of their systolic function. A history of hospital admission, in turn, predicts further hospitalizations and morbidity, and a higher number of hospitalizations determine higher mortality. Congestion is therefore the driving force of the natural history of heart failure. Congestion is the syndrome shared by heart failure with preserved and reduced systolic function. These two conditions have almost identical morbidity, mortality, and survival because the outcomes are driven by congestion. A small difference in favor of heart failure with preserved systolic function comes from decreased ejection fraction and left ventricular remodeling which is only present in heart failure with decreased systolic function. The magnitude of this difference reflects the contribution of decreased systolic function and ventricular remodeling to the progression of heart failure. The only treatment available for congestion is fluid removal via diuretics, ultrafiltration, or dialysis. It is the only treatment that works equally well for heart failure with reduced and preserved systolic function because it affects congestion, the main pathogenetic feature of the disease. Diuretics are pathogenetic therapy for heart failure

What Did We Learn about VADs in 2018?

This is our 6th annual literature review on mechanical circulatory support (MCS) devices. Our previous reports for 2014, 2015, 2016, 2017, 2018 were published as open access articles and were well received by the readers. In this paper, we summarize the most interesting and important, from our standpoint, publications from 2019. As we have done for the past two years, a section on extracorporeal membrane oxygenation (ECMO) is included and primarily addresses new developments in veno-arterial ECMO use

Hemodynamic Goals in Shock Management: Is There One Target for All?

The current guidelines for managing cardiogenic shock lack specificity and clarification. The main criterion for cardiogenic shock is low cardiac output, and the most important goal is to achieve adequate output from a shock state. Because of the complex nature of cardiogenic shock, a “one-size-fits-all outline may not be the best solution. Historically, hemodynamic goals in cardiogenic shock are copied from septic shock. Because septic shock and cardiogenic shock are different hemodynamic entities, the goals should be different

What Did We Learn about VADs in 2021?

This is our 8th annual literature review on mechanical circulatory support (MCS) devices. Our previous reports were well received by the readers. The full text of the reviews for 2014, 2015, 2016, 2017, 2018, 2019, and 20201-7 were downloaded 821, 861, 701, 869, 951, 272, and 365 times, respectively. In this review, we summarized the most interesting and important, from our standpoint, publications from 2021. There may be some slight overlap with the end of 2020 because some papers were published online first, and the year of the publication changed when they became available in print. For the fifth time, we added a section on extracorporeal membrane oxygenation (ECMO), which primarily addresses new developments in veno-arterial ECMO. Readers who wish to supplement this review, argue with the author’s statements, or express their opinions are encouraged to do so by sending letters to the editor at [email protected] or posting on our Facebook page at https://www.facebook.com/TheVADJournal

A Case of HeartMate 3 Outflow Graft Twisting with Extraluminal Thrombosis: Is Computed Tomography Angiography Helpful?

Twists in the outflow graft of the HeartMateTM 3 device (Abbott) have recently been described as a sporadic, late complication. We present a case with a unique combination of external compression of the HeartMate 3 outflow graft by a surgical scar compounded by thrombus formation in the space between the band relief and the outflow graft with associated twist of the outflow graft and severe flow limitation. Computed tomography angiogram (CTA) of the chest was suggestive of outflow graft thrombosis. Our case sheds additional light on the limited specificity of gated CTA in distinguishing the outflow graft twisting from thrombotic obstruction and kinking