Nonischemic Donor Heart Preservation: New Milestone in Heart Transplantation History

Heart transplantation is considered the gold standard for the treatment of advanced end-stage heart failure. However, standard donors after brain death are decreasing, whereas patients on the heart transplant waitlist are constantly rising. The introduction of the ex vivo machine perfusion device has been a turning point; in fact, these systems are able to significantly reduce ischemic times and have a potential effect on ischemia-related damage reduction. From a clinical standpoint, these machines show emerging results in terms of heart donor pool expansion, making marginal donors and donor grafts after circulatory death suitable for donation. This article aims to review mechanisms and preclinical and clinical outcomes of currently available ex vivo perfusion systems, and to explore the future fields of application of these technologies

A step-by-step problem-solving strategy in a patient with heart failure and cerebral aneurysm

Left ventricular assist devices (LVAD) implantation is an established treatment for patients with end-stage heart failure. HeartMate 3 (HM3) is a continuous-flow centrifugal pump, recently introduced in the clinic, which has shown greater hemocompatibility compared to similar devices of previous generations. Nevertheless, anticoagulation is still required after HM3 implant to avoid pump dysfunction. Hereafter, we describe the case of a patient candidate to LVAD implantation for end-stage heart failure presenting a concomitant cerebrovascular lesion, accidentally found during pre-operative assessment, which would have contraindicated the procedure (for the prohibitive risk of cerebral hemorrhage), unless a step by step problem-solving approach was adopted

Photo-realistic 3D Echocardiographic View of the Mitral Valve

Three-dimensional (3D) real-time echocardiography offers significant additional clinical information to traditional 2-dimensional echocardiography, improving visualization of cardiac structures and transcatheter device implantation. The recent development of high-definition photo-realistic rendering (EPIQ CVX, TrueVue, Philips Healthcare, Andover, USA) has been proposed as a new technological advancement aiming to increase the perception of 3D anatomical details, as in the case of degenerative mitral valve (MV) disease showing ruptured chords, height of the prolapse, and overriding of the posterior leaflet with respect to the anterior leaflet (Figure 1, and Video 1A and 1B of the supplementary data). The technology allows users to change the lighting conditions to improve contrast. The light source can be moved around an annular plane to change the shadows of the MV (Video 2A and 2B of the supplementary data) or can be positioned at different heights with respect to a defined structure. In the case of MV analysis, the light source can be placed in the left atrium (Figure 2A), in the left atrium is just above the mitral annular plane (Figure 2B), in the left ventricle just below the mitral annular plane (Figure 2C), or deep in the left ventricle (Figure 2D). The photorealistic lighting effect has the potential advantage of improving our preoperative perception of cardiac anatomy (Figure 3A, and Video 3A of the supplementary data). It may also help in the assessment of morphological changes after cardiac procedures, such as transapical beating heart MV repair with neochord implantation showing a physiologic restoration of leaflet coaptation with simultaneous 2D-multiplane echocardiographic views (Figure 3B, and video 3B of the supplementary data). In future, the clinical adoption of photo-realistic 3D echocardiography may improve our knowledge of this innovative technology, defining its real benefits and limitations

Long-Term Fate of the Neoaortic Root After Neonatal Ross Operation: A Case Series

The aim of this study is to analyze the adaptation properties of the pulmonary autograft in four infants who underwent the Ross operation before one year of life. The patients underwent serial echocardiographic assessments of the autograft diameters at short- and long-term follow-up and values were reported as the Z scores for normal aortic and pulmonary diameters. At a median follow-up time of 18.5 years (range: 18.2-19.4 years), all the patients are alive, none requiring autograft reinterventions. This series shows excellent adaptation potential of the “infant pulmonary autograph” in the long-term, during somatic growth of the patient

Reversing Inoperability in Eisenmenger Syndrome: The "Drug-and-Banding" Approach

Eisenmenger syndrome (ES) has been considered a cause of inoperability in patients with congenital heart disease (CHD). Even if long-standing vasodilators are efficient to reduce pulmonary vascular resistance (PVR), the best approach to grant stable repair of these patients is still unknown. We describe the case of a 28-year-old man with a diagnosis of untreated large ventricular septal defect and established ES. After few years of vasodilator therapy, the patient underwent pulmonary banding with significant reduction of his PVR. His CHD was then repaired, with clinical and functional improvement at 2-year follow-up

Feasibility of percutaneous coronary intervention before mitral NeoChord implantation: Single-center early results

Micro-invasive cardiac surgery identifies procedures performed off-pump, on beating heart. Aim of this single-center retrospective study was to assess early outcomes of a totally micro-invasive strategy (percutaneous coronary intervention-PCI-followed by transapical off-pump NeoChord mitral repair) in patients with concomitant coronary artery disease (CAD) and degenerative mitral regurgitation (MR)

Learning curve analysis of transapical NeoChord mitral valve repair

Transapical off-pump mitral valve intervention with neochordae implantation is a novel, minimally invasive procedure for treatment of degenerative mitral valve regurgitation. The aim of this study was to apply control charts (CUSUM curves) to monitor the performance of NeoChord repair during the initial phase of its adoption