This article deals with the electromagnetic interference (EMI) in a cardiac implantable electronic device (e.g., implantable cardioverter-defibrillator or cardiac resynchronization therapy) generated by a left ventricular assisted device (LVAD) powered by a wireless power transfer (WPT) system. Wireless LVAD, not yet available in the market, is currently being investigated for many aspects spanning from electronics, hydraulic, electrical feeding, mechanical, and its possible impact on other implanted devices, such as a cardiac implantable electronic device (CIED). No results are yet published on possible EMI effects produced by the WPT coil currents in the pacing leads of a CIED implanted in the same patient with the LVAD. To this aim, the next generation of wireless LVADs with transcutaneous WPT system is first described, and, then, used to predict the induced voltage by the WPT system on a CIED lead. The obtained results demonstrate as the proposed WPT system, tested in accordance with the ISO 14117 standard, does not interfere with other CIEDs.

This article deals with the design of a wireless powering system for a left ventricular assist device (LVAD). The modern LVAD is mainly a miniaturized blood pump attached to the heart and is driven by an electric motor powered by a cable driveline that exits the patient's body through the skin to be connected with an external battery. The driveline is a portal to the exterior environment and this can cause frequent and severe infections. The goal of this article is the elimination of the cable link between the interior and the exterior of the human body. To this aim, an innovative powering design of the LVAD is proposed adopting the wireless power transfer (WPT) technology based on magnetic resonant coupling. The main challenges in the design of a WPT system for LVAD application are the considerable implantation depth (5-10 cm) and the relatively high power (≈ 5 W) required by the device to operate continuously. Two different design solutions are proposed: 1) a subcutaneous receiving coil connected to the LVAD by a short driveline completely inside the human body and 2) an LVAD with a receiving circuit and coil, both integrated on it.

An increased need of extracorporeal membrane oxygenation (ECMO) support is going to become evident as treatment of SARS-CoV-2 respiratory distress syndrome. This is the first report of the Italian Society for Cardiac Surgery (SICCH) on preliminary experience with COVID-19 patients receiving ECMO support. Data from 12 Italian hospitals participating in SICCH were retrospectively analyzed. Between March 1 and September 15, 2020, a veno-venous (VV) ECMO system was installed in 67 patients (94%) and a veno-arterio-venous ECMO in four (6%). Five patients required VA ECMO after initial weaning from VV ECMO. Thirty (42.2%) patients were weaned from ECMO, while 39 (54.9%) died on ECMO, and six (8.5%) died after ECMO removal. Overall hospital survival was 36.6% (n = 26). Main causes of death were multiple organ failure (n = 14, 31.1%) and sepsis (n = 11, 24.4%). On multivariable analysis, predictors of death while on ECMO support were older age (p = 0.048), elevated pre-ECMO C-reactive protein level (p = 0.048), higher positive end-expiratory pressure on ventilator (p = 0.036) and lower lung compliance (p = 0.032). If the conservative treatment is not effective, ECMO support might be considered as life-saving rescue therapy for COVID-19 refractory respiratory failure. However warm caution and thoughtful approaches for timely detection and treatment should be taken for such a delicate patients population.

Background: Anticancer treatments are improving the prognosis of patients fighting cancer. However, anticancer treatments may also increase the cardiovascular (CV) risk by increasing metabolic disorders. Atherosclerosis and atherothrombosis related to anticancer treatments may lead to ischemic heart disease (IHD), while direct cardiac toxicity may induce non-ischemic heart disease. Moreover, valvular heart disease (VHD), aortic syndromes (AoS), and advanced heart failure (HF) associated with CV risk factors and preclinical CV disease as well as with chronic inflammation and endothelial dysfunction may also occur in survivors of anti-carcer treatments. Methods: Public electronic libraries have been searched systematically looking at cardiotoxicity, cardioprotection, CV risk and disease, and prognosis after cardiac surgery in survivors of anticancer treatments. Results: CV risk factors and disease may not be infrequent among survivors of anticancer treatments. As cardiotoxicity of established anticancer treatments has been investigated and is frequently irreversible, cardiotoxicity associated with novel treatments appears to be more frequently reversible, but also potentially synergic. Small reports suggest that drugs preventing HF in the general population may be effective also among survivors of anticancer treatments, so that CV risk factors and disease, and chronic inflammation, may lead to indication to cardiac surgery in survivors of anticancer treatments. There is a lack of substantial data on whether current risk scores are efficient to predict prognosis after cardiac surgery in survivors of anticancer treatments, and to guide tailored decision-making. IHD is the most common condition requiring cardiac surgery among survivors of anticancer treatments. Primary VHD is mostly related to a history of radiation therapy. No specific reports exist on AoS in survivors of anticancer treatments. Conclusions: It is unclear whether interventions to dominate cancer- and anticancer treatment-related metabolic syndromes, chronic inflammation, and endothelial dysfunction, leading to IHD, nonIHD, VHD, HF, and AoS, are as effective in survivors of anticancer treatments as in the general population. When CV diseases require cardiac surgery, survivors of anticancer treatments may be a population at specifically elevated risk, rather than affected by a specific risk factor.