Cardiopulmonary exercise test (CPET) parameters are established prognosticators in heart failure. However, the prognostic value of preimplantation and postimplantation CPET parameters in left ventricular assist device (LVAD) therapy is unclear and it is evaluated in this study. Adult patients who were implanted with an LVAD and underwent CPET during the preimplantation or postimplantation period were retrospectively analyzed. Five CPET parameters were calculated: vO₂ max, oxygen uptake efficiency slope (OUES), VE/vCO₂ Slope, VE/vCO₂ min, and VE/vCO₂ max. The relationship between CPET parameters and postimplantation outcomes was evaluated with multivariable analysis. Pre and postimplantation CPET cohorts included 191 and 122 patients, respectively. Among preimplantation CPET parameters: vO₂ max and OUES were associated with 1, 3, and 5 year mortality, VE/vCO₂ min was associated with 3 and 5 year mortality, whereas VE/vCO₂ Slope was associated with 5 year mortality. From postimplantation CPET parameters: vO₂ max was an independent predictor of 3 and 5 year mortality, whereas VE/vCO₂ max was an independent predictor of 3 year mortality following LVAD implantation. Preimplantation CPET parameters have a prognostic value for long-term survival following LVAD implantation, whereas their association with early postimplantation outcomes appears to be weaker. Postimplantation vO₂ max and VE/vCO₂ max values are associated with survival on device support and may provide a second chance for prognostication in patients without preimplantation CPET data.

Hepatocellular carcinoma (HCC), constituting the predominant manifestation of liver cancer, stands as a formidable medical challenge. The prognosis subsequent to surgical intervention, particularly for individuals presenting with a solitary tumor, relies heavily on the degree of invasiveness. The decision-making process surrounding therapeutic modalities in such cases assumes paramount importance. This case report illuminates a rather unusual clinical scenario. Here, we encounter a patient who, following a disease-free interval, manifested an atypical presentation of HCC, specifically, a solitary cardiac metastasis. The temporal interval of remission adds an additional layer of complexity to the case. Through a multidisciplinary planning process, the decision was made for surgical removal of the metastatic tumor.

Abdominal aortic aneurysms represent a health challenge, particularly among older adults. In certain cases, surgical repair necessitates reconstruction of the renal artery. Various techniques are employed for this purpose, including Carrel patch reimplantation, synthetic graft interposition, aortorenal endarterectomy during aortic graft implantation, and the use of covered, self-expandable Viabahn stent grafts. Although the efficacy and safety of Viabahn stent grafts are well-established in endovascular settings, their application in open surgical procedures remains a novel and less common approach. Here, we discuss three cases where the self-expandable Viabahn stent graft was successfully utilized as a bailout technique to preserve renal function, addressing an unexpected need for renal artery revascularization during open suprarenal aortic aneurysm repair.