Background: Pulmonary arterial elastance (Ea) is a helpful parameter to predict the risk of acute postoperative right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation. A new method for calculating Ea, obtained by the ratio between transpulmonary gradient and stroke volume (Ea^B), has been proposed as a more accurate measure than the Ea obtained as the ratio between pulmonary artery systolic pressure and stroke volume (Ea^C). However, the role of Ea^B in predicting acute RVF post-LVAD implantation remains unclear. Methods and Results: A total of 35 patients who underwent LVAD implantation from 2018 to 2021 were reviewed in this retrospective analysis. Acute RVF after LVAD implantation occurred in 12 patients (34%): 5 patients with moderate RVF (14% of total) and 7 patients with severe RVF. The Ea^B was not significantly different between the “severe RVF” vs. “not-severe RVF” groups (0.27 ± 0.04 vs 0.23 ± 0.1, p < 0.403). However, the combination of arterial elastance and central venous pressure was significantly different between the “not-severe RVF” group (central venous pressure < 14 mmHg and Ea^C < 0.88 mmHg/mL or Ea^B < 0.24 mmHg/mL; p < 0.005) and the “severe RVF” group (central venous pressure > 14 mmHg and Ea^C > 0.88 mmHg/mL or Ea^B > 0.24 mmHg/mL; p < 0.005). Conclusions: Ea is a reliable parameter of right ventricular afterload and helps discriminate the risk of acute RVF after LVAD implantation. The combined analysis of Ea and central venous pressure can also risk stratify patients undergoing LVAD implantation for the development of RVF.

Left ventricular assist devices (LVADs) are used to provide haemodynamic support to patients with critical cardiac failure. Severe complications can occur because of the modifications of the blood flow in the aortic region. In this work, the effect of a continuous flow LVAD device on the aortic flow is investigated by means of a non-intrusive reduced order model (ROM) built using the proper orthogonal decomposition with interpolation (PODI) method. The full order model (FOM) is represented by the incompressible Navier-Stokes equations discretized by using a Finite Volume (FV) technique, coupled with three-element Windkessel models to enforce outlet boundary conditions in a multi-scale approach. A patient-specific framework is proposed: a personalized geometry reconstructed from Computed Tomography (CT) images is used and the individualization of the coefficients of the three-element Windkessel models is based on experimental data provided by the Right Heart Catheterization (RCH) and Echocardiography (ECHO) tests. Pre-surgery configuration is also considered at FOM level in order to further validate the model. A parametric study with respect to the LVAD flow rate is considered. The accuracy of the reduced order model is assessed against results obtained with the full order model.

Heart failure is a growing disease that affects millions of people around the world. Heart transplantation is currently the therapy of choice for these patients. However, the lack of donors has forced the physician to evolve another kind of therapy such as ventricular assist device (VAD) as a bridge to transplant to compensate the lack of organs. Ventricular assist devices are today a successful therapy for the treatment of heart failure; the evolution of these devices and their progressive miniaturization have allowed an evolution of their implantation technique. To date, therefore, in addition to the traditional implant through sternotomy, there are more mini-invasive implant techniques. The purpose of the treaty is to describe these techniques, the implantation sites, and the benefits they can bring to patients.

Objectives: To evaluate predictors of early and long-term outcomes of surgical repair of Type A aortic dissection. Methods: Between March1998 and August 2013, 227 patients underwent surgery at our institution. Two patients with no data were excluded from the study. The follow-up was complete for 219 patients (97%). We performed a multivariate analysis of preoperative and operative data. Results: Mean age was 65 years, 73% had a De Bakey type I, 19% a type II and 8% an intramural haematoma. Two hundred and two (90%) were acute dissections and 23 (10%) chronic. Fourteen patients (6%) died intraoperatively, 141 of the remaining (67%) had postoperative complications. Thirty-day mortality was 18% (38 patients). Median ICU and hospital stay were 3 and 12 days, respectively. During a mean follow-up time of 5 ± 4 years we observed 53 deaths (29%). Twenty-seven patients (15%) needed late cardiac or thoracic aorta reoperation. Results from the multivariate analysis are as follows. Thirty-day mortality was associated with higher cross-clamping time (P = 0.009). The incidence of postoperative complications was related to age at intervention (P = 0.049), type of dissection (P = 0.05) and preoperative cardiogenic shock (P = 0.049). Mortality at follow-up was significantly increased by age at intervention (P = 0.01), with a logarithmic growth after 60 years, female sex (P < 0.001), preoperative limb ischaemia (P = 0.02) and deep hypothermic circulatory arrest (DHCA) (P = 0.01). Reintervention occurred more frequently in patients older at intervention (P = 0.05) or with aortic diseases familiarity (P = 0.03). Conclusion: The surgical results of type A aortic dissection are affected by age at intervention with a logarithmic increase of late mortality in patients older than 60 years.

In patients with advanced heart failure (HF), left ventricular assist devices (LVADs) have demonstrated to be effective in improving the quality of life and reducing further hospitalizations. Although uncommon, LVAD outflow graft obstruction (OGO) is a potentially life-threatening complication and percutaneous treatment has been proposed as a standard intervention strategy in such cases. We report the case of a 69 year old man admitted due to LVAD failure causing unstable HF. Past medical history included percutaneous intervention on the outflow graft with stent implantation one year before. The patient was under chronic treatment with vitamin K antagonists (VKA). Emergent percutaneous angiography was performed, showing recurrent OGO due to thrombosis located at a kinking site, distally to the previously treated segment. Using distal anchoring technique, a balloon-expandable 10 × 79 mm endoprosthesis (GORE^® Viabahn^® VBX) was effectively positioned and post-dilated. Final angiography confirmed the patency of the stent implanted one-year before. Despite the procedure succeeding in restoring LVAD function, the patient died due to septic shock ten days after. Our case suggests that recurrent OGO can be effectively treated with percutaneous redo and that long-term stent patency can be achieved with a standard antithrombotic treatment, despite further thrombotic events in other segments of the graft are still possible (especially at the kinking site). Moreover, other noncardiac conditions as infective complications, can dramatically impact the clinical course and lead to unfavorable outcomes.