Background: Recent advances in left ventricular assist device (LVAD) therapy have significantly contributed to the improved management of severe heart failure. The unignorable risk of bleeding events associated with the device therapy, however, remains to be addressed. Predictive factors for bleeding events are not fully defined. Methods: Patients implanted with various types of LVADs were assessed for von Willebrand factor (VWF)-related values and platelet proteins from 2011 to 2023 at Tohoku University Hospital. We evaluated the relationship between these parameters and bleeding events at remote periods after LVAD implantation. Results: The VWF large multimer index (VWF-LMI), the ratio of VWF ristocetin cofactor activity to VWF antigen level (VWF:RCo/VWF:Ag), and maximal ristocetin (1.2 µg/mL) induced platelet aggregation (RIPA) rates decreased in a pump speed- and device type-dependent manner. Major bleeding events, defined according to the Interagency Registry for Mechanically Assisted Circulatory Support criteria, occurred in 28.8% (19/66) of the patients. Kaplan–Meier methods, log-rank tests, and Cox regression analyses revealed that VWF-LMI <42.3 (p=0.0002), VWF:RCo/VWF:Ag <0.52 (p=0.0239), and maximal RIPA rate <79.2 (p=0.0012) predicted bleeding events with hazard ratios of 6.96, 2.89, and 13.4, respectively. The platelets of the patients with LVAD support exhibited significantly reduced expression levels of glycoprotein (GPVI; p=0.0334) and glycoprotein b (GPIb; p=0.0061) compared with healthy subjects. Nevertheless, patients with bleeding events did not exhibit reduced GPVI (p=0.5267) or GPIb (p=0.6674) levels compared to those without bleeding events. Conclusions: VWF-related values, including VWF-LMI, VWF:RCo/VWF:Ag, and maximal RIPA rate, but not reduced platelet proteins, predicted bleeding events in patients with LVADs. Registration: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000027761 Clinical Perspective: What Is New?: Comprehensive measurements of von Willebrand factor-related values, platelet proteins, and ristocetin-induced platelet aggregation rates were obtained in patients with left ventricular assist device support to evaluate their association with bleeding events. The von Willebrand factor large multimer index, ratio of von Willebrand factor ristocetin cofactor activity to von Willebrand factor antigen levels, and maximal ristocetin-induced platelet aggregation rate predicted bleeding events in patients implanted with a left ventricular assist device. What Are the Clinical Implications?: Predictors of bleeding events in patients with left ventricular assist device support were identified in this study. Understanding how von Willebrand factor-related values are associated with bleeding events will facilitate the management of potential bleeding events. The ratio of von Willebrand factor ristocetin cofactor activity to von Willebrand factor antigen levels is a predictor of bleeding events that can be measured and evaluated relatively easily in many centers without special techniques or equipment, in contrast to analysis of the von Willebrand factor large multimer index.

Significant progress has been achieved in the treatment of acute aortic dissection over the past 90 years, following the first surgical intervention. This review pays tribute to the dedication of pioneers and innovators who developed advanced medical devices and therapeutic strategies to address this challenging condition. While navigating uncertainties in treatment optimization, the primary focus remains on saving lives by increasing survival rates during the acute phase and preventing aorta-related lethal events and late thoracoabdominal aortic replacements. A strategy for managing this disease was established in 2013, demonstrating excellent early and long-term outcomes. From a fair and neutral standpoint, this review traces over 90 years of progress in treating acute aortic dissection. It outlines the journey that led to the establishment of the Oda strategy as the optimal approach and provides valuable insights for exceptional cardiovascular surgeons who will be utilizing this strategy in the future. We hope that as many patients as possible will benefit from this strategy and will receive treatment rationally, without over- or under-treatment.

Medical intervention for ischemic heart disease began approximately 150 years ago with nitrates, and for nearly a century thereafter, little fundamental progress was made. With the advent of the left internal thoracic artery to the left anterior descending artery (LITA-LAD) bypass in the 1960s, treatment entered a new stage; however, its essential significance remained insufficiently recognized for many years. Numerous studies were subsequently conducted to evaluate alternative or parallel treatment strategies, but these investigations also helped bring the durable capacity of LITA-LAD to perfuse ischemic myocardium into sharper focus. Over the past quarter century, the treatment of ischemic heart disease has remained in a state of uncertainty, and its central prognostic foundation has often been obscured, although in recent years this uncertainty has begun to resolve. In this review, we reexamine the historical process by which the significance of LITA-LAD remained incompletely appreciated in parts of the cardiology and cardiac surgical communities. We further outline how the principal basis of the long-term prognostic benefit conferred by LITA-LAD gradually became evident and define the contemporary roles of medical therapy and percutaneous coronary intervention in relation to LITA-LAD-based coronary artery bypass grafting (CABG).

Significant progress has been achieved in the treatment of acute aortic dissection over the past 90 years, following the first surgical intervention. This review pays tribute to the dedication of pioneers and innovators who developed advanced medical devices and therapeutic strategies to address this challenging condition. While navigating uncertainties in treatment optimization, the primary focus of the therapeutic strategies has been to save lives by increasing survival rates during the acute phase and to prevent aorta-related lethal events and late-stage thoracoabdominal aortic replacements. From a neutral standpoint, this review traces over 90 years of progress in treating acute aortic dissection. We hope that as many patients as possible will receive treatment rationally, without over- or under-treatment.