Stenosis or occlusion of a large right coronary artery or its vein grafts in symptomatic patients who underwent previous bypass grafting procedure with patent left-sided grafts is mostly managed by percutaneous interventions. When percutaneous interventions fail, it is a difficult decision to reoperate on a such patient for a single-vessel disease considering the risk of resternotomy. We present our technique which involves small anterior thoracotomy and partial sternotomy.

Background: Driveline infection (DLI) is the most common device-specific infection in patients supported with ventricular assist devices (VADs) and remains a major cause of morbidity during long-term mechanical circulatory support. This study aimed to evaluate the incidence, risk factors, microbiological characteristics, and antimicrobial resistance patterns of DLIs in patients undergoing durable left ventricular assist device (LVAD) implantation. Methods: This retrospective cohort study included 772 consecutive patients who underwent durable LVAD implantation at a single tertiary center between January 2012 and December 2024. Patients were categorized according to the development of DLI: the DLI group (n = 158) and the non-DLI group (n = 614). Demographic, clinical, laboratory, perioperative, and postoperative variables were analyzed. Multivariate logistic regression analysis was performed to identify independent predictors of DLI. Microbiological isolates and antimicrobial resistance patterns were also evaluated. Results: Driveline infection developed in 20.5% of patients during follow-up. Patients with DLI had a significantly higher body mass index (26.4 vs. 24.8 kg/m², p = 0.002) and a higher prevalence of diabetes mellitus (28.2% vs. 12.1%, p < 0.001). In multivariate analysis, diabetes mellitus (OR 3.29, p = 0.013) and longer LVAD support duration (p = 0.003) were independently associated with DLI. Device type showed differences in crude infection rates but was not an independent predictor. The most frequently isolated pathogens were Staphylococcus aureus (36%) and Pseudomonas aeruginosa (19%). The most common antimicrobial resistance patterns included fluoroquinolone resistance (23%), methicillin-resistant Staphylococcus aureus (10%), and resistance to piperacillin/tazobactam and carbapenems. Conclusions: In this large single-center cohort, diabetes mellitus and prolonged device support duration were the main independent predictors of driveline infection. Staphylococcus aureus and Pseudomonas aeruginosa were the predominant pathogens, with notable antimicrobial resistance patterns. These findings highlight the importance of metabolic optimization, meticulous driveline exit-site care, and structured long-term surveillance strategies for reducing infection risk in LVAD recipients.

Background: Continuous-flow left ventricular assist devices (LVADs) generate non-pulsatile circulation, rendering conventional oscillometric blood pressure measurements unreliable. Accurate monitoring is critical to prevent complications including stroke, pump thrombosis, and aortic regurgitation. Doppler-based measurement is widely used as a non-invasive alternative, yet its accuracy relative to invasive arterial pressure remains insufficiently characterized. Methods: In this prospective single-centre study, 32 adult continuous-flow LVAD patients underwent simultaneous invasive radial artery and Doppler blood pressure measurements twice daily over three consecutive days (192 paired readings; Day 3: n = 27 due to technical recording issues). Pulsatility was assessed by means of peripheral pulse palpation and transthoracic echocardiography. Spearman’s rho, Wilcoxon signed-rank test, and Bland–Altman analysis were applied. Results: Median invasive MAP was 73.0 [IQR 66–80] mmHg and median Doppler pressure was 75.0 [IQR 70–80] mmHg. Doppler measurements demonstrated strong-to-excellent correlation with invasive MAP across all time points (r = 0.78–0.91, p < 0.001), with no significant paired differences (all p > 0.05). Bland–Altman analysis revealed a bias of −0.35 mmHg with limits of agreement of −9.10 to +8.40 mmHg, within the accepted ±10 mmHg threshold. Correlation with systolic pressure was lower (r = 0.66–0.89, p < 0.001), with a positive bias of +13.47 mmHg and wide limits of agreement (+1.28 to +25.67 mmHg), indicating clinically unacceptable agreement. Conclusions: Doppler-derived blood pressure may provide a reliable estimate of invasive MAP in continuous-flow LVAD patients, whereas its utility for systolic pressure estimation appears limited. Doppler measurement represents a practical, non-invasive tool for routine MAP monitoring in both inpatient and outpatient settings.