Background: It was hypothesized that the time-appropriate return to a resting heart rate (HR) after cessation of exercise could be a marker for predicting outcomes in patients with heart failure (HF). We aimed to evaluate the prognostic value of HR recovery in functional improvement among adults with severe aortic stenosis undergoing percutaneous aortic valve implantation (TAVI). Methods: We performed a 6 min walk test (6MWT) in 93 individuals before TAVI and 3 months after the procedure. The change in walking distance was calculated. During the pre-TAVI 6MWT, we analyzed the differences between baseline HR, HR at the end of the test, and HR at the 1st, 2nd, and 3rd minute of recovery. Results: After 3 months, 6MWT distances improved by 39 ± 63 m and reached a total of 322 ± 117 m. Multiple linear regression proved the differences between HR after 2 min of recovery and baseline HR in pre-TAVI after a 6MWT was the only significant predictor of waking distance improvement during follow-up. Conclusions: Our study suggests that analysis of HR recovery after a 6MWT may be a helpful and easy parameter to assess improvements in exercise capacity after TAVI. This simple method can help to identify patients in whom no significant benefit in functional improvement can be expected despite successful valve implantation.

Background: Multi-organ failure (MOF) is a common complication of advanced heart failure (HF), significantly influencing patient prognosis. This study aimed to assess and compare the impact of orthotopic heart transplantation (HTx) and left ventricular assist device (LVAD) implantation on the severity of MOF, as measured by the model for end-stage liver disease excluding INR (MELD-XI) score. Methods: Data from 1 month before to 1 year after HTx or LVAD implantation were analysed. The MELD-XI score was calculated using average bilirubin and creatinine values. Comparative assessments of MELD-XI scores were performed within the HTx and LVAD groups at various time points pre- and post-procedure. Results: The analysis included 107 HTx patients and 30 LVAD patients. The median MELD-XI score 1 month pre-procedure was 11.7 (9.4–16.7) in all patients. There were no significant differences in MELD-XI scores between the groups at 3-, 6-, and 12-month follow-ups. However, a significant difference was observed 1 month post-procedure [HTx: 14.8 (9.4–17.7) vs. LVAD: 11.2 (7.3–14.9), p = 0.02]. In the LVAD group, a significant decrease in MELD-XI score was noted for 3 months post-procedure compared to 1 month pre-procedure (p < 0.001), whereas at 6- and 12-month follow-ups the score did not differ from pre-procedural scores. In the HTx group, significant decreases in MELD-XI scores were observed from 3 months, 6 months, and 1 year post-procedure compared to 1 month pre-procedure (p < 0.002). Conclusions: The MELD-XI scale reveals different MOF trajectories between HTx and LVAD recipients. Both interventions lead to early improvements in liver and kidney function, with sustained benefits in HTx patients, highlighting the distinct impacts on organ function.

Background/Objectives: Multi-organ failure (MOF) often complicates advanced heart failure (HF), contributing to a poor prognosis. The Model of End-Stage Liver Disease 3.0 (MELD-3.0) scale incorporates liver and kidney function parameters. This study aims to evaluate the prognostic significance of the MELD-3.0 score in patients with advanced HF who have undergone heart transplantation (HTx). Methods: The MELD-3.0 score was computed using the average values of the international normalized ratio and bilirubin, creatinine, sodium, and albumin levels during a hospital stay following HTx. The average MELD-3.0 scores from the period of 1 month preceding HTx and 1 week after HTx were analyzed. The primary endpoint of the study was the 6-month total mortality, and the secondary endpoint was ICU hospitalization time after HTx. Results: The analysis included 106 patients undergoing HTx, with a median age of 53 years (44–63), 81% of whom were male. Within 6 months post-HTx, 17 patients (16%) died; those patients had a higher 1-week post-HTx MELD-3.0 score of 18.3 (14.5–22.7) in comparison to survivors, whose average score was 13.9 (9.5–16.4), p < 0.01. There was no difference in MELD 3.0 score in the pre-HTx period: 16.6 (11.4–17.8) vs. 12.3 (8.6–17.1), p = 0.36. The post-HTx MELD-3.0 score independently predicted death: RR 1.17 (95% CI 1.05–1.30), p < 0.01. A Receiver Operating Characteristic (ROC) determined the cut-off value of the MELD-3.0 score as 17.3 (AUC = 0.83; sensitivity—67%; specificity—86%). Survivors with scores above this value had a longer ICU hospitalization time: 7 (5.0–11.0) vs. 12 (8–20) days (p = 0.01). Conclusions: The post-HTx MELD-3.0 score serves as an independent predictor of an unfavorable prognosis in patients with advanced HF undergoing HTx. The evaluation of MELD-3.0 scores provides additional prognostic information in this population.

Introduction: Heart transplantation (HTx) remains the definitive treatment for selected patients with advanced heart failure. The early post-transplant period is characterized by substantial morbidity and requires intensive surveillance. The aim of this study was to describe the clinical course of the first 100 heart transplant recipients treated at our newly established center, with particular emphasis on in-hospital outcomes and the 12-month follow-up. Methods: We retrospectively analyzed 100 consecutive patients who underwent orthotopic HTx between February 2021 and May 2023 at our center. Demographic, clinical, hemodynamic, laboratory, treatment, and post-transplant follow-up data were collected. The follow-up assessment included survival, rejection, infectious complications, renal replacement therapy (RRT), heart failure decompensation, hospitalizations, outpatient visits, and changes in pharmacotherapy. Cox proportional hazards regression and Receiver Operating Characteristic (ROC) analyses were also performed to assess factors associated with 12-month mortality. Results: The study population comprised 82 (82%) men and 18 (18%) women with a median age of 54 years (IQR, 45–64). The in-hospital course was characterized by substantial early morbidity: 17 patients (17%) died during the index hospitalization, with a median time to death of 17 days (IQR, 3–78). RRT was required in 44% of patients. Among hospital survivors, the median length of hospital stay was 43 days and the median ICU stay was 7 days. During the 12-month follow-up, clinically significant cellular graft rejection (grade ≥ 3) occurred at least once in 51% of patients, infectious complications in 45%, and one patient underwent retransplantation. The twelve-month all-cause mortality was 23%. Patients had a mean of 8 planned hospitalizations, 0.4 unplanned admissions, and 1.3 outpatient visits per patient. Exploratory analyses identified possible associations between selected pre-transplant variables and 12-month mortality. Conclusions: The first 100 HTx recipients treated at the newly established center experienced a clinically demanding in-hospital course, with a 17% in-hospital mortality. After discharge, the first year remained characterized by frequent cellular rejection incidence, and infectious complications. The twelve-month survival was 77%. These findings provide a comprehensive description of the early in-hospital and 12-month clinical course of a newly established Htx program.

Background/Objectives: Currently, the most popular techniques for orthotopic heart transplantation (OHTx) are bicaval and total OHTx. Although bicaval OHTx has shown advantages over the biatrial approach, comparisons between bicaval and total OHTx reain limited. To compare the functional and morphological characteristics of the left atrium (LA) in patients after bicaval and total OHTx. Methods: Sixty-six patients (age 51.2 ± 10.5 years) after total OHTx (33 patients) and bicaval OHTx (33 patients) were included in this case–control study. Recipients were matched for sex, age, and time from transplantation and absence of severe graft rejection based on routine endomyocardial biopsies (EMB) performed during follow-up. Echocardiography included standard measurements along with a speckle-tracking assessment of LA strain. Results: Compared with the bicaval OHTx, the total OHTx group showed higher atrial mitral inflow velocity, resulting in a lower E/A ratio, lower LA volume index, and higher LA emptying fraction. Both the reservoir and contraction components of LA function, as assessed by LA deformation, were found to show more favorable profiles in the total OHTx group than in the bicaval group (26.5 ± 6.9 vs. 17.4 ± 4.7, p < 0.001 and 14.8 ± 5.8 vs. 6.0 ± 4.5, p < 0.001, respectively). Multivariable analysis identified surgical technique, left ventricular global longitudinal strain, and the presence of diabetes in the recipient as independent determinants of LA strain. Conclusions: Total OHTx is associated with better LA morphology and function than bicaval OHTx. This may provide better conditions for LA-LV coupling in transplanted hearts and contribute to a more stable electrophysiological environment in atrial tissue.

Background/Objectives: Impella 5.5 provides a higher flow rate than smaller microaxial pumps and has been increasingly adopted for cardiogenic shock (CS). This study aimed to evaluate whether its introduction into our Shock Team program in 2023 improved outcomes compared with a historical cohort supported with other mechanical circulatory support (MCS) devices. Methods: We retrospectively analyzed patients with CS treated with MCS between 2020 and 2024 at a tertiary center. The Impella 5.5 group (n = 17) included patients managed after device implementation, either as stand-alone or sequential therapy. The historical cohort comprised 40 patients treated with ECMO, Impella CP, CentriMag, or IABP prior to 2023. Propensity score matching (age, sex, etiology, lactate, SCAI stage) generated 17 matched pairs. The primary outcome was survival at discharge, 30 days, 3 months, and 6 months. Secondary outcomes included bridging to recovery, heart transplantation (HTx), durable LVAD, and major complications. Results: Impella 5.5 was associated with higher survival at discharge (94.1% vs. 58.8%, p = 0.039), 30 days (94.1% vs. 58.8%, p = 0.039), and 3 months (94.1% vs. 58.8%, p = 0.039). At 6 months, survival remained higher (88.2% vs. 58.8%) but did not reach statistical significance in point analysis (p = 0.118). Bridging occurred more frequently with Impella 5.5 (HTx 64.7% vs. 52.9% (p = 0.464), recovery 17.6% vs. 5.9% (p = 0.292)), while LVAD implantation rates were similar (11.8% vs. 17.6%, p = 1.0). Major bleeding (17.6% vs. 47.1%, p = 0.141), stroke/TIA (5.9% vs. 17.6%, p = 0.601), and the need for renal replacement therapy (5.9% vs. 23.5%, p = 0.335) were numerically lower with Impella 5.5. Conclusions: In this single-center, retrospective analysis, the introduction of Impella 5.5 was associated with higher short-term survival and favorable bridging metrics; estimates are imprecise due to small, heterogeneous samples. These hypothesis-generating findings warrant confirmation in larger, prospective multicenter cohorts