Žaliūnas, Remigijus

Background and Objectives: Transcatheter aortic valve replacement (TAVR) in large aortic annuli poses challenges due to limited valve-size options and increased complication risks. The aim is to evaluate the safety and performance of XL sizes (30.5 mm and 32 mm) of the Myval transcatheter heart valve (THV) for treating patients with severe aortic stenosis and large aortic annuli. Material and Methods: This retrospective observational study included consecutive patients undergoing TAVR with XL sizes of the Myval THV between December 2023 and December 2024 at a single centre. During this period, 146 TAVI procedures were performed, of which 15 patients (10.3%) with large aortic annuli (mean systolic annular area 786.5 ± 48.2 mm2) received XL valves and were included in the present analysis. Patients were followed up at discharge, 3–6 months, and 1 year. Patient evaluation included echocardiography and clinical assessments following the Valve Academic Research Consortium-3 criteria. Results: All patients were male, with a mean age of 79.1 ± 5.9 years. Technical success was achieved in 100% of cases. At discharge, none of the patients had moderate or greater paravalvular leakage (PVL); 11 patients had no PVL, while 1 had trace and 3 had mild PVL. The mean effective orifice area (EOA) improved from 0.75 ± 0.15 cm2 at baseline to 2.31 ± 0.21 cm2 at discharge (p < 0.0001). At the 12-month follow-up, the mean EOA was 2.4 ± 0.3 cm2, and no moderate or severe PVL or major adverse clinical outcomes were observed. One patient required a permanent pacemaker implantation due to an atrioventricular block. Conclusions: The XL sizes of Myval THV showed both safety and efficacy in patients with large aortic annuli, demonstrating acceptable hemodynamic performance and low complication rates. However, large-scale studies with longer follow-ups are needed to validate these findings in diverse populations.

Širdies ir kraujagyslių ligos yra pagrindinė mirties priežastis visame pasaulyje, o perkutaninė vainikinių arterijų intervencija (PVAI) per pastaruosius dešimtmečius tapo dominuojančiu kraujotakos atkūrimo metodu Europoje ir laikoma aukso standartu gydant ūminę širdies išemiją. Stipininės arterijos prieiga vis labiau keičia seniau naudotą šlaunies arterijos prieigą, sumažindama kraujagyslinių komplikacijų riziką, sutrumpindama stacionarizacijos laikotarpį ir didindama pacientų pasitenkinimą. Nepaisant privalumų, po procedūros prieigos vietoje galimos komplikacijos: kraujagyslės spazmas, kraujavimas, prieigos vietoje aplinkinių struktūros pažeidimas, skausmas ir net ilgalaikė rankos disfunkcija. Literatūroje vis dažniau aprašomi prieigos vietos skausmo klinikiniai atvejai po PVAI, kai stiprus skausmas išlieka kelias savaites ar ilgiau, pereidamas į lėtinę būklę . Daugiamodalinio skausmo valdymo (DMSV) modelis, kai taikomi kelių farmakologinių ir nefarmakologinių metodų derinys, gali būti pagrindinis sprendimas sudėtingam skausmui valdyti. Šio tyrimo tikslas – nustatyti stiprinės arterijos prieigos vietos skausmo pasireiškimą, intensyvumą ir DMSV taikymo efektyvumą po PVAI. Uždaviniai: 1) Įvertinti prieigos vietos skausmo pasireiškimą ir intensyvumą po perkutaninės vainikinių arterijų angiografijos; 2) Nustatyti galimus veiksnius, turinčius įtakos prieigos vietos skausmui išsivystyti po PVAI; 3) Išskirti prognozinius rizikos veiksnius skausmo perėjimui į lėtinį procesą; 4) Įvertinti DMSV poveikį skausmo pasireiškimui, intensyvumui ir komplikacijoms.

Širdies nepakankamumo (ŠN) ir aortos pokyčių diagnostika vis dažniau remiasi echokardiografija, tačiau įvertinimo kompleksiškumas ir priklausomybė nuo tyrėjo sustiprina automatizuotų sprendimų poreikį. Gilieji neuroniniai tinklai (GNT) parodė didelį potencialą echokardiografinių vaizdų analizėje, tačiau daugiacentrinių realios praktikos tyrimų, ypač apimančių krūvio echokardiografiją, dar trūksta. Šiame tyrime įtraukta daugiau kaip 500 pacientų iš 6 tarptautinių centrų. Pilnai automatizuotos GNT pagrįstos analizės sprendimai taikyti kairiojo skilvelio (KS) diastolinei funkcijai, aortos šaknies ir kylančiosios aortos diametrams, KS ir kairiojo prieširdžio (KP) tūriams bei sistolinei funkcijai ramybės ir farmakologinio krūvio echokardiografijos metu įvertinti. Automatizuoti rezultatai buvo nepriklausomai lyginami su ekspertų kardiologų atliktais matavimais. GNT parodė didelę diagnostinę gebą ir vidutinę–stiprią koreliaciją su ekspertų vertinimais vertinant KS diastolinius parametrus (r = 0,55–0,94), aortos matmenis (r = 0,67–0,86) bei KS ir KP tūrius ramybės ir krūvio metu (r = 0,84–0,93). Diastolinės disfunkcijos klasifikacija buvo tiksliausia normalios ir restrikcinės formos atvejais. Modelių veikimas išliko pakankamas esant skirtingai vaizdų kokybei, o geriausi rezultatai pasiekti analizuojant geros ir optimalios kokybės vaizdus. Tyrimas parodė, kad automatizuota echokardiografinių ŠN ir aortos parametrų analizė gali būti pritaikoma ir tiksli realioje klinikinėje praktikoje.

Funkcinis triburio vožtuvo nesandarumas (fTVN) - kliniškai reikšminga dešiniosios širdies patologija, kurią sukelia ne pirminė vožtuvo burių pažaida, bet dešiniojo skilvelio (DS) geometrijos ir funkcijos pokyčiai. Nustatyta, kad fTVN progresavimas lemia DS remodeliaciją ir disfunkciją, širdies nepakankamumą bei blogesnę pacientų prognozę. Nors triburio vožtuvo (TV) žiedo plastika laikoma saugia ir veiksminga procedūra bei rekomenduojama fTVN korekcijai atliekant kairiosios širdies operacijas, chirurginis gydymas neretai taikomas pavėluotai, jau esant negrįžtamiems DS struktūriniams ir funkciniams pokyčiams. Be to, grįžtamojo TVN dažnis po chirurginės korekcijos išlieka reikšmingas ir yra susijęs su blogesniais ilgalaikiais klinikiniais rezultatais. Šio darbo tikslas buvo trimatės echokardiografijos metodu kompleksiškai įvertinti TV ir DS geometriją bei funkciją esant skirtingos etiologijos ir sunkumo fTVN, taip pat nustatyti šių rodiklių pokyčius po chirurginės TVN korekcijos. Atliktame darbe nustatyti echokardiografiniai rodikliai ir jų ribinės vertės, leidžiančios prognozuoti grįžtamojo TVN išsivystymą po chirurginės fTVN korekcijos, bei įvertintas TV žiedo plastikos De Vega metodika poveikis širdies geometrijai ir funkcijai vėlyvuoju pooperaciniu laikotarpiu. Gauti rezultatai pagrindžia individualizuotą diagnostikos, gydymo ir pooperacinės stebėsenos strategiją, galinčią pagerinti funkcinio TV nesandarumo chirurginio gydymo rezultatus.

Introduction: HeartMate 3 (HM3) is a widely used left ventricular assist device(LVAD) for patients with advanced heart failure, either as a bridge to heart transplantation or as long-term therapy for that ineligible for a transplant. The success of HM3implantation is influenced by various factors, including preoperative parameters, cardiopulmonary bypass time (CBT) and the quality of postoperative care. How-ever, the specific relationship between these preoperative factors and CBT remainsunclear. Aim: The aim of this study is to investigate whether preoperative parameters, such as body mass index, blood test results, and cardiovascular system measurements, influence the duration of CBT during HM3 implantation. Methods: This retrospective cohort study involved patients undergoing HM3implantation at an academic centre between March 2017 and November 2023. All required examinations were initiated, and the decision to implant HM3 adhered to the recent guidelines outlined by the European Society of Cardiology (ESC). Prior to LVAD implantation, conventional echocardiographic measurements were obtained and pulmonary artery catheterization to measure hemodynamic parameters was conducted. Demographic data and laboratory results were systematically collected. Cardiopulmonary bypass time (CBT) was extracted from the surgical protocols and patients were divided into two groups where 111 minutes represents the median CBT of the study cohort: 1. Patients with a CBT of less than 111 minutes; 2. patients with a CBT exceeding 111 minutes. Statistical analyses were carried out using SPSS version 27 (IBM, Armonk, NY, USA), and p-values <0.05 were deemed statistically significant. Results: Among the patient cohort, 85% were male, with a mean age of 56 (27-67years) at the time of HM3 implantation. The distribution of biomarkers and conventional echocardiography parameters across study groups are shown in Table 1.Analysis of the data suggests that preoperative clinical and hemodynamic parameters do not significantly affect the duration of CBT. Although some trends were observed, such as a higher body mass index, larger left ventricular end-diastolic diameter, and elevated NT-proBNP levels in the group with longer CBT, none of these differences were statistically significant. However, patients who died during follow-up were more likely to have experienced longer cardiopulmonary bypass times compared to survivors (7 [77.8 proc.] vs. 2 [22.2 proc.], respectively; p = 0.018).Conclusions: These findings highlight that survival following HM3 implantation is influenced more by the quality of postoperative care than by the duration of surgery or preoperative parameters. This highlights the importance of optimized and effective postoperative management strategies in improving survival rates and overall patient outcomes after HM3 implantation.

Introduction: HeartMate 3 (HM3) is a leading left ventricular assist device (LVAD)for advanced heart failure, yet mortality post-implantation remains a concern. Pre-implantation hemodynamic parameters’ value, for predicting outcomes and guiding clinical decisions remains unclear. Aim: The aim of this study was to explore the predictive values of pre-implantation hemodynamic parameters that may predispose post-HM3 implantation mortality. Methods: This retrospective cohort study involved patients undergoing HM3implantation at an academic centre between March 2017 and November 2023. All required examinations were initiated, and the decision to implant HM3 adhered to the recent guidelines outlined by the European Society of Cardiology (ESC).Prior to LVAD implantation, conventional echocardiographic measurements were obtained and pulmonary artery catheterization to measure hemodynamic parameters was conducted. Receiver-operating characteristic (ROC) analysis was per-formed to determine the optimal cut-off values for hemodynamic parameters in predicting mortality post-implantation. The accuracy of these cut-off values was assessed using the area under the ROC curve (AUC). Statistical analyses were carried out using SPSS version 27 (IBM, Armonk, NY, USA), and p-values <0.05 were deemed statistically significant. Results: Among the patient cohort, 85% were male, with a mean age of 56 (27-67years) at the time of HM3 implantation. Table 1 highlights several pre-operative hemodynamic parameters that may serve as mortality predictors after HM3 implantation. Central venous pressure and median right ventricular (RV) pressure emerged as the most reliable predictors, with high AUC values and significant p-values(AUC = 0.875 and 0.889, respectively; p < 0.001). These parameters also demonstrated strong sensitivity and specificity, suggesting their practical importance in identifying high-risk patients. Pulmonary vascular resistance (PVR) also showed significant predictive value (AUC = 0.811, p = 0.041). This suggests that a PVR above7.5 Wood units is a significant predictor of higher mortality risk after the HM3 implantation. In contrast, parameters such as diastolic RV, systolic pulmonary artery pressures, cardiac output, and cardiac index demonstrated little to no predictive value. Conclusions: Pre-implantation hemodynamic parameters, particularly central venous pressure, right ventricular pressure, and pulmonary vascular resistance, show strong predictive value for post-HeartMate 3 implantation mortality. These findings show the importance of thorough hemodynamic assessment prior to LVAD implantation to better stratify patient risk and guide clinical decision-making. Incorporating these parameters into pre-operative evaluations may improve outcomes by identifying high-risk patients who require increased perioperative attention.

Background: The HeartMate 3 (HM3) left ventricular assist device (LVAD) has demonstrated improved clinical outcomes in patients with advanced heart failure (HF). However, the influence of underlying HF etiology—ischemic cardiomyopathy (ICM) versus dilated cardiomyopathy (DCM)—on post-implantation outcomes remains insufficiently characterized. Objectives: This paper aims to evaluate early postoperative outcomes following HM3 LVAD implantation in patients with ICM versus DCM and to identify the preoperative hemodynamic and clinical predictors of early mortality and hemodynamic instability. Methods: We conducted a retrospective single-center cohort study of 30 patients who underwent HM3 LVAD implantation between 2017 and 2024. Patients were stratified by HF etiology (ICM, n = 17; DCM, n = 13), and preoperative clinical, echocardiographic, and right heart catheterization data were analyzed. The primary endpoint was 30-day postoperative survival. Secondary endpoints included postoperative hemodynamic stability and the need for vasopressor support. Results: Non-survivors (n = 13) demonstrated elevated central venous pressure (>16.5 mmHg), mean right ventricular pressure (>31.5 mmHg), and pulmonary vascular resistance (>7.5 Wood units), in addition to higher preoperative creatinine levels and longer cardiopulmonary bypass times. Vasopressor requirement postoperatively was associated with elevated pre-implant systolic pulmonary artery pressure. Conclusions: Preoperative right-sided pressures and renal dysfunction are strong predictors of early mortality following HM3 LVAD implantation. Patients with ICM exhibit greater early left ventricular recovery compared to those with DCM. These findings underscore the importance of comprehensive and personalized preoperative risk stratification—particularly in patients with DCM and pulmonary hypertension—to optimize postoperative outcomes and guide patient selection for durable LVAD support.

Herein, we review the critical role of a multi-disciplinary team approach in managing the intricate complications of ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Mechanical circulatory support (MCS) implantation represents a potentially life-saving intervention, often serving as a bridge to heart transplantation (HTx). However, complications from prior interventions, in patients receiving MCS due to STEMI-CS, may present additional challenges to successful HTx candidacy. A 63-year-old male suffered out-of-hospital cardiac arrest and was hospitalized due to acute anterior STEMI-CS. Emergency percutaneous coronary intervention was performed in the setting of cardiopulmonary resuscitation. Despite successful revascularization and subsequent optimal medical therapy hemodynamic status remained compromised, the decision was made to implant a HeartMate 3 (HM3) left ventricular assist device (LVAD) as a bridge to HTx. HM3 LVAD was implanted without complications and patient was weaned from mechanical ventilation. The later postoperative period was complicated by infections leading to the LVAD-related complications. Moreover, the patient experienced repeated episodes of stridor, which were attributed to significant tracheal stenosis (due to temporary tracheostomy). Finally, a suitable heart donor was found and a successful HTx was performed.