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Background: With more than 15,000 implanted patients worldwide and a survival rate of 80% at 1-year and 59% at 5-years, left ventricular assist device (LVAD) implantation has become an interesting strategy in the management of heart failure patients who are resistant to other kinds of treatment. There are limited data in the literature on the change over time of exercise capacity in LVAD patients, as well as limited knowledge about the beneficial effects that rehabilitation might have on these patients. Therefore, the aim of our study was to evaluate the evolution of exercise capacity on a cohort of patients implanted with the same device (HeartWare © ) and to analyse the potential impact of rehabilitation., Methods: Sixty-two patients implanted with a LVAD between June 2011 and June 2015 were screened. Exercise capacity was evaluated by cardiopulmonary exercise testing at 6 weeks, 6 and 12 months after implantation., Results: We have observed significant differences in the exercise capacity and evolution between the trained and non-trained patients. Some of the trained patients nearly normalised their exercise capacity at the end of the rehabilitation programme., Conclusions: Exercise capacity of patient implanted with a HeartWare © LVAD increased in the early period after implantation. Rehabilitation allowed implanted patients to have a significantly better evolution compared to non-rehabilitated patients.

Objectives: The objective of this study was to investigate the patient characteristics and outcomes in 1406 patients undergoing intra-aortic balloon pump (IABP) counterpulsation., Methods: Between 1998 and 2008, 1406 consecutive patients were recorded in a prospective database. Based on the main clinical indication for IABP use, we defined 3 groups: group A, 630 cases of coronary ischaemia or infarction without serious left ventricular (LV) dysfunction; group B, 466 patients with left ventricular failure or cardiogenic shock; group C, 310 patients where IABP was used for miscellaneous procedures such as weaning from cardiopulmonary bypass or during high-risk angioplasty or surgery., Results: Global mortality was 28% (n = 390), with a significant difference between group A (15%, n = 95) and group B (41%, n = 191) (P < 0.001). Mortality in group C was 34% (n = 104). Most insertions were done in the catheterization laboratory (n = 943) with subsequent mortality of 23% whereas 199 balloons were inserted in the operation room with 34% mortality. 170 balloons inserted in the intensive care unit resulted in 46% mortality (P < 0.001). Major IABP-induced complications were 6.8% with no statistical differences between the three groups. Advanced age, left ventricular failure and low BMI were identified as prognostic risk factors for early mortality., Conclusions: IABP deployed at an early clinical stage yields the best results, especially for acute coronary patients with preserved LV function whereas LV failure and late insertion result in worse outcome.

Aneurysm formation is a well-known complication of untreated long-standing dissection of the aorta. Despite numerous advances in cardiac surgery, intrinsic diseases of the ascending aorta and aortic arch requiring surgical therapy, remain a technical challenge. However, surgery is the only option for effective treatment of ascending aorta aneurysm but carries an increased risk of severe morbidity and mortality, particularly in the elderly. We report on the successful repair of a giant ascending aorta aneurysm due to chronic dissection in an elderly woman with dyspnoea as main symptom.

Post-operative cognitive decline occurs in 20-70% of the coronary artery bypass surgery patients during the first week after surgery. After 6 weeks the incidence declines to 10-40% and remains at this level thereafter.Although the neuropsychological consequences are subclinical, they can interfere with daily life. In this paper, we discuss the impact of surgical factors, with a focus on the use of the heart-lung machine and its intra-operative embolic load. The pre-morbid cardiac condition of the patient as another underlying mechanism for cognitive decline is addressed. We also describe the methodological pitfalls in arriving at an adequate estimation of the prevalence of cognitive decline. Among these are the definition of cognitive decline, testing intervals, the choice of cognitive domains and the appropriate use of control groups.We also pay attention to the relation between cognition, depression and anxiety. Finally, the ecological validity of this study domain is discussed. It is concluded that (1) the literature remains undecided on the role of intra-operative emboli and cognitive decline after surgery. Researchers should focus on the composition, size and location instead of the absolute number of intra-operative emboli; (2) growing awareness of neurocognitive decline in chronic vascular disease patients must challenge both clinicians and investigators.The preoperative cognitive status can increase the risk for post-operative cognitive decline; (3) researchers should include--at the least--the core battery as stated in the Statement of Consensus on assessment of neurobehavioural outcomes after cardiac surgery. They also should work towards a consensus on the definition of cognitive decline and the definition of control groups; (4) depression and anxiety as confounders for postoperative cognitive decline might lead to an overestimation of cognitive decline at least for the majority of neuropsychological domains; (5) much more attention should go to the ecological validity of this research.

The intra-aortic balloon pump (IABP) is a valuable tool in the treatment of cardiogenic shock or instable myocardial ischaemia. We report on our recent experience with interhospital transport of haemodynamically unstable patients using on-site stabilization with IABP. A 75% survival rate encourages us to keep using this technique despite the logistic efforts it demands.

We report the case history of a 52-year-old man with the Wolff-Parkinson-White syndrome and a fistula from the left anterior descending artery to the pulmonary artery. He had a left lateral bypass tract. To our knowledge, this is the first reported case of this association. Arterial malformations, along with vascular malformations of the coronary sinus, can be present in patients with a WPW syndrome. Coronary angiography with attention to the possible presence of arterial and venous malformations is indicated when atypical symptoms or signs are present in the WPW syndrome.