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Background An optimal donor work-up to exclude preexisting conditions is recommended, but urgency and technical equipment in donor centers must be considered. We report a case of two coronary stents present in the donor heart and the related long-term outcome. Case presentation A 59-year-old European male patient suffering from dilated cardiomyopathy with severely reduced left ventricular function and presenting with NYHA III underwent cardiac transplantation in 2004. At the one-year follow-up, during routine cardiac catheterization, two stents were found, one in the right coronary artery and one in the circumflex artery, in the patient’s transplanted heart. As no stent implantation was performed since transplantation, these were present prior to transplantation and had been transplanted without causing clinical signs. One of the stents showed in-stent restenosis, and the patient received an additional stent 7 years after transplantation. The other stent still showed a good result, and no further intervention has been required so far. The patient is currently in good clinical condition. Conclusion This is the first case report of favorable long-term stented coronary arteries prior to transplantation. This case highlights the importance of the donor work-up and meticulous palpation of the coronary arteries during donor evaluation.

OBJECTIVES The Edwards INTUITY Valve System is a balloon-expandable bioprosthesis, inspired from the Edwards Magna valve and transcatheter technology, with a subvalvular stent frame to enable rapid deployment. We report a single-centre experience of aortic valve replacement with this novel bioprosthesis. METHODS Five hundred consecutive patients, of whom 45.6% were female with a mean age of 73.5 [standard deviation (SD) 7.9 years], with severe aortic stenosis who received a rapid deployment aortic valve between May 2010 and July 2017 were included in a prospective and ongoing database. The median follow-up time was 12 months, and the total accumulated follow-up time was 818 patient years. Preoperative characteristics, operative parameters, survival, valve-related adverse events and valve haemodynamics were assessed. RESULTS Thirty-day mortality was 0.8% (4/500), and overall survival at 1, 3 and 5 years was 94%, 89% and 81%, respectively. A minimally invasive surgical approach was chosen in 236 patients (47%), of which 122 (24%) were operated on through an anterior right thoracotomy. Cross-clamp and cardiopulmonary bypass times for isolated aortic valve replacement were 53 (SD 17) and 89 (SD 29) min for full sternotomy as well as 75 (SD 23) and 110 (SD 31) min for minimally invasive surgery approaches (P

Evidence concerning an association between cytomegalovirus (CMV) infection and accelerated cardiac allograft vasculopathy (CAV) is inconclusive. Data were analyzed retrospectively from 297 consecutive heart transplants between 1.1.2002 and 31.12.2012. Patients ≤18 years of age, survival, and follow-up ≤1-year post-transplant and patients with early CAV were excluded. CMV-infection was diagnosed and monitored closely in the first year. CAV was diagnosed by coronary angiography via left heart catheterization, and results were categorized according to the International Society of Heart and Lung Transplantation (ISHLT) scoring system. Risk factors for CAV were tested in a multivariable model. Median follow-up was 7.5 years (IQR: 5.6-10.3). CMV infection in the first year after transplantation occurred in 26% of patients (n = 78), CMV disease in 5% (n = 15). CAV ≥1 ISHLT was detected in 36% (n = 108). Incidence of CAV >1 ISHLT and severity of CAV increased over time. No statistically significant association between CMV infection and disease within the first year and risk of CAV after 1-year post-HTx was detected in the univariate (P = 0.16) and multivariable [hazard ratio (HR), 1.36; confidence interval (CI), 0.89-2.07; P = 0.16] Cox regression. In the multivariable Cox regression, donor age (HR, 1.04; 95% CI, 1.02-1.06; P < 0.01) and acute cellular rejection (ACR) ≥2R in the first year after HTx (HR, 1.77; 95% CI, 1.06-2.95; P = 0.03) were independent risk factors for CAV development. In our cohort, CMV infection and disease in the first year after transplantation did not significantly influence the risk of CAV in the long-term follow-up.

Purpose Long-term survival after heart transplant is still limited due to immunological and drug related adverse events. Immunosuppressive therapy is solely managed via pharmacokinetic analysis and clinical events. TTV (Torque Teno Virus) is a small single-stranded DNA virus associated with increasing viral load under immune compromising conditions. Studies in both kidney and lung transplantation have already shown that the level of plasma TTV - DNA load is associated with the magnitude of immunosuppression. The aim of this prospective observational study was to analyze TTV viral load in patients after heart transplantation (HTX). Methods We prospectively determined the TTV load in 50 heart transplant patients. Samples were collected at pre-transplant and each HTX visit in the out-patient clinic. Viral load analysis was performed by PCR from plasma or serum on the Department of Virology. TTV viral load was compared between pre-transplant and peak levels post transplant. Pre-TX TTV load was compared between different patient groups and between different immunosuppressive protocols after transplantation. Results Patients were transplanted between 1/2016-6/2018. Median age at transplant was 60 (42-67) years and 38% were female. 50%(n=25) of patients were transplanted due to ischemic disease, 44% (n=22) due to dilative Cardiomyopathy and 6% (n=3) due to other disease. 16% of patients were bridged with a mechanical assist device (n=8). Pretransplant TTV levels were 4.4E+00±2.03E+00 cps/ml and significantly increased to 9.39E+00 ±0.75E+00 (p Conclusion TTV viral load increases significantly after heart transplantation and reaches its peak after 90-120 days. VAD pretransplant has an influence of TTV viral load and the choice of calcineurin inhibitor drug seems to be associated with differences in TTV viral load. TTV viral load might be useful as a biomarker for the state of immunosuppression.

BACKGROUND Sympathetic reinnervation after heart transplantation (HTX) is a known phenomenon, which has an impact on patient heart rate variability and exercise capacity. The impact of reinnervation on myocardial structure has not been evaluated yet. PROPOSE To evaluate the feasibility of simultaneous imaging of cardiac reinnervation and cardiac structure using a hybrid PET/MRI system. STUDY TYPE Prospective / pilot study. SUBJECTS Ten patients, 4-21 years after cardiac transplantation. FIELD STRENGTH/SEQUENCE 3 T hybrid PET/MRI system. Cine SSFP, T1 mapping (modified Look-Locker inversion recovery sequence) pre/postcontrast as well as dynamic [11 C]meta-hydroxyephedrine ([11 C]mHED) PET. ASSESSMENT All MRI and PET parameters were evaluated by experienced readers using dedicated postprocessing software packages for cardiac MRI and PET. For all parameters a 16-segment model for the left ventricle was applied. STATISTICAL TESTS Mann-Whitney U-test; Spearman correlations. RESULTS Thirty-six of 160 myocardial segments showed evidence of reinnervation by PET. On a segment-based analysis, mean native T1 relaxation times were nonsignificantly altered in segments with evidence of reinnervation (1305 ± 151 msec vs. 1270 ± 112 msec; P = 0.1), whereas mean extracellular volume (ECV) was significantly higher in segments with evidence of reinnervation (35.8 ± 11% vs. 30.9 ± 7%; P = 0.019). There were no significant differences in wall motion (WM) and wall thickening (WT) between segments with or without reinnervation (mean WM: 7.6 ± 4 mm vs. group B: 9.3 ± 7 mm [P = 0.13]; WT: 79 ± 63% vs. 94 ± 74% [P = 0.27]) under resting conditions. DATA CONCLUSION The assessment of cardiac reinnervation using a hybrid PET/MRI system is feasible. Segments with evidence of reinnervation by PET showed nonsignificantly higher T1 relaxation times and a significantly higher ECV, suggesting a higher percentage of diffuse fibrosis in these segments, without impairment of rest WM and WT. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1326-1335.

OBJECTIVES The aim of this study was to evaluate the long-term durability and function of pulmonary homografts used for right ventricular outflow tract reconstruction in the Ross procedure at a single centre with 25 years of experience. METHODS The study included 274 patients (212 male patients and 62 female patients; age 3-59 years), who underwent the Ross procedure between 1991 and 2014. Homograft-related complications and reinterventions were assessed. Homograft haemodynamic function was determined using transthoracic echocardiography undertaken by a single cardiologist. RESULTS The all-cause 30-day mortality was 1.1% (3 patients), and there were 17 late deaths. One death was associated with a homograft-related complication. During the observation period (median 13.3 years; 3327.5 cumulative patient-years), 21 patients (7.7%) underwent at least 1 right ventricular outflow tract reintervention. Freedom from homograft reintervention was 95.6%, 90.4% and 87.5% at 10, 15 and 20 years, respectively. Paediatric patients had a significant lower rate of freedom from reintervention (log-rank P

Purpose Hyperlipidemia is a major factor in the development of graft vasculopathy (GVP) after heart transplant. The incidence of hyperlipidaemia in heart transplant (HTX) patients under immunosuppressive therapy is 74% in the first year, and 91% in the first five years. Lipid-lowering therapy with statins presents a great challenge due to interactions and adverse effects. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have already proven very effective in high-risk cardiovascular patients. In our centre, PCSK9-inhibitors have been administered to selected HTX-patients, in which the target LDL-Cholesterol of 100mg/dl could not be reached with reasonable doses of statins and/or Etizimib. Methods In the period 02/2017 to 06/2018, 15 adult HTX-patients (median age 55.3, (25-75%: 48.2-64.6), 25% female) were selected. The patients were at a median of 35.1 (25-75%: 28.4-78.6) months post-HTX. The selected patients were evaluated together in the lipid clinic (licenced for PCSK9-inhibitors). Therapy was initiated with Alirocumab 75mg. Statin-therapy was changed and appropriately documented when changes in lipid-parameters and/or adverse effects occurred. In order to evaluate incidence and prevalence of myopathy and hepatotoxicity, CK and liver enzymes and were measured 1, 3, 6, 9, 12, and 15 months post conversion. Analysis of effectiveness were conducted by measuring blood lipids (LDL-C, HDL, total cholesterol, triglycerides, and LP(a)). Results Total cholesterol (231 (198-245) vs. 151 (139-175) mg/dl; p Conclusion Therapy with PCSK9-inhibitors (Alirocumab) constitutes an effective and safe option in therapy of hyperlipidaemia after heart transplant. Under treatment liver and kidney parameters stayed stable, while a significant reduction of lipid levels could be achieved. To evaluate the long-term effects of PCSK9-Inhibitors longer observation period is necessary.

To prospectively evaluate image quality (IQ) and radiation dose of dual-source cardiac computed tomography (CCTA) using different imaging protocols. CCTA was performed in 150 patients using the retrospective ECG-gated spiral technique (rECG) the prospective ECG-gated technique (pECG), or the prospective ECG-gated technique with systolic imaging and automated tube voltage selection (pECGsys). IQ was rated using a 16-segment coronary artery model. Techniques were compared for overall IQ, IQ of the large and the small coronary artery segments. Effective dose was used for comparison of radiation dose. Overall IQ and IQ of the large segments showed no differences between the groups. IQ analysis of the small segments showed lowered IQ in pECGsys compared to rECG (p = 0.02), but not to pECG (p = 0.6). Effective dose did not differ significantly between rECG and pECG (p = 0.13), but was significantly lower for pECGsys (p

Background. Because of improved long-term survival after heart transplantation (HTx), late graft pathologies such as valvular disease or cardiac allograft vasculopathy (CAV) might need surgical intervention to enhance longer survival and ensure quality of life. To this date, there exist no guidelines for indication of cardiac surgery other than retransplantation after HTx. Methods. In this retrospective, single-center study, we evaluated patients who underwent cardiac surgery after HTx at our institution. Results. Between March 1984 and October 2016, 17 (1.16%) of 1466 HTx patients underwent cardiac surgery other than retransplantation after HTx. Indication were valvular disease (n = 7), CAV (n = 6), and other (n = 4). Of these, 29.4% (n = 5) were emergency procedures and 70.6% were elective cases. Median age at time of surgery was 61 years (interquartile range, 52-66 years); 82.4% (n = 14) were male. Median time to surgery after HTx was 9.3 years (2.7-11.1 years). In-hospital, mortality was 11.8% (n = 2); later need of retransplantation was 11.8% (n = 2) due to progressing CAV 3 to 9 months after surgery. One-year survival was 82.35%; overall survival was 47.1% (n = 8) with a median follow-up of 1477 days (416-2135 days). Overall survival after emergency procedures was 209 days (36-1119.5 days) whereas, for elective procedures, it was 1583.5 days (901.5-4319 days). Conclusions. Incidence of cardiac surgery after HTx in our cohort was low (1.16%) compared with that of other studies. In elective cases, long-term survival was good.