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Objectives Redo sternotomy and explantation of left ventricular assist devices (LVAD) for heart transplantation (HT) involve prolonged dissection, potential injury to mediastinal structures and/or bleeding. Our study compared a complete expanded polytetrafluoroethylene (ePTFE) wrap versus minimal or no ePTFE during LVAD implantation, on outcomes of subsequent HT. Methods Between July 2005 and July 2018, 84 patients underwent a LVAD implant and later underwent HT. Thirty patients received a complete ePTFE wrap during LVAD implantation (Group 1), and 54 patients received either a sheet of ePTFE placed in the anterior mediastinum or no ePTFE (Group 2). Results Baseline characteristics were similar between Groups 1 and 2. Surgeons reported subjective improvements in speed, predictability and safety of dissection with complete ePTFE compared with minimal or no ePTFE. Time from incision to initiation of cardiopulmonary bypass (CPB) were similar between groups (97±38 min vs 89±29 min, p=0.3). Injury to mediastinal structures during the dissection was similar between groups (10% vs 11%, p>0.9). While surgeons reported less intraoperative bleeding in Group 1 (43% vs 61%), this trend did not reach significance (p=0.1). In-hospital mortality, ICU length of stay and hospital length of stay were similar between both groups. Conclusions In patients undergoing LVAD explant-HT, there was a trend towards reduced surgeon reported intraoperative bleeding with ePTFE placement. Despite qualitatively reported greater ease and speed of mediastinal dissection with ePTFE membrane placement, time to initiation of CPB did not differ, likely because surgeons remained cautious, allowing extra time for unanticipated difficulties.

This case report describes the case of a 45-year-old female with a heart transplant who developed severe aortic insufficiency after insertion of a 5L Impella device. The case is unusual as there has been no published report of aortic valve injury leading to persistent and significant aortic regurgitation after insertion of an Impella device.

Background: Dominant frequency (DF) analysis is a common way of quantitatively studying the spatio-temporal variation of frequency during VF. Areas of high frequencies (e.g. rotors) and low frequencies (e.g. blocks) have been associated with the occurrence and maintenance of VF. However, the relation of these high or low frequency areas to anatomical or physiological substrate remains unclear. Objective: We tested the hypothesis that the Max-Min DF locations in the epicardium during VF are due to anatomical substrate. Methods and Results: We analyzed 33, 4 seconds VF episodes acquired from 6 isolated human hearts using a Langendorff setup. The hearts were received from the heart-transplanted patients with informed consent. Electrode array consisting 112 bipolar electrodes was used to acquire the surface unipolar and bipolar electrograms from the epicardium. DF was computed as the peak frequency of the VF segment from each of electrodes using Welch’s modified periodogram method. From the DF distribution, the regions of max and min frequencies were identified for LV and RV regions. Scar maps were computed for each of the 6 hearts using a previously published method by mapping the amplitude of bipolar electrograms ( shows the match between the max-min DF frequency locations and the scar locations. 50% of max-min DF frequencies locations match the scar locations and in 97% of the matched locations the max-min DF occur at the vicinity of the scar. Conclusion: During human VF, DF dynamics are only partially explained by the anatomical substrate. This suggests that ion channel heterogeneity and dynamic physiological factors may play an important role in determining fibrillation dynamics. Match Between Max-Min DF locations and Scar Locations

Background: We had recently established a model for the study of VF in humans using an optical mapping technique in Langendorff perfused human hearts. The optical mapping technique allows for the unequivocal evaluation of wavefront identification, the origin of wavefronts and their directional spread. Objective: The objective of this study was to measure wavefront sizes from different regions during human VF to determine the minimal spatial resolution required to study human VF in-vitro. Methods: The hearts were explanted from seven cardiomyopathic patients who underwent transplantation. The hearts were Langendorff perfused with Tyrode’s solution (95%O 2 +5%CO 2 ) and the potentiometric dye (0.2 mg Di-4-ANEPPS dissolved in 20mg of perfusate) was injected as a bolus into the coronary circulation. The imaged region was physically immobilized to minimize motion. The fluorescence was excited at 530 nm with a HL 150 W halogen lamp, the emission signal was longpass filtered at 610 nm and recorded with a CCD and CMOS camera (MiCAM02, Ultima, BrainVision Inc., Japan). The spatial resolution depending on the mapping window was 0.65–0.85 mm and the temporal resolution was 1 kHz. The heart was paced at a cycle length of 600 ms and the VF was induced by briefly touching the heart with the two poles of a 9V battery. The changes in dye signal were recorded over 1887 ms and analyzed using BV-analyzer software (BrainVision Inc, Japan). Wavefronts were identified using high-pass filter (0.01 Hz) on the fluorescence data. Recordings were performed at 4 sites: LV Septum (LVS), Right Ventricle Endocardium (RV), Left Ventricle Endocardium (LVendo) and Left Ventricle Epicardium (LVepi). Results: 16 episodes of VF were recorded and a total of 54 wavefronts were identified. Average wavefront size was 23.6 mm. By region, the average wavefront sizes were: LVS = 26.3 mm; RV = 22.4 mm; LVendo = 29.7 mm; LVepi = 19.3 mm. Conclusion: These results show that different regions on the human ventricle during VF show different wavefront size suggesting that propensity for wavebreak maybe spatially differentially distributed. To study human VF with multi-electrode mapping tools using inter-electrode spacing of less than 1–2 cm should provide sufficient resolution.