【Abstract】 Background:Cardiac pacemakers are still an effective method for the treatment of atrioventricular block diseases(AVB). Ventricular pacing results in adverse clinical outcome. For patients with atrioventricular conduction system disease, minimization ventricular pacing not be used to reduce the proportion of ventricular pacing and improve cardiac function. Recent studies have shown that His bundle pacing(HBP) can be an effective treatment for patients with atrioventricular block . The purpose of this study was to evaluate the effectiveness of His bundle in patients with AVB. Methods:We searched the studies from Pubmed,Embase and Cochrane Library database to evaluate the application of HBP in patients with AVB. From these studies, we extrated and summarized the related data such as implantation success rate, QRS width, pacing threshold at baseline and follow-up, assessment left ventricular function, complications. Results:This Meta- analysis included eight studies, including 430 patients. The success rate of implantation varied from 65% to 93%. The main indications of HBP were patients with AVB, including patients with atrioventricular node block and intranodal block. Left ventricular function(left ventricular ejection fraction) was not significantly improved during follow-up. The duration of QRS after HBP implantation was more narrow (113±18ms). Compared with the baseline level, the threshold of HBP was not significantly increased during follow-up. During an average of 12 months of follow-up, pacemaker-related complications occurred in 16 patients. Conclusion:Permanent HBP has shown promising results for patients with AVB in small observational studies. Randomized controlled trials are needed to assess the efficacy of HBP in these patients.

Background: This study investigated the impact of weight change in waitlisted candidates on posttransplant outcomes following orthotopic heart transplantation (OHT). Methods: The United Network for Organ Sharing database was queried to identify adult patients undergoing isolated, primary OHT from 1/1/2010 to 3/20/2020. Patients were stratified into 3 cohorts based on percent weight change from listing to OHT. The primary outcome was one-year survival, and multivariable modeling was used for risk-adjustment. A secondary analysis compared outcomes of recipients waitlisted ≥90 days. Results: A total of 22,360 patients were included, 18,826 (84.2%) with stable weight, 1,672 (7.5%) with ≥5% weight loss, and 1,862 (8.3%) with ≥5% weight gain. Median age was similar across cohorts. Waitlist time was longest in patients with weight gain and shortest in those with stable weight (417 vs 74 days, P<0.001). The weight loss cohort had higher rates of dialysis dependency, pacemaker, and drug-treated acute rejection at one year (all P<0.05). Ninety-day and one-year posttransplant survival was lowest in the weight loss cohort. Multivariable modeling identified both ≥5% weight loss (HR 1.26, 95% CI 1.07-1.48) and decreasing weight (per 1%, HR 1.02, 95% CI 1.01-1.03) as risk-adjusted predictors of one-year mortality. In sub-analysis of recipients waitlisted ≥90 days, ≥5% weight loss and decreasing weight remained significant independent predictors for mortality. Conclusion: Waitlisted OHT candidates with ≥5% weight loss comprised a small, but higher-risk population with increased rates of postoperative complications and decreased survival. Efforts focused on nutritional optimization and preventing weight loss while awaiting OHT appear warranted.

Effect of VA - ECMO Vs Impella on Survival from Jan 1st 2017 – Aug 3rd 2020Frank H Annie, PhD1; Kayce Boggess1; Aravinda Nanjundappa, MD2;1. CAMC Health Education and Research Institute3200 MacCorkle Ave. SE, Charleston, WV 25304.2. CAMC Vascular Center of Excellence, Charleston Area Medical Center.3200 MacCorkle Ave SE, Charleston, WV 25304Study Locations:Charleston Area Medical Center, 3100 McCorkle Ave SE, Charleston, WV, 25302 and Charleston Area Medical Center Research Institute and Center for Clinical Sciences Research, 3200 McCorkle Ave SE, Charleston, WV, 25302Correspondence:Frank Annie M.A; MPA, PhDResearch ScientistCAMC Health Education and Research Institute3200 MacCorkle Ave. SE,Charleston, WV 25304Phone 304-388-9921Fax: 304-388-9921Email: [email protected] word count: 451Author Disclosure Block: NoneKey words: ECMO, Impella, MIRunning Title: Effect of VA - ECMO Vs Impella on SurvivalTotal Number of Tables and Figures: Figures 1Extracorporeal membrane oxygenation (ECMO) is used as a heart-lung bypass to oxygenate and pump blood outside the body. VA – ECMO supports both heart and lungs. Impella catheter is a pump that is used to increase blood flow from the inlet area which pulls from the left ventricle through the aorta of the heart. As both of these devices are support devices their effectiveness in terms of mortality as a result of individuals having a myocardial infarction then that required the implantation of either an ECMO and or Impella or their long term survival outcome(1-2).In order to understand long term survival of ECMO vs Impella we queried the TriNetx database (Research Network) which is a network of 38 health care organizations with cases from Jan 1st 2017 – August 3, 2020. We identified VA-ECMO (N=579) and Impella (N=1,377). We followed the cases until follow-up was lost. In order to compare the differences we conducted a Prosperity Score Match with a 1:1 (N= 482/482) match with the covariates (Age, Male, Female, Hypertension, CAD, CHF, Diabetes, CKD, Smoking History, COPD, Stroke History, Liver Disease History, Cardiogenic Shock, Medications, ACE, ARB Warfarin). After the match was complete a measure of association and a Kaplan Meir survival curve was conducted as long with a long-rank test.The unmatched age at event of MI that required the use of VA – ECMO was (56.1± 13.5), Impella (67.1±11.9) (P = <0.01), CAD (70.2% vs 81.3%) (P= <0.01) COPD (13.6% vs 20.4%) (P = 0.04), ACE (26.5% vs 41.4%) (P= < 0.01) Cardiogenic Shock (82.9% vs 54.8%) (P=<0.001). The matched cohort had a difference of mortality of (45.8% vs 25.1%) (P = <0.01). The Kaplan Meir Survival Curve showed that VA-ECMO had a much lower chance of survival compared to Impella with a log-rank test of (P=<0.01) as seen in and a lower survival probability of (0.49/0.72).We found that it appears that VA-ECMO cases even after the PSM was conducted had worse outcome as compared to Impella cases in terms of mortality. Even controlling for literature driven covariates it appears that VA-ECMO as a result of MI have worse outcomes compared to Impella.Figure Legend - ECMO V IMPELLA (Morality)

The Impact of COVID-19 on Surgery and Procedures: A CommentaryFrank H Annie, PhD1; Jaineet Singh Chhabra3; Aravinda Nanjundappa, MD2;1CAMC Health Education and Research Institute3200 MacCorkle Ave. SE, Charleston, WV 25304.2CAMC Vascular Center of Excellence, Charleston Area Medical Center.3200 MacCorkle Ave SE, Charleston, WV 253043Marshall University, School of Medicine.1600 Medical Center Dr, Huntington, WV 25701

Frank H Annie, PhD1; Aravinda Nanjundappa, MD2;1CAMC Health Education and Research Institute3200 MacCorkle Ave. SE, Charleston, WV 25304.2CAMC Vascular Center of Excellence, Charleston Area Medical Center.3200 MacCorkle Ave SE, Charleston, WV 25304

Objective: The aim of this study is to define the correlation between intramyocardial left anterior descending artery (IMLAD) and coronary artery angiography (CAG); our clinical intraoperative experiences. Material and Methods: Between January 2014 and May 2019, 196 patients underwent coronary artery bypass grafting (CABG) surgery in Bozok University Medicine Faculty Hospital. The correlation between the typical “wide-U” image of left anterior descending artery (LAD) depression(Cicekcioglu sign) on CAG and our intraoperative surgical observations of the patients were studied. Results: Of the 196 patients, 5 were excluded due to the total occlusion of proximal LAD. 30 had a typical “wide-U” image(Cicekcioglu sign) on CAG and 22 were observed to have an IMLAD. Of the 25 patients being observed to have IMLAD intraoperatively, 3 had a normal preoperative CAG imaging. The prevalence of the IMLAD was 13%. Sensitivity of CAG was measured as 88% and specificity of CAG was 95.1%. Discussion: In CAG, in case of LAD composing a “wide-U” imaging(Cicekcioglu sign) the image of LAD course is often observed to have a correlation with the intraoperative detection of IMLAD.

Background: Careful preoperative selection and operative management in coronary artery disease patients with low EF undergoing CABG improve early outcome(LVEF,NYHA class). Material and Methods:This is descriptive observational retrospective study of 113 patients of coronary artery disease with moderate to severe left ventricular dysfunction who underwent CABG during study period. Results: Male patients (76%) outnumbered female patients (24%). Male to female ratio was 3.19:1. Most common age group was 60-69 yrs (34 %), followed by 70-79 yrs (29 %) & 50-59 yrs (21 %) . Mean age was 66.28 yrs. Majority patients had LM (43 %) & TVD (Triple vessel disease)(42%) as coronary artery disease in present study.LIMA+Vein (91 %) were most commonly used grafts . 61 (54 %) patients needed 3 grafts, while 24 (21%) & 19 (17%) respectively required 4 & 2 grafts respectively. 32(29 %) patients had mitral regurgitation. In 6(5 %) patients emergency CABG was done. Total mortality rate was 7.9%. We compared LVEF values in preop, immediate postop & 3 months follow up period. Statistically significant (p – 0.004) difference was noted in pre-op & 3 months follow up values of LVEF. Similarly we compared NYHA class in preop & 3 months follow up period. A statistically significant (p – 0.003) difference was noted in pre-op & 3 months follow up values of NYHA class in our patients. Conclusion: Postoperative improvement of EF and NYHA functional class reflects the high benefit of CABG in patients with coronary artery disease with moderate to severe LV dysfunction.

Transcatheter valve-in-valve implantation may be considered in patients with failing surgical bioprosthesis caused by severe regurgitation or stenosis, regardless of sur¬gical valve position. This case report presents a 70-years-old woman presenting with worsening dyspnea, according to New York Heart Association (NYHA) Class III, after she had received a Sorin Perceval® S sutureless valve due to severe aortic valve stenosis one year ago. Echocardiography revealed severe valvular aortic regurgitation and stenosis. Instead of reoperation, the transcatheter valve in the valve procedure was planned. Here we present the first case of the trans-femoral implant of a self-expandable (Portico) aortic valve in a leaking sutureless self-expandable valve.

We're presenting a unique case where a 2 month old female presented with URI symptoms at a local clinic and went into cardiac arrest after a nasopharyngeal swab test was done. Subsequent work up revealed she had an intrapericardial mass and a large pericardial effusion, which may have precipitated the arrest. The patient recovered after emergent pericardiocentesis and subsequent pericardial mass excision via sternotomy and pericardiectomy. The infant was recovering appropriately at her 4 month post-op follow up.

Although early postoperative outcomes after Fontan improved in the modern era, the convincing evidence in the resource-scare setting was sparse. Our study aimed to determine the incidence of early Fontan failure (EFF) in a contemporary series of palliated patients and to identify its potential risk factors. A single-center retrospective study was conducted between 2012 and 2019 on 145 patients undergoing the Fontan procedure. The primary outcome of interest was EFF, defined as death, Fontan takedown, or listing for heart transplantation prior to hospital discharge or within 30 postoperative days. Our study reported the incidence of EFF of 9.66% (n = 14: thirteen deaths, and one Fontan takedown). In the univariate analysis for pre-operative data, the anatomical diagnosis of unbalanced atrioventricular (AV) septal defect, situs inversus form, AV valve regurgitation, large aorta-pulmonary circulation in Doppler echocardiography, elevated pulmonary artery pressure (PAP), and elevated pulmonary vascular resistance were significantly associated with EFF. At the Fontan, four risk factors influencing EFF included pulmonary artery reconstruction, AV valve repair, bleeding, and elevated PAP. Post-operative edema was also significantly associated with EFF. A final reduced model with multivariate logistic regression analysis indicated preoperative elevated PAP, AV valve repair at Fontan, and postoperative elevated PAP were independent predictors for EFF. In conclusion, EFF is relatively high in our series, and is associated with significant mortality. Patients with a single ventricle physiology undergoing preoperative elevated PAP, AV valve repair at Fontan, and postoperative elevated PAP were identified as independent risk factors to predict EFF.

Sutureless/rapid deployment valves provide surgeons with a new tool for aortic valve replacement (AVR) therapy, which can simplify the procedure. A main concern being the development of a paravalvular leak. We retrospectively reviewed our Aortic Valve Replacement database, were able to identify 25 rapid deployment aortic valves (INTUITY Valve System, Edwards Life Sciences LLC, Irvine, Calif) that had documented intraoperative Transesophageal Echocardiographic Annular measurements. All valves were implanted in the Aortic position. In this cohort, only patients that had their native aortic valve replaced either isolated or as part of any additional procedure were included. Patients that underwent Intuity valve implantation for Redo Aortic valve replacement were excluded from this study. After review of 25 patients who underwent rapid deployment valve implantation in the aortic position, 36% of patients had the same size valve as the measured aortic annulus, 48% of patients had a valve implanted that was 1 mm different, and 16% of patients had 2 mm difference. The mean annular size based on intraoperative TEE was 22.4 mm (range: 21-28 mm). The mean valve size that we implanted was 23.3 mm (range: 21-27 mm). No statistically significant difference between the mean annular measurement and the valve size selected (0.9 mm , p = 0.8) were found. TEE is perhaps remains as one of our most important tool to further enhance valve sizing and appropriately guide one through a proper and safe deployment.