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Right ventricular failure (RVF) is increasingly recognized as a complicating feature of a number of disease states, including pulmonary arterial hypertension (PAH) and advanced heart failure. It not only contributes to symptoms and complicates management, but also dramatically impacts prognosis. In PAH, early disease detection and institution of PAH therapy can prevent or delay RVF. Once established, therapy for RVF focuses on optimizing afterload reduction with PAH therapy, controlling volume, and judiciously using inotropic support when needed. In patients undergoing implantation of a LVAD, preoperative assessment and management of RVF is critical. Risk factors for the development of RVF after LVAD have been described, and may identify a population best managed with biventricular support. Postoperative management of RVF focuses on supportive therapy, judicious use of inotropes and volume management. Ongoing research may yield insights into specific therapies to prevent or reverse RVF.

Background Induction immunosuppression in heart transplant recipients varies greatly by center. Basiliximab (BAS) is the most commonly used induction immunosuppressant but has not been shown to reduce rejection or improve survival. The objective of this retrospective study was to compare rejection, infection, and mortality within the first 12 months following heart transplant in patients who received BAS or no induction. Methods This was a retrospective cohort study of adult heart transplant recipients given BAS or no induction from January 1, 2017 to May 31, 2021. The primary endpoint was incidence of treated acute cellular rejection (ACR) at 12‐months post‐transplant. Secondary endpoints included ACR at 90 days post‐transplant, incidence of antibody‐mediated rejection (AMR) at 90 days and 1 year, incidence of infection, and all‐cause mortality at 1 year. Results A total of 108 patients received BAS, and 26 patients received no induction within the specified timeframe. There was a lower incidence of ACR within the first year in the BAS group compared to the no induction group (27.7 vs. 68.2%, p < .002). BAS was independently associated with a lower probability of having a rejection event during the first 12‐months post‐transplant (hazard ratio (HR) .285, 95% confidence interval [CI] .142–.571, p < .001). There was no difference in the rate of infection and in mortality after hospital discharge at 1‐year post‐transplant (6% vs. 0%, p = .20). Conclusion BAS appears to be associated with greater freedom from rejection without an increase in infections. BAS may be a preferred to a no induction strategy in patients undergoing heart transplantation.

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The Iowa gambling task (IGT) was developed as a neuropsychological assessment of “real‐life” decision making in a laboratory setting by Bechara, Damasio, Damasio, and Anderson in . The IGT was originally implemented as a manual task during which the participants selected paper cards. The task has since evolved into a computerized assessment tool (Psychological Assessment Resources IGT or PAR™IGT) that uses only virtual cards and reinforcement schedules that are somewhat different from those in the original version. Caution should be used when psychological assessments change from manual to virtual formats. Such changes may unintentionally introduce confounds that render the 2 tests nonequivalent as shown with the Wisconsin Card Sorting Task by Steinmetz, Brunner, Loarer, and Houssemand in . In this study, we compared IGT performance when participants used either a laptop computer or a touchscreen tablet. Each device was used in 2 conditions: “involved” and “noninvolved.” Participants in the involved condition turned over physical cards and mimicked their own selections by clicking (laptop) or reaching out and touching (tablet) the corresponding virtual cards. Participants in the noninvolved condition only made selections of virtual cards, whereas an adjacent experimenter turned over the corresponding physical cards. Results showed that performance systematically and significantly improved as degree of physical involvement increased in the following order: laptop noninvolved (lowest performance), tablet noninvolved, laptop involved, and tablet involved (highest performance). In addition, participants' verbalized understanding of the task was significantly more accurate with increased physical involvement.