Background: Sarcopenia is characterized by progressive loss of skeletal muscle and has frequently been associated with poor clinical outcomes in patients with advanced heart failure (HF). The urinary creatinine excretion rate (CER) index is an easily measured marker of muscle mass, but its predictive capacity for mortality and cerebrovascular events has not been investigated in patients with a continuous-flow implantable left ventricular assist device (CF-iLVAD). Methods and Results: We retrospectively reviewed 147 patients (mean [±SD] age 43.7±12.5 years, 106 male) who underwent CF-iLVAD implantation between April 2011 and June 2019. CER indices in 24-h urine samples before CF-iLVAD implantation were determined. Over a median follow-up of 2.3 years, there were 10 (6.8%) deaths and 43 (29.3%) cerebrovascular events. Patients were divided into 2 groups (low and high CER index) according to the median CER index in men and women (i.e., 13.71 and 12.06 mg • kg −1 • day −1 , respectively). Mortality and intracranial hemorrhage rates after CF-iLVAD implantation were significantly higher in the low than high CER index group (mortality 12.3% vs. 1.4% [P<0.01]; intracranial hemorrhage 23.3% vs. 8.1% [P=0.01]). Multivariate Cox proportional hazard models revealed that a low CER index was an independent predictor of intracranial hemorrhage in patients receiving a CF-iLVAD (hazard ratio 3.63; 95% confidence interval 1.43-9.24; P<0.01). Conclusions: A low preoperative CER index is an independent, non-invasive predictor of intracranial hemorrhage after CF-iLVAD implantation.

acute cellular rejection (ACR), antibody-mediated rejection (AMR), and infections remains challenging. 1 Risk factors for poor clinical prognosis or difficulties for their management by healthcare practitioners for patients necessitate alternative immunosuppression strategies. 1 Induction T riple immunosuppressive therapy including calcineurin inhibitors (CNIs), mycophenolate mofetil (MMF), and steroids, has substantially improved outcomes for heart transplant (HTx) recipients. Nevertheless, the management of CNI-related nephrotoxicity, fatal

Left ventricular assist device (LVAD) therapy is increasingly used in patients with end‐stage heart failure. However, LVADs are associated with challenges, especially in the presence of a cardiac implantable electronic device. Although a leadless pacemaker (PM), the Micra™ Transcatheter Pacing System, can be used with LVADs, data regarding HeartMate 3™ LVAD are limited. In this report, we present a patient with a HeartMate 3™ LVAD who underwent successful leadless PM implantation after the removal of an infected cardiac resynchronization therapy defibrillator.

Aortic insufficiency (AI) is an important adverse event in patients with continuous-flow (CF) left ventricular assist device (LVAD) support. AI is often progressive, resulting in elevated 2-year morbidity and mortality. The effectiveness of echocardiographic ramp studies in patients with AI has been unclear. Here, we describe a patient with a CF-LVAD implant who underwent aortic valve replacement (AVR), following assessment of AI using a hemodynamic ramp test with simultaneous echocardiography and right heart catheterization (RHC). The patient was a 21-year-old man with cardiogenic shock due to acute myocarditis, who underwent HeartWare CF-LVAD (HVAD) implantation. Heart failure persisted despite increased doses of diuretics and inotrope, as well as an increased HVAD pump rate. HVAD monitoring revealed a correlation between increased HVAD pump rate and flow at each speed step. A hemodynamic ramp test with simultaneous transthoracic echocardiography and RHC revealed a significant discrepancy between HVAD pump flow and cardiac output (CO) at each speed step; moreover, pulmonary capillary wedge pressure remained high. Therefore, the patient underwent AVR. Subsequently, his low CO symptoms disappeared and inotropes were successfully discontinued. A postoperative hemodynamic ramp test revealed that AVR had successfully closed the loop of blood flow and reduced the discrepancy between HVAD pump flow and CO, thereby increasing CO. The patient was then discharged uneventfully. In conclusion, a hemodynamic ramp test with simultaneous echocardiography and RHC was useful for the evaluation of the causal relationship between AI and low CO, and for selection of surgical treatment for AI in a patient with CF-LVAD.

LVAD implantation. 4 The recent Japanese registry for Mechanically Assisted Circulatory Support (J-MACS) reported that early bleeding events after CF-LVAD implantation are the most frequent complication within 30 days, and many of these early bleeding events arre reported to have a surgical cause and thus require re-exploration. 5 Re-exploration for bleeding may delay recovery, prolong the length of stay in the intensive care unit, and cause hemodynamic instability. However, studies evaluating the risk factors and clinical effect of re-exploration for bleeding after CF-LVAD implantation A dvanced heart failure (HF) is a life-threatening condition, for which the 2-year survival is only 8% with optimal medical therapy. 1 The continuous-flow left ventricular device (CF-LVAD) has revolutionized the management of advanced HF, being associated with a 2-year survival rate exceeding 70% in these patients. 2 However, numerous complications still occur after CF-LVAD implantation, of which bleeding was the most common in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), 3 and accounting for one-third of the causes of re-hospitalization after CF