Background Aortic valve insufficiency can have significant hemodynamic consequences for patients with left ventricular assist devices. A circulation loop can limit systemic blood flow and increase left ventricular filling pressure. Case presentation A 64-year-old male with non-ischemic dilated cardiomyopathy underwent Heartware™ HVAD left ventricular assist device implantation with successful concomitant aortic valve replacement with an Edwards Intuity rapid deployment prosthetic valve. Conclusions The use of this rapid deployment valve may have benefits over other techniques including shorter cross clamp times during surgery, intermediate-long term durability, and preservation of aortic valve opening to allow for potential ventricular recovery. The Intuity rapid deployment valve should thus be considered a viable and suitable option for aortic insufficiency intervention during LVAD implantation.

Cardiac surgery remains one of the most commonly performed surgeries in the world. Intensive insulin therapy has shown to reduce infection in patients undergoing open-heart surgery and is considered standard of care. New technologies are available to achieve and maintain recommended blood glucose goals. These include computer-driven intensive insulin protocols (vs paper-based algorithms) and continuous blood glucose monitors. Managing tight glucose control in cardiac surgery patients has been shown to decrease costs in terms of measurable outcomes including infection, mortality, and length of stay. The advanced practice nurse is uniquely qualified to implement new technologies and can be instrumental in increasing compliance with clinical practice guidelines while decreasing hospital costs.

Introduction: Ventricular assist devices (VAD) are a primary method of treatment for patients with advanced heart failure. Previous studies have provided some evidence for alterations in ICD lead parameters following VAD implants, but all have had a very small sample size. Hypothesis: VAD implantation causes alterations in ICD lead parameters. Methods: Electronic medical records of a large patient cohort receiving VAD implants at Northwestern Hospital from 2012-2018 were manually reviewed. When available, high-voltage (HV) impedance, right ventricular (RV) lead pacing impedance, pacing threshold, and sensing amplitude were compared both immediately (I) and late (L), at 6-12 months follow-up after VAD implant, to baseline (B) pre-implant values. Results: A total of 271 VAD patient records were reviewed. Long-term, HV impedance changed from 51 ± 16 Ω to 49 ± 15 Ω (N=63, p=0.04), and 29% of patients had a long-term absolute change of at least 10 Ω. RV pacing impedance decreased slightly acutely from 405± 84 to 427 ±78 (N=96, p=.006), but there was no significant change long-term: 443 ± 201 Ω vs 449 ± 94 Ω (N=85, p=0.77). Yet, 19% of patients had a long-term change ≥ 100 Ω. Long-term RV pacing threshold was not significantly changed 1 ± 0.8 V to 1.1 ± 0.7 V (N=47, p=0.5), and all leads were still functional for pacing. RV sensing amplitude decreased acutely from 10.8 ± mV to 8.6 ± 4.3 mV (N=81, p<0.001). Additionally, 17% of patients had a change that was more than 50%, and new R waves below 5 mV were noted in only 13 patients (16%). Long-term RV sensing amplitude decreased from 11.3 ± 5 mV to 8.2 ± 4.3 mV (N=73, P<0.001), and 18 patients had a decrease in R wave of at least 50%. Conclusions: In conclusion, our data suggest that VAD implantation in patients with an ICD may result in immediate and long-term ICD parameter changes. For many patients, these changes may be clinically insignificant, but careful monitoring is warranted. The clinical impact of those changes merits further investigation.