Lorenzo Giovannico

Background: To address organ shortage and reduce waitlist mortality, the use of extended criteria donors (ECDs) in heart transplantation is increasing. Methods: We retrospectively analysed outcomes in 236 heart transplant recipients: 140 received standard donor (SD) hearts and 96 received ECD hearts. Results: No significant differences were found in early or mid-term survival between the SD and ECD groups with a 30-day mortality rates of 13% vs. 10% (p = 0.662) and estimated 1-year survival of 75% (95% CI: 62.3–78.3%) and 71% (95% CI: 55.3–76.2%) (p = 0.556), respectively. Mechanical ventilation prior to transplant (p < 0.001), ischemic time (p = 0.022), peripheral vascular disease (p = 0.011), and chronic obstructive pulmonary disease (p = 0.022) were the only independent predictors of mortality. Conclusions: In our cohort, heart transplantation using ECD was not associated with increased early or mid-term adverse events. This approach may help expand the donor pool without compromising post-transplant outcomes.

Candida auris is an emerging multidrug‐resistant fungal pathogen increasingly implicated in healthcare‐associated outbreaks worldwide. Its presence in organ donors poses a significant threat to transplant recipients due to the risk of invasive infection and limited antifungal treatment options. We report the first isolation of Candida auris in a heart transplant donor at a transplant center in Southern Italy. The donor, a 45‐year‐old woman from Greece, was colonized with C. auris in the bronchoaspirate sample collected at the time of organ retrieval. Despite this colonization, the donor heart was successfully transplanted into a 62‐year‐old male recipient with end‐stage heart failure secondary to myocardial infarction and cardiogenic shock. The recipient received targeted perioperative prophylaxis and was placed under strict isolation protocols. Repeated microbiological surveillance, including blood, urine, and mucosal cultures, revealed no evidence of C. auris transmission. Environmental surveillance of the operating room and ICU also tested negative. The patient recovered uneventfully, showing good cardiac function and no signs of graft rejection or infection. This case emphasizes the critical importance of early detection, thorough microbiological assessment, and stringent infection control in transplantation involving donors colonized with multidrug‐resistant organisms. It also raises the question of whether C. auris should be routinely screened in potential donors and if specific transplant guidelines should be developed to address such emerging threats.

This case report details a rare instance of recurrent spontaneous coronary artery dissection (SCAD) in a 39‐year‐old woman following the delivery of twins, leading to cardiogenic shock. SCAD, although occurring most commonly in middle‐aged women (45–52 years), can also occur in young, otherwise healthy women, in association with pregnancy. In this situation, it poses significant diagnostic and therapeutic challenges, particularly during pregnancy or postpartum periods. This patient's emergency coronary angiography revealed double‐vessel SCAD, and initial treatment with a drug‐eluting stent failed. Surgical intervention with coronary artery bypass grafting (CABG) was ultimately necessary due to recurrent dissection and hemodynamic instability. The case underscores the utility of CABG as a definitive treatment for SCAD, particularly when percutaneous interventions are insufficient. Additionally, the report discusses the importance of early diagnosis using advanced imaging techniques and highlights postoperative management, including beta‐blockers to reduce recurrence risk. This case provides insights into SCAD's complex pathophysiology and the critical role of tailored intervention strategies for young women postpartum.

Introduction: Emery–Dreifuss muscular dystrophy (EDMD) is a rare inherited neuromuscular disorder frequently associated with progressive cardiac involvement, particularly in patients carrying LMNA mutations. End‐stage heart failure may develop despite optimal medical and device therapy, although heart transplantation remains an uncommon therapeutic option because of concerns regarding the underlying neuromuscular disease. Case Presentation: We report the case of a 35‐year‐old woman with LMNA ‐related EDMD who developed advanced biventricular heart failure complicated by recurrent atrial and ventricular arrhythmias, complete atrioventricular block, implantable cardioverter‐defibrillator implantation, and multiple thromboembolic events. Pretransplant neurological and respiratory assessments demonstrated preserved functional status without severe musculoskeletal impairment. Owing to refractory ventricular tachyarrhythmias and progressive heart failure, the patient underwent orthotopic heart transplantation in December 2022. Postoperative recovery was uneventful, with discharge on postoperative day 21. At 43‐month follow‐up, she remained alive with preserved graft function, no episodes of rejection, stable respiratory function, and no evidence of neurological deterioration. Conclusion: Heart transplantation may be a feasible treatment option for carefully selected patients with EDMD and end‐stage heart failure. Careful multidisciplinary assessment is essential to identify candidates who can achieve favorable long‐term outcomes.

Massive hemoptysis following TEVAR, especially in patients with prior coil embolization, should raise immediate suspicion for aortobronchial fistula. This rare but life‐threatening condition demands prompt imaging, bronchoscopy, and often urgent surgical repair. Early multidisciplinary collaboration significantly improves prognosis.

Background/Objectives: Heart transplantation is a life-saving procedure for patients with end-stage heart failure, yet it involves significant psychological and emotional challenges throughout its various stages. International guidelines recommend a multi-professional approach to the care of these patients and a psycho-social assessment for listing. The recommendations focus on content aspects, but not on the psychometric measure to be administered to patients as part of the assessment. Therefore, the purpose of this study is to provide the preliminary results of administering the protocol used by our center, measuring coping strategies, cognitive functioning, quality of life, and psychological distress in a sample of patients who are candidates for and undergo cardiac transplantation, and to observe any variations after the procedure. Methods: We conducted a comprehensive psychological-clinical assessment involving 40 patients, focusing on psychosocial functioning, cognitive reserves, mental health, and coping strategies. Tools such as the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), Beck Depression Inventory-II (BDI-II), Montreal Cognitive Assessment (MoCA), General Anxiety Disorder 7 (GAD-7), and Medical Outcomes Survey Short Form 36 (SF-36) were employed to evaluate readiness for transplantation and post-transplant adaptation. Results: Results showed high levels of clinical anxiety (52.5%) and low perceived physical health (98%) before the transplant, while post-operative evaluations indicated reduced anxiety (13.51%) and depressive symptoms (10.81%), along with improved psychological well-being and reintegration into daily life. Conclusions: These results show improvement in physical and cognitive levels, accompanied by a state of enhanced psychological well-being after transplantation. A longitudinal psychological approach, from pre-transplant screening to post-discharge follow-up, is needed to address distress, improve coping mechanisms, and promote treatment adherence. This integrative strategy is critical to improving the quality of life and long-term outcomes for heart transplant recipients.

This case report highlights an innovative surgical approach in orthotopic heart transplantation (OHT) for a patient with the largest recorded giant left atrium, measuring a biplanar volume of 1906 mL. The patient, a 63‐year‐old man with severe heart failure and a history of mitral and aortic valve replacements, presented with atrial fibrillation, moderate systolic dysfunction, and severe cardiomegaly. Despite optimized medical therapy, his condition warranted heart transplantation. The procedure involved a novel surgical technique utilizing Teflon reinforcement and a bovine pericardial patch to reconstruct the significantly enlarged left atrium. Postoperative outcomes were favorable, with no rejection episodes and resolution of pulmonary symptoms. This report underscores the challenges of atrial size mismatch in OHT and the necessity for tailored surgical strategies to address extreme anatomical variations. The successful outcome exemplifies the potential of customized approaches in complex heart transplant cases.

Background/objectives: Heart transplantation remains the definitive treatment for end-stage heart failure. However, donor shortages and the increasing age of candidates present significant challenges. This report aims to highlight the feasibility and successful outcome of heart transplantation in an elderly patient, questioning traditional age-based eligibility criteria.Methods: A 76-year-old male with idiopathic dilated cardiomyopathy and severe heart failure underwent orthotopic heart transplantation. Preoperative assessments included right heart catheterization, echocardiography, and cardiac index evaluation. A suitable 66-year-old female donor was identified, and transplantation was performed using the bicaval technique. Postoperative outcomes were monitored through echocardiography and biopsy analysis.Results: The patient had an uneventful postoperative course, with extubation on day 1 and discharge on postoperative day 30. Follow-up at 14 months showed excellent clinical recovery, with an improved left ventricular ejection fraction (LVEF) of 58% and global longitudinal strain (GLS) of −20.8%. No signs of rejection were observed on biopsy.Conclusions: This case represents the oldest documented successful heart transplant recipient discharged home. The findings suggest that age alone should not be a limiting factor in transplantation eligibility. Expanding criteria to include well-selected elderly patients could help address the growing demand for donor hearts.

This report presents a rare case of a 60‐year‐old man with acute respiratory failure due to a giant lipoma‐like liposarcoma. Following the successful surgical removal of the 2850‐g mass, the patient's respiratory function improved immediately. This case highlights the importance of diagnosis and surgical intervention in managing large mediastinal tumors.