Daler Rahimov

Background: Utilization of microaxial pumps for temporary mechanical circulatory support in children has increased in recent years. However, data on patient selection, implantation techniques, and outcomes remain limited. Methods: A systematic literature search was conducted in July 2025 to identify case reports and case series reporting the use of microaxial pumps in patients aged 18 years or less. Forty‐four studies comprising 100 patients were identified, and patient‐level data were extracted for analysis. Results: The median age of the patients was 14 [IQR, 11.5–16] years, with a median weight of 52 [40–73] kg and median body surface area of 1.59 [1.35–1.85] m ² . The most common diagnoses were cardiomyopathy (29%), heart allograft rejection (26%), and myocarditis (21%). Impella CP was the most frequently used device (48%), followed by Impella 2.5 and Impella 5.5 (each 21%). Access was predominantly obtained via the femoral artery (47%). Percutaneous implantation was performed in 47% of patients. Patients were weaned from microaxial support for cardiac recovery (42%) or heart transplantation (31%). Fourteen patients (14%) died prior to discharge, with significantly higher mortality among patients supported with ECPella (29%) compared with microaxial pump alone (6%; p = 0.01). The median duration of support was 6 [4–13] days. At the median follow‐up of 119 [23–180] days overall survival was 84%. Conclusion: Microaxial pumps represent an important addition to temporary mechanical circulatory support in pediatric patients and can serve as an alternative to VA‐ECMO in selected cases. Outcomes were less favorable when used in tandem configurations such as ECPella, reflecting the greater severity of illness in these patients.

Background: Advanced biventricular heart failure may require durable biventricular assist device (BiVAD) support when heart transplantation is not immediately feasible or patients are ineligible for heart transplantation. We aimed to compare baseline characteristics, perioperative features, and clinical outcomes between patients supported with HeartMate 3‐BiVAD (HM3‐BiVAD) and HeartWare‐BiVAD (HW‐BiVAD). Methods: A systematic search was performed in October 2025 across MEDLINE, Embase, Cochrane Library, Scopus, and CINAHL. We identified studies of adult patients supported with dual HeartMate 3 LVAD and HeartWare HVAD continuous‐flow pumps in a BiVAD configuration. Study‐level data were pooled to compare patients supported with HM3‐BiVAD and those with HW‐BiVAD. Results: The proportion of females was significantly lower among HM3‐BiVAD patients [HM3: 4.8% (95% CI: 1.2, 17.1) vs. HW: 22.5% (16.8, 29.4), p = 0.02], whereas patient age was comparable between groups [HM3: 47 (43, 52) years vs. HW: 48 (45, 50) years, p = 0.9]. Chronic kidney disease [HM3: 57.1% (23, 85.6) vs. HW: 10.9% (4.6, 23.6), p = 0.01] was more common among HM3‐BiVAD patients. Concomitant right ventricular assist device (RVAD) placement was the predominant approach across both groups [HM3: 66.2% (35.5, 87.4) vs. HW: 78.5% (70.1, 85), p = 0.36]. Right atrium was used more frequently as RVAD implantation site in the HM3‐BiVAD group [HM3: 96.7% (63.4, 99.8) vs. HW: 33.9% (19, 52.9), p = 0.01], whereas the right ventricle predominated in the HW‐BiVAD group [HM3: 3.2% (0.2, 36.6) vs. HW: 64.5% (45.2, 80.1), p = 0.01]. Overall survival was significantly higher among HM3‐BiVAD patients [78.1% (49.3, 92.9)] compared to HW‐BiVAD patients [48% (40.6, 55.4); p = 0.05]. The mean follow‐up was 274 (200, 349) days in patients with HM3‐BiVAD and 210 (143, 277) days in HW‐BiVAD patients ( p = 0.21). Conclusion: Patients with HW‐BiVAD were characterized by a higher proportion of females and more frequent use of the RV as the RVAD implantation site, likely both due to the smaller device profile. HM3‐BiVAD patients demonstrated higher post‐implant survival despite a more severe preimplant clinical profile, suggesting a possible device‐related advantage.

Background: Conventional mechanical circulatory support offers limited options for patients with small or restrictive left ventricles. Left atrial inflow (LA–Ao) ventricular assist device (VAD) configuration represents an alternative to conventional apical left ventricular assist device (LVAD). However, outcomes data remain limited. To address this, we evaluated patient characteristics, procedural details, and outcomes of LA–Ao VAD configuration in this population. Methods: A systematic search was conducted to identify case reports and series of patients with small or restrictive left ventricles who underwent LA–Ao LVAD implantation. A total of 21 reports, representing 27 patients, were included. Patient‐level data were extracted for analysis. Results: Thirteen adult and 14 pediatric patients underwent LA–Ao VAD implantation. Median age was 57 [46–62] years in adults and 3.5 [0.8–9] years in children. Hypertrophic cardiomyopathy and restrictive cardiomyopathy were the predominant diagnoses in both adults and children, accounting for 54% (7/13) and 29% (4/14), and 46% (6/13) and 43% (6/14), respectively. Median left ventricular ejection fraction was 44% [39–53] in adults and 45% [36–61] in children, and median left ventricular end‐diastolic diameter was 42 [35–42] mm in adults and 33 [29–34] mm in children. The most used devices were HeartWare HVAD (46%, 6/13) in adults, and Berlin Heart (64%, 9/14) in children. Overall pulmonary capillary wedge pressure decreased from 23 [19–27] to 7 [0–9] mmHg ( p = 0.02), and cardiac index increased from 2.0 [1.3–2.8] to 3.1 [2.7–3.7] L/min/m ² ( p = 0.04). In‐hospital mortality included one fatal case (7.7%) in each group. Overall survival was 85% (11/13) in adults at median follow‐up of 6.7 [4.4–19.9] months and 86% (12/14) in children at 2.3 [1.2–8.1] months. Conclusion: The LA–Ao configuration of VAD is a viable strategy for mechanical circulatory support in patients with small or restrictive left ventricles. It offers effective unloading of the left atrium and improved cardiac index, supporting its role as an alternative to the conventional LVAD approach.

Background: Microaxial devices provide effective short‐term hemodynamic support in patients with cardiogenic shock or during high‐risk procedures. However, there is a paucity of data regarding device‐associated valvular complications. We sought to pool existing data to understand its incidence, management, and outcomes. Methods: An electronic search was conducted in October 2024 to identify studies reporting microaxial device–associated valvular complications that did not resolve with device explantation. A total of 26 case reports and case series, representing 27 patients, were included. Patient‐level data were extracted for analysis. Results: The median age was 50 years [IQR 34–65], and 78% (21/27) were male. The indications for microaxial support were cardiogenic shock (85.2%, 23/27), coronary bypass grafting (7.4%, 2/27), and high‐risk percutaneous coronary intervention (7.4%, 2/27). The most commonly used devices were the Impella 5.0 (41%, 11/27) and Impella CP (22%, 6/27). Aortic regurgitation (AR) developed in 67% of patients (18/27). Mitral regurgitation (MR) developed in 33% (9/27) of patients, all of which were severe. The median duration of microaxial support was 10 [3–15] days. Overall, 74% (20/27) of patients underwent surgical management, 11% (3/27) underwent transcatheter treatment, and 15% (4/27) were managed nonoperatively. In‐hospital/30‐day mortality was 11% (3/27), including two deaths among patients with MR (22%) and one in a patient with AR (5.6%) with a pre‐existing bioprosthetic aortic valve ( p = 0.19). When considering the patients with only native valves and excluding the bioprosthetic aortic valve, mortality was significantly higher among MR patients compared to those with AR (MR: 22%; AR: 0%, p = 0.04). At a median follow‐up of 183 [30–365] days, overall survival was 89% (24/27). Conclusion: AR was more common than MR; however, all MR cases were severe. MR may be associated with worse outcomes. Surgical management appears to be the most frequently employed strategy for valvular injury.

Background: In the United States, the donor heart allocation policy change in October 2018 granted high priority to patients on temporary mechanical circulatory support (MCS), positively influencing their pre‐transplant outcomes with reduced waitlist time. However, the impact of this policy change on patients requiring biventricular support remains undetermined. Methods: We analyzed data from the United Network for Organ Sharing (UNOS) database from May 2013 to March 2024. Patients with biventricular assist devices (BiVADs), including temporary or durable devices, and total artificial hearts (TAHs) were included. The cohort was divided into two groups based on listing: before and after policy change groups. Waitlist and post‐transplant survival were compared between both groups. Results: Patients on biventricular support comprised 1.5% (611/39 829) of all waitlisted candidates, and 2.6% (732/28 643) of all isolated heart transplants. There was a significantly lower prevalence of biventricular support after the policy change in both waitlisted candidates (Pre: 2.0% versus Post: 1.2%, p < 0.001) and at the time of transplantation (Pre: 3.1% versus Post: 2.1%, p < 0.001). Following the policy change, there was a significantly lower median waitlist time (Pre: 88 [29–190] days versus Post: 22 [7–69] days, p < 0.001), and a higher proportion of transplanted patients (Pre: 65% versus Post: 85%, p < 0.001). Both waitlist survival ( p < 0.001) and post‐transplant survival ( p = 0.05) improved after the policy change. Conclusions: The 2018 policy revision was associated with a decline in biventricular support utilization in both waitlisted and transplanted cohorts. This shift corresponded with shorter waitlist durations, more frequent transplants, and better waitlist and post‐transplant survival.

Background: We sought to estimate left ventricular assist device use (LVAD) with waitlist and post‐transplant survival trends in patients supported on durable LVAD in relation to the UNOS donor heart allocation policy revision. Methods: Adult patients implanted with HeartMate II LVAD, HeartWare HVAD, or HeartMate 3 LVAD, and listed for isolated heart transplantation between October 18, 2013, and June 16, 2023, were identified in the UNOS database and were stratified into pre‐ and post‐policy revision groups. Patients on temporary circulatory support, right, or biventricular assist devices, total artificial hearts, recipients of donation after circulatory death (DCD) hearts, and those undergoing simultaneous multiorgan transplants were excluded. Waitlist and post‐transplant survival were compared between the groups. Results: Policy revision was associated with a decrease in LVAD use both at the time of listing (pre: 28% vs. post: 24.5%, p < 0.01) and at the time of transplant (pre: 45.8% vs. post: 31.7%, p < 0.01). For those listed with an LVAD, more patients eventually underwent transplantation (pre: 89.6% vs. post: 94.3%, p < 0.01) following the policy change. Overall waitlist and post‐transplant survival among patients supported on LVAD worsened following the policy change, both showing statistical significance ( p < 0.01). Conclusion: In the post‐policy era, a decline in durable LVAD utilization was observed, along with worse waitlist and post‐transplant outcomes among LVAD‐supported patients.

Background: While various models are useful for donor‐recipient size matching, the optimal approach for predicting the correct match remains unclear. We sought to determine the association between ideal body weight (IBW) ratio and post‐transplant survival. Methods: The United Network for Organ Sharing (UNOS) database was queried for all patients who underwent isolated heart transplantation between July 2000 and July 2023. Donor‐recipient size matching was assessed using predicted heart mass (PHM), ideal predicted heart mass (IPHM), and IBW. Ratios were stratified as undersized (≤0.8), properly sized (>0.8 to p < 0.01). For IPHM, survival was highest in the properly sized patients, lower in the oversized, and lowest in the undersized patients ( p < 0.01). For IBW, survival was superior in properly sized group compared to undersized and oversized patients ( p < 0.03). Non‐linear analysis of PHM showed increased mortality risk with undersizing and decreased risk with oversizing ( p < 0.01). IPHM demonstrated higher mortality risk with undersizing but no notable risk with oversizing ( p < 0.01), whereas IBW showed increased risk with both undersizing and oversizing ( p < 0.01). Conclusion: The IBW model appears to be non‐inferior to PHM. IBW penalized equally for both undersizing and oversizing, making it potentially an additional useful metric in the evaluation of donor‐recipient size matching.

Heart transplant (HTx) in dystrophy patients has been shown to have a similar survival to cardiomyopathy from other causes, but postoperative rehabilitation remains an issue. This study aimed to review and analyze the reports in the literature to determine whether pre- and post-transplant functional status along with wheelchair dependence in dystrophy patients can influence post-HTx outcomes. Relevant databases were queried for all case reports and case series regarding HTx in patients with dystrophy-associated cardiomyopathy published in the literature. Clinical data were extracted and tabulated. Patient survival was stratified according to preoperative and postoperative functional status, and Kaplan-Meier survival analysis was performed. We identified 22 studies yielding 36 patients with muscular dystrophy who underwent HTx. At baseline, there were three patients who were wheelchair dependent, and 22 patients had a diminished functional status preoperatively. Overall survival did not differ significantly between patients with normal baseline functional status and those with diminished functional status, either before or after transplantation. Although no significant survival difference was found, diminished functional status, both pre- and post-transplant, appear to be associated with worse survival, highlighting its importance in transplant decision-making.