Background: Left ventricular assist device (LVAD) has been increasingly used in patients with advanced heart failure. This study aimed to assess the impact of implementation of LVAD therapy on heart transplantation (HTx) service in Hong Kong (HK). Methods: LVAD program was started in 2010 in HK and patients who had been put on HTx waiting list since the start of HTx program in HK from 1992 to 2020 were included for analysis. Survival on HTx waiting list between pre-LVAD era 1992-2009 and post-LVAD era 2010-2020 were analyzed by Kaplan-Meier method and compared by log-rank test. Multivariate analysis by time-dependent Cox-proportional hazard model was used to identify independent predictors of HTx waiting list mortality. Results: A total of 478 heart transplant listing episodes involving 457 patients were included for analysis.There were 232 heart transplantations (HTxs), including one re-transplantation, during the study period.There were 110 patients who received LVAD as bridge to transplantation (BTT) and 30 of them had undergone subsequent HTx. The 1-, 2-and 3-year survival on waiting list were 82.3%, 61.7% and 43.0% respectively in the pre-LVAD era (n=178), while the 1-, 2-and 3-year survival were significantly improved at 85.7%, 81.8% and 78% respectively in the post-LVAD era (n=300), (P=0.003). Time-dependent multivariate analysis revealed that LVAD support was independently associated with significant reduction of waiting list mortality [odds ratio (OR): 0.21; 95% confidence interval (CI): 0.10-0.44, P<0.001]. There was no significant difference when comparing survival after LVAD as BTT and survival after HTx up to 8 years (76.1% vs. 72% at 8 years respectively, P=0.732). Conclusions: Waiting list survival improved in the post-LVAD era driven by the implementation of LVAD service. Long-term survival for LVAD recipients as BTT were comparable to heart transplant recipients in HK.

Video clip is available online. Kartagener syndrome (KS) is a rare congenital disease characterized by a triad of sinusitis, bronchiectasis, and situs inversus. Bronchiectasis can progress to end-stage lung failure, and lung transplantation (LTx) might be the only effective treatment. LTx in patients with KS has been technically challenging; however, available reported data are scarce. We have described 2 cases of bilateral sequential LTx in patients with KS and highlighted the pitfalls encountered. The institutional review board of the University of Hong Kong approved the study protocol, and the included patients provided written informed consent. CASE REPORT Patient 1Our first patient was 40-year-old nonsmoking woman with KS and advanced bronchiectasis requiring repeated hospital admissions for infective exacerbation. She had been listed for LTx in 2013 and had undergone bilateral sequential LTx in 2015. The donor and recipient characteristics are listed in Table 1. During the recipient procedure, a clamshell incision was used, and chest entry was performed through the fourth intercostal space. We inserted a Medtronic EOPA 18F arterial cannula and Medtronic Carmeda venous cannula (Medtronic, Dublin, Ireland) into the ascending aorta and right atrium, respectively, and venoarterial extracorporeal membrane oxygenation (ECMO) support using the Cardiohelp system (Maquet, Rastatt, Germany) was begun. The recipient's morphologically right (anatomically left) lung was explanted. The right main bronchus was anastomosed, followed by left atrial anastomosis. The donor pulmonary artery (PA) had to be transposed in a posterosuperior direction to anastomose it to the superiorly located recipient PA. On the left side, the donor PA was displaced anteriorly, circumventing the left main bronchus (Figure 1, A). The remainder of the left lung implant was performed in accordance with standard practice. The duration of ECMO support was 5 hours, 44 minutes. Because of the significant size mismatch, nonanatomic lung volume reduction over the right middle lobe

Background and Aims: Epithelioid hemangioendothelioma is a rare malignant vascular tumor with limited literature. Aims:We reported an innovative endovascular biopsy of the right innominate vein tumor.Materials and Methods: Endovascular suction thrombectomy was performed with multipurpose catheter and constant negative pressure under fluoroscopic guidance.Results: Epithelioid hemangioendothelioma was diagnosed preoperatively and a complete margin-free tumor resection with patch repair of the right innominate vein was achieved via sternotomy.Discussion: Preoperatively diagnosis is usually not available due to lesions' location.Identifying malignant vascular tumors becomes valuable to guide the surgical treatment.Conclusions: In this case report, this innovative endovascular approach led to a rare preoperative diagnosis of EHE and subsequent margin-free resection.

Background:The year 2022 marks the 30th anniversary of heart transplant service in Hong Kong (HK). In this study, we describe prevailing trends and outcomes of advanced heart failure (AHF), including heart transplantations (HTx), in HK over the past 30 years. Methods: Trends in heart failure prevalence in HK from 1993 to 2021 were analyzed based on data from the Hospital Authority Clinical Data and Reporting System. All AHF patients referred for HTx consideration between 1992 and 2021 were reviewed. The bridge-to-transplant (BTT) utilization of short-term mechanical circulatory support (ST-MCS) devices, including venoarterial extracorporeal membrane oxygenation (VA-ECMO) and durable left ventricular assist devices (LVADs), from 2010 to 2021 was reviewed. Results: Overall, 237 heart transplants were performed in HK, with 10-year posttransplant and median survival of 68.1% and 18.7 years, respectively. An increase in AHF clinic referrals was correlated with increasing heart failure prevalence (R 2 =0.635, P<0.001). In total, 146 referrals were made for ST-MCS, and an observed increase in ST-MCS referrals was correlated with increasing VA-ECMO utilization (R 2 =0.849, P<0.001). Among 62 patients accepted for AHF therapy, those with durable LVAD implementation had better 1-year survival (71.5%) than those receiving an extracorporeal CentriMag (Levitronix) device as BTT (40%, P=0.008). In total, 143 LVADs were implanted, with 130 as BTT or bridge-to-candidacy (BTC) methods. The survival rate among the 130 BTT/BTC LVAD patients resembled that of HTx recipients (73.8% vs. 69.8% at 9 years, P=0.296). Conclusions: The burden of AHF management has increased and gained complexity over the past 30 years in Hong Kong.

Lung transplantation in Hong Kong: history and settingLike many western countries, organ transplant in Hong Kong is regulated under the Ordinance which, inter alia, prohibits commercial dealings in human organs intended for transplanting and restricts the transplanting of imported organs. Currently, all cadaveric organ transplants are from brain-death donors. The cadaveric organ donation and transplant are coordinated under the Hospital Authority, which is a government funded public body responsible for all public hospital medical services. An opt-in system is