Background Right ventricular (RV) failure is a source of morbidity and mortality after left ventricular assist device (LVAD) implantation. We sought to define hemodynamic changes in afterload and RV adaption to afterload both early after implantation and with prolonged LVAD support. Methods We reviewed right heart catheterization (RHC) data from participants who underwent continuous-flow LVAD implantation at our institutions (n=244), excluding those on inotropic or vasopressor agents, pulmonary vasodilators, or additional mechanical support at any RHC. Hemodynamic data was assessed at five time intervals: 1) pre-LVAD (within 6 months), 2) early post-LVAD (0–6 months), 3) 7–12 months, 4) 13–18 months and 3) very-late post-LVAD (18–36 months). Results Sixty participants met the inclusion criteria. All measures of right ventricular load (effective arterial elastance, pulmonary vascular compliance and pulmonary vascular resistance) improved between the pre- and early post-LVAD time periods. Despite decreasing load and pulmonary capillary artery pressure (PAWP), RAP remained unchanged and the RAP:PAWP ratio worsened early post-LVAD (0.44 [0.38, 0.63] versus 0.77 [0.59, 1.0], p<0.001), suggesting a worsening of RV adaptation to load. With continued LVAD support, both RV load and RAP:PAWP decreased in a steep, linear and dependent manner. Conclusion Despite reducing RV load, LVAD implantation leads to worsened RV adaptation. With continued LVAD support, both RV afterload and RV adaptation improve, and their relationship remains constant over time post-LVAD. These findings suggest the RV afterload sensitivity increases after LVAD implantation, which has important clinical implications for patients struggling with RV failure.

Objectives To assess the safety and efficacy of the Absorb bioresorbable vascular scaffold (BVS) in complex, infrapopliteal lesions for the management of chronic limb ischemia. Background The interventional management of infrapopliteal PAD remains challenging due to high restenosis rates with metallic drug‐eluting stents and balloon angioplasty. Metallic stents are associated with impaired vessel vasomotor tone, remodeling, autoregulation, and long‐term inflammation. BVSs are biodegradable scaffolds that provide short‐term vascular support before degrading to allow restoration of vasomotor tone and endothelial function. A recent trial reported excellent 12‐month vessel patency rates in simple infrapopliteal arterial lesions treated with Absorb BVS. Methods This single‐center, retrospective study evaluated the use of the Absorb BVS (everolimus impregnated poly‐L‐lactic scaffold) in patients with infrapopliteal PAD with respect to safety (thrombosis and TIMI bleeding), technical success, and clinically driven target vessel failure (CD‐TVF) at 12 months. Results Thirty‐one patients (51.6% male) with a median age of 67 years with advanced infrapopliteal disease were treated with 49 BVS in 41 vessels. The mean stenosis was 94% (80–100), with 49% of lesions being CTOs. No scaffold thrombosis or periprocedural bleeding was observed. Procedural success was achieved in all patients. Freedom from CD‐TVF was 95.1% at 12 months driven by one revascularization and one amputation. Primary patency was 96.7% at 12 months. All patients were alive at 12 months, and 96.8% of patients improved their Rutherford–Becker classification. Conclusions At 12 months, our study found that patients with advanced infrapopliteal PAD who were treated with Absorb BVS reported improved clinical status and a low rate of CD‐TVF.

BACKGROUND-Historically, invasive hemodynamic guidance was not superior compared to clinical assessment in patients admitted with acute decompensated heart failure (ADHF). This study assessed the accuracy of clinical assessment versus. invasive hemodynamics in patients with ADHF.METHODS AND RESULTS-We conducted a prospective cohort study of patients admitted with ADHF. Prior to RHC, physicians categorically predicted right atrial pressure (RAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI) and hemodynamic profile (Wet/ Dry, Warm/Cold) based on physical exam and clinical data evaluation. "Warm"= CI > 2.2 L/min/m 2 ; "Wet" = PCWP >18 mmHg. 218 surveys (83 cardiology fellows, 55 attending cardiologists, 45 residents, 35 interns) evaluating 97 patients were collected. 46% were receiving inotropes prior to RHC. Positive and negative predictive values of clinical assessment compared to RHC for the "Cold and Wet" subgroup were 74.7% and 50.4%. Accuracy of categorical prediction was 43.6% for RAP, 34.4% for PCWP, 49.1% for CI, and did not differ by clinician (P >0.05 for all). Interprovider agreement was 44.4%. Therapeutic changes following RHC occurred in 71.1% overall (P <0.001).

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