Ventricular arrhythmias (VAs) are common in patients with a left ventricular assist device (LVAD), but the literature remains inconclusive regarding the benefits of an automatic implantable cardioverter-defibrillator (AICD) in this population, especially in those with a preexisting device before LVAD implantation. Here, we report the acute hemodynamic consequences of polymorphic ventricular tachycardia in a patient with a preexisting biventricular AICD who was implanted with an LVAD (HeartMate 3). This case underscores the importance of considering AICD placement on a case-by-case basis and highlights the need for a well-designed study to establish its benefit in this population.

David Taylor was an eminent luminary in the field of advanced heart failure and transplantation. As past president of the International Society for Heart and Lung Transplantation, he significantly impacted the field and was a mentor to many young heart failure cardiologists. In addition to many professional activities, David was an integral part of Brano meetings, including numerous eastern European trips promoting education and training in advanced heart failure, mechanical circulatory support, and transplantation

Postcardiotomy cardiogenic shock is a rare complication with high mortality. When patients do not respond to the placement of an intra-aortic balloon pump or pharmacological treatment, therapy with peripheral venoarterial extracorporeal membrane is a viable option that allows active resuscitation. The adjunct use of Impella® (Abiomed, Danvers, MA, USA) allows active unloading of the dysfunctional left ventricle. However, left atrial venoarterial extracorporeal membrane oxygenation (LAVA-ECMO) is an appealing and effective strategy in cases of aortic dissection, aortic valve replacement, or bioprosthesis of the aorta. Insertion of an extraction cannula that can discharge both atria or only the left atrium allows biventricular discharge or discharge of only the left ventricle, respectively. We present a case series of patients who underwent Bentall-De Bono surgery with severe aortic regurgitation secondary to aortic dissection and/or aneurysm. In one case, the aortic dissection extended before the bifurcation of the iliac arteries, and LAVA-ECMO was a safe treatment option. To our knowledge, this is the first published experience of LAVA-ECMO after cardiac surgery in this population.

Despite the remarkable progress made over the past few decades in the management of patients with both solid and hematologic malignancies, radiation-and chemotherapy-related cardiotoxicity remains an ongoing problem. This is true even for newer highly targeted therapies, including tyrosine kinase inhibitors (TKIs). This report presents a case of late/severe right heart dysfunction secondary to pulmonary hypertension, developed after ten years of therapy with dasatinib. We also review the history of this known, but often unrecognized, and potentially reversible complication, and we suggest treatment options. Additionally, this case highlights the remarkable effectiveness of TKIs in patients with chronic myelogenous leukemia while also emphasizing the ever-present concern that even in the absence of clinical or laboratory evidence of residual leukemic disease, discontinuing chemotherapeutic agents may result in prompt recrudescence and death.

Since 2007, the Branislav “Brano” Radovancevic Heart Failure Forum has been held annually to provide a venue for experts to present and discuss “Innovations and New Treatment Strategies in Heart Failure.” Clinicians and researchers gather yearly in a different Eastern European city to discuss the latest in heart failure diagnostics and therapeutics. The forum was postponed in 2020 due to the COVID-19 pandemic and then resumed in September of 2021 in Graz, Austria. It was attended by over 75 faculty from 13 countries. Due to the ongoing pandemic, 13 presentations were given virtually. Throughout the forum, 17 separate sessions focused on challenges and solutions related to mechanical circulatory support and heart transplantation. In this special issue of The VAD Journal, a summary of conference highlights from available presentations is presented.

Background: We aimed to analyze the potential benefits of implementing a hospital-wide extracorporeal cardiopulmonary resuscitation (ECPR) protocol. Methods: We analyzed in-hospital cardiac arrests in a large, academic hospital for two consecutive years. For this model, we assumed that ECPR would be started in all adults, with no upper age limit, who have a full code status. We excluded codes lastingminutes, arrests with asystole as an initial rhythm, and patients with hemorrhagic shock or who coded due to new stroke (contraindications for anticoagulation). We calculated how many extra lives could be saved per year if ECPR was initiated during each code meeting these criteria. Results: During two consecutive years, a total of 710 in-hospital cardiac arrests occurred. We excluded 91 codes due to bleeding or new stroke, 96 cases with asystole as an initial rhythm, and 206 codes lasting less than 15 minutes. In the remaining 317 codes, ECPR could have been used. In 229 cases out of 317, patients survived conventional CPR, so ECPR would be futile. Out of remaining 88 codes, only 38 (3.5%) were due to reversible cardiac or non-cardiac emergencies and resulted in death. They could have favorable outcomes if ECPR was used. Using the Extracorporeal Life Support Organization data, survival to discharge after ECPR is about 30%. So, we estimate that 13 patients (1.2%) could have been saved in 2 years, or ~7 patients per year. Considering 317 veno-arterial extracorporeal membrane oxygenation (VA ECMO) initiations, the ratio would be 24.4 VA ECMO initiations per one life saved. Conclusion: An implementation of a hospital-wide ECPR could change outcomes from unfavorable to favorable in 1.2% of patients, at the cost of initiation of 24.4 VA ECMO initiations per one life saved.

The Branislav “Brano” Radovancevic Heart Failure Forum (BHFF) was established in 2008. Each year, experts in the field of heart failure gather to learn, discuss and debate the recent advances and theories related to diagnostics and therapeutics. The 12th Annual BHFF was held September 18-21, 2019, in Belgrade, Serbia, and was attended by over 350 participants from 15 countries. Over four days, seventeen separate sessions focused on challenges and solutions related to mechanical circulatory support and heart transplantation. For the first time, a summary of selected presentations was organized and presented herein.

Background
 A wide range of left ventricular (LV) recovery rates on left ventricular assist device (LVAD) support have been reported. In this case series, we summarize our experience with LVAD explantation for presumed LV recovery.
 Case series 
 Out of 240 patients who received an LVAD implant in our program since its inception, we explanted/inactivated the pump for presumed LV recovery in only three patients. All three of these patients had relapse of cardiomyopathy within 6 months of explantation.
 Conclusion 
 Our experience does not support the existence of LV recovery following LVAD implantation as a common phenomenon. Improvement in LV function on LVAD is sustainable only with mechanical circulatory support and once the offloading support provided by the device is removed recurrent failure quickly ensue. Likely the term “remission” reflects the status more accurately than the term “recovery”.

Mechanical circulatory support (MCS) for patients with advanced heart failure (HF) is becoming more commonplace as technology has progressed and reliability of these systems has improved. We report our experience with three patients with cardiopulmonary arrest in the hospital and propose a protocol for the prompt assessment and treatment of an unresponsive patient with a LVAD in place. We presented three cases of unresponsive patients on LVAD support with low flow or no flow through the LVAD. Although all three of them were alive after resuscitation, none survived to discharge. In all three cases, there were no flaws in LVAD per se, with power source and controller appropriately attached, and the pump functioning normally. The low flow state was secondary to non-cardiac conditions (respiratory acidosis, dehydration, and stroke). In early 2017 we developed our algorithm for unresponsive LVAD patients. Utilization of LVAD flow, which can be obtained quickly and non-invasively at the bedside of a patient is used to direct resuscitation efforts in this proposed protocol. Rapid and standardized protocol for resuscitation of LVAD patients with in-hospital cardiopulmonary arrest is necessary to decrease morbidity and mortality. Further investigation regarding the best practice in this clinical scenario is evolving and further studies are needed.

Background
 Capsule endoscopy (CE) is mainstream in the evaluation of obscure gastrointestinal bleeding (GIB) in the general population. However, the diagnostic and therapeutic impact of CE in LVAD patients susceptible to transient bleeding remains largely unexplored. This study aimed to assess the benefits of CE in the evaluation of LVAD associated GIB.
 Methods
 Retrospective review of patients implanted with a continuous flow LVAD who underwent inpatient capsule endoscopy (CE) between January 2014 and May 2017 at our center. Identification of lesions with high bleeding potential or presence of frank blood were considered abnormal findings on CE study.
 Results
 Twenty-five inpatients who underwent 41 CE were identified. All patients presented with GIB and had preceding negative upper endoscopy and colonoscopy in the past 4 weeks. On the first capsule in each patient, 19 had interpretable images, abnormal findings were detected in 5 patients (high risk lesion in 3, frank blood in 2), four of these underwent an enteroscopy and only 2 (8%) patients had confirmation of the capsule findings with APC treatment (true positive). Excluding patients with malfunction, LVAD interference and poor bowel prep, 14 patients had negative/equivocal CE, of which 4 underwent enteroscopy due to continued bleeding and 2 of these patients had treatable culprit lesions (false negative). A total of 17 (68%) patients were discharged without any therapeutic intervention irrespective of the success or findings on CE due to clinical stabilization. Twenty patients (80%) had recurrence in a mean 154 days. As expected, repeat capsules in the same admission increased the diagnostic yield (p=0.031). Only nine patients (36%) had capsule-image evidence of reaching the cecum while 4 patients (16%) had retention which had to be retrieved without further complication.
 Conclusions
 This study demonstrated that evaluation of GIB with CE is feasible and safe but was associated with a low diagnostic yield and low conversion to therapeutic intervention. With a true positive yield of 4% in our cohort, the efficacy and cost-effectiveness of CE in the LVAD population is debatable. The role of CE in LVAD patients may need to be reevaluated. An identification of patients who would benefit from a capsule-first approach would allow optimum utilization of resources and reduce healthcare expenditure.