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Seguchi O, Azarbal B, Mirocha J, Youn JC, Passano E, Patel J, Kobashigawa J. Change in First-year Intravascular Ultrasound Results Predicts Adverse Events in Heart Transplant Recipients: Implications for Clinical Trial Endpoints. Transplantation 2023; 107:737-747. [PMID: 36358011 DOI: 10.1097/tp.0000000000004395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Heart transplantation (HTx) is an established therapeutic option for patients with advanced heart failure who are refractory to conventional guideline-directed treatments. This study aimed to reassess whether intravascular ultrasound variables could predict adverse events after HTx in the modern era. METHODS One hundred primary HTx recipients with available serial intravascular ultrasound examination results of the left anterior descending artery 4-8 wk and 1 y after HTx were enrolled, with an average follow-up duration of 5.7 y. The primary endpoint was a composite of all-cause death, nonfatal major adverse cardiac events, and angiographic cardiac allograft vasculopathy. RESULTS Forty-three patients developed primary endpoints. The baseline maximal intimal thickness was independently associated with the primary endpoint (hazard ratio, 8.24; 95% confidential interval [CI], 3.21-21.21; P < 0.001), and the optimal cutoff value was 0.64 mm. A change in the plaque atheroma volume in a proximal 20-mm segment from the left anterior descending artery bifurcation >1.05 mm 3 /mm (hazard ratio, 2.75; 95% CI, 1.28-5.89; P = 0.009) and a change in the first-year maximal intimal thickness >0.27 mm (hazard ratio, 2.63; 95% CI, 1.05-6.56; P = 0.04) were independent predictors of the primary endpoint 1 y after intravascular ultrasonography. CONCLUSIONS The aforementioned important clinical implications of intravascular ultrasound parameters are useful predictors of outcomes, which may be considered endpoints in modern clinical HTx trials.
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Affiliation(s)
- Osamu Seguchi
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Babak Azarbal
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - James Mirocha
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jong-Chan Youn
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Elizabeth Passano
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - Jignesh Patel
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - Jon Kobashigawa
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
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Grady KL, Kao A, Spertus JA, Hsich E, Dew MA, Pham DT, Hartupee J, Petty M, Cotts W, Pamboukian SV, Pagani FD, Lampert B, Johnson M, Murray M, Takeda K, Yuzefpolskaya M, Silvestry S, Kirklin JK, Andrei AC, Elenbaas C, Baldridge A, Yancy C. Health-Related Quality of Life in Older Patients With Heart Failure From Before to Early After Advanced Surgical Therapies: Findings From the SUSTAIN-IT Study. Circ Heart Fail 2022; 15:e009579. [PMID: 36214123 PMCID: PMC9561242 DOI: 10.1161/circheartfailure.122.009579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Restoring health-related quality of life (HRQOL) is a therapeutic goal for older patients with advanced heart failure. We aimed to describe change in HRQOL in older patients (60–80 years) awaiting heart transplantation (HT) with or without pretransplant mechanical circulatory support (MCS) or scheduled for long-term MCS, if ineligible for HT, from before to 6 months after these surgeries and identify factors associated with change.
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Affiliation(s)
- Kathleen L. Grady
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | - Andrew Kao
- St. Luke’s Medical Center, Kansas City, MO (A.K.)
| | | | | | | | - Duc-Thinh Pham
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | | | - Michael Petty
- University of Minnesota Medical Center, Minneapolis (M.P.)
| | | | | | | | | | | | | | - Koji Takeda
- Columbia University, New York, NY (K.T., M.Y.)
| | | | | | | | - Adin-Cristian Andrei
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | - Christian Elenbaas
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | - Abigail Baldridge
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | - Clyde Yancy
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
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3
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Pinto‐Salinas M, Morón‐Castro J, Chavarri‐Velarde F, Soplopuco‐Palacios F, Palma‐Ortecho L, Lescano‐Alva M. Heart transplantation at the Peruvian National Heart Institute: One‐decade single‐center experience. J Card Surg 2022; 37:1550-1558. [DOI: 10.1111/jocs.16429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/22/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Julio Morón‐Castro
- Medical School Universidad Nacional Mayor de San Marcos Lima Peru
- Department of Cardiovascular Surgery Instituto Nacional Cardiovascular “Carlos Alberto Peschiera Carrillo” Lima Peru
| | - Fernando Chavarri‐Velarde
- Medical School Universidad Nacional Mayor de San Marcos Lima Peru
- Department of Cardiopediatrics Instituto Nacional Cardiovascular “Carlos Alberto Peschiera Carrillo” Lima Peru
| | - Franz Soplopuco‐Palacios
- Department of Cardiovascular Surgery Instituto Nacional Cardiovascular “Carlos Alberto Peschiera Carrillo” Lima Peru
| | - Luis Palma‐Ortecho
- Department of Cardiopediatrics Instituto Nacional Cardiovascular “Carlos Alberto Peschiera Carrillo” Lima Peru
| | - Miguel Lescano‐Alva
- Department of Clinical Cardiology Instituto Nacional Cardiovascular “Carlos Alberto Peschiera Carrillo” Lima Peru
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Abstract
PURPOSE OF REVIEW Timely referral of eligible candidates for consideration of advanced therapies, such as a heart transplantation or mechanical circulatory support is essential. The characteristics of heart transplantation candidates have changed significantly over the years, leading to a more complex evaluation process. The present review summarizes recent advances in the evaluation process for heart transplantation eligibility. RECENT FINDINGS The heart transplantation allocation policy was recently reviewed in the USA in an effort to reduce waitlist mortality and to ensure fair geographic allocation of organs to the sickest patients. Moreover, patients with chronic infectious diseases, as well as malignancies, are being currently considered acceptable candidates for transplantation. Listing practices for heart transplantation vary between programmes, with a greater willingness to consider high-risk candidates at higher-volume centres. SUMMARY The ultimate decision to place high-risk candidates on the heart transplantation waitlist should be based on a combination of quantitative and qualitative data analysis informed by clinical judgement, and the chronic shortage of organ donors makes this process an important ethical concern for any society. Future guidelines should discuss approaches to achieve fair organ allocation while preserving improved outcomes after transplantation.
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Affiliation(s)
- Jefferson L Vieira
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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5
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Medical Contraindications to Transplant Listing in the USA: A Survey of Adult and Pediatric Heart, Kidney, Liver, and Lung Programs. World J Surg 2019; 43:2300-2308. [PMID: 31111229 DOI: 10.1007/s00268-019-05030-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Listing practices for solid organ transplantation are variable across programs in the USA. To better characterize this variability, we performed a survey of psychosocial listing criteria for pediatric and adult heart, lung, liver, and kidney programs in the USA. In this manuscript, we report our results regarding listing practices with respect to obesity, advanced age, and HIV seropositivity. METHODS We performed an online, forced-choice survey of adult and pediatric heart, kidney, liver, and lung transplant programs in the USA. RESULTS Of 650 programs contacted, 343 submitted complete responses (response rate = 52.8%). Most programs have absolute contraindications to listing for BMI > 45 (adult: 67.5%; pediatric: 88.0%) and age > 80 (adult: 55.4%; pediatric: not relevant). Only 29.5% of adult programs and 25.7% of pediatric programs consider HIV seropositivity an absolute contraindication to listing. We found that there is variation in absolute contraindications to listing in adult programs among organ types for BMI > 45 (heart 89.8%, lung 92.3%, liver 49.1%, kidney 71.9%), age > 80 (heart 83.7%, lung 76.9%, liver 68.4%, kidney 29.2%), and HIV seropositivity (heart 30.6%, lung 59.0%, kidney 16.9%, liver 28.1%). CONCLUSIONS We argue that variability in listing enhances access to transplantation for potential recipients who have the ability to pursue workup at different centers by allowing different programs to have different risk thresholds. Programs should remain independent in listing practices, but because these practices differ, we recommend transparency in listing policies and informing patients of reasons for listing denial and alternative opportunities to seek listing at another program.
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Harmon DM, Tecson KM, Jamil AK, Felius J, Gonzalez-Stawinski GV, Joseph SM, Hall SA. Outcomes of orthotopic heart transplantation and left ventricular assist device in patients aged 65 years or more with end-stage heart failure. Proc (Bayl Univ Med Cent) 2019; 32:177-180. [PMID: 31191122 DOI: 10.1080/08998280.2019.1576095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/21/2019] [Indexed: 12/31/2022] Open
Abstract
Age has traditionally been a limiting factor for advanced heart failure (HF) therapies. Orthotopic heart transplantation (OHT) age guidelines have become less restrictive, and left ventricular assist devices (LVADs) are increasingly utilized as destination therapy for patients ≥65 years. Although indications differ, we assessed outcomes for both modalities in this older population. We reviewed charts of consecutive advanced HF therapy recipients aged ≥65 years at our center from 2012 to 2016. Of 118 patients evaluated, 46 (39%) received an LVAD and 72 (61%) received OHT. Gender, body mass index, and rate of prior sternotomy were similar between groups; OHT recipients were younger, less likely to have diabetes mellitus, and more likely to have HF due to ischemic etiology. Forty-six percent of patients receiving LVADs were urgent need (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] profile 1-2), compared to 29% of patients receiving OHT (United Network for Organ Sharing 1A criteria; P = 0.068). OHT recipients had shorter lengths of stay and better 1-year survival compared to LVAD recipients. Although many centers do not offer advanced HF therapy to patients aged ≥65 years, our results indicate that age alone should not be prohibitive for advanced HF therapy, particularly OHT.
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Affiliation(s)
- David M Harmon
- Department of Internal Medicine, Mayo ClinicRochesterMinnesota
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, Baylor Scott & White Research InstituteDallasTexas
| | - Aayla K Jamil
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research InstituteDallasTexas
| | - Joost Felius
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research InstituteDallasTexas
| | - Gonzalo V Gonzalez-Stawinski
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research InstituteDallasTexas.,Center for Advanced Heart and Lung Disease, Baylor University Medical CenterDallasTexas.,Department of Cardiac and Thoracic Surgery, Baylor University Medical CenterDallasTexas
| | - Susan M Joseph
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research InstituteDallasTexas.,Center for Advanced Heart and Lung Disease, Baylor University Medical CenterDallasTexas
| | - Shelley A Hall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research InstituteDallasTexas.,Center for Advanced Heart and Lung Disease, Baylor University Medical CenterDallasTexas
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7
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Bianco JC, Mc Loughlin S, Denault AY, Marenchino RG, Rojas JI, Bonofiglio FC. Heart Transplantation in Patients >60 Years: Importance of Relative Pulmonary Hypertension and Right Ventricular Failure on Midterm Survival. J Cardiothorac Vasc Anesth 2018; 32:32-40. [DOI: 10.1053/j.jvca.2017.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Indexed: 11/11/2022]
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8
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Del Rio JM, Maerz D, Subramaniam K. Noteworthy Literature Published in 2017 for Thoracic Transplantation Anesthesiologists. Semin Cardiothorac Vasc Anesth 2018; 22:49-66. [DOI: 10.1177/1089253217749893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Thoracic organ transplantation constitutes a significant proportion of all transplant procedures. Thoracic solid organ transplantation continues to be a burgeoning field of research. This article presents a review of remarkable literature published in 2017 regarding perioperative issues pertinent to the thoracic transplant anesthesiologists.
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Affiliation(s)
- J. Mauricio Del Rio
- Duke University, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - David Maerz
- University of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kathirvel Subramaniam
- University of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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9
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Jamil A, Qin H, Felius J, Saracino G, Rafael AE, MacHannaford JC, Gonzalez-Stawinski GV, Lima B. Comparison of Clinical Characteristics, Complications, and Outcomes in Recipients Having Heart Transplants <65 Years of Age Versus ≥65 Years of Age. Am J Cardiol 2017; 120:2207-2212. [PMID: 29056228 DOI: 10.1016/j.amjcard.2017.08.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/11/2017] [Accepted: 08/17/2017] [Indexed: 10/18/2022]
Abstract
Advanced recipient age remains a limiting factor for heart transplant candidacy, with many centers reluctant to transplant older patients. Here, we report our experience with recipients aged ≥65 years compared with younger recipients in terms of baseline characteristics, intraoperative and immediate postoperative experiences, and post-transplant morbidity and survival. The main study outcome was primary graft dysfunction (PGD), which has not been widely studied in this population. Donor and recipient data from 255 heart transplantations performed between 2012 and 2016 were reviewed. Seventy (27%) recipients were ≥65 years and 185 were younger. The older group had a higher frequency of ischemic cardiomyopathy and more frequently had a previous sternotomy than the younger recipients (all p <0.007). We found no significant differences in post-transplant morbidity (intensive care unit and hospital stay, pneumonia, infections, reoperation for bleeding, stroke, renal failure, or in-hospital mortality; all p >0.12). One-year survival was also similar in the 2 groups (p = 0.88). The incidence of moderate or severe PGD was lower in the older group (6%) than in the younger group (16%; p = 0.037). Multivariate logistic regression found pretransplant creatinine and donor undersizing by predicted heart mass to be predictors of moderate to severe PGD, whereas recipient age ≥65 years was identified as protective against PGD in this cohort. In conclusion, our study showed comparable survival and outcomes in recipients ≥65 years of age with otherwise similar nutritional status and body mass composition.
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10
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Bolliger D, Bouchez S, Mauermann E. Re-examining Factors Associated With Mortality After Heart Transplantation: A Focus on Recipient Age and Relative Pulmonary Hypertension. J Cardiothorac Vasc Anesth 2017; 32:41-43. [PMID: 29221977 DOI: 10.1053/j.jvca.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel Bolliger
- Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Stefaan Bouchez
- Department of Anesthesiology and Perioperative Medicine, University Hospital Ghent, Ghent, Belgium
| | - Eckhard Mauermann
- Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland; Department of Anesthesiology and Perioperative Medicine, University Hospital Ghent, Ghent, Belgium
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