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Yang Y, Gyoten T, Amiya E, Ito G, Kaobhuthai W, Ando M, Shimada S, Yamauchi H, Ono M. Impact of prolonged cardiopulmonary resuscitation on outcomes in heart transplantation with higher risk donor heart. Gen Thorac Cardiovasc Surg 2024; 72:455-465. [PMID: 38180694 DOI: 10.1007/s11748-023-01990-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES To evaluate the influence of prolonged cardiopulmonary resuscitation (CPR) on outcomes in heart transplantation with higher risk donor hearts (HRDHs). METHODS Patients transplanted in our hospital between May 2006 and December 2019 were divided into 2 groups, HRDH recipients and non HRDH recipients. HRDH was defined as meeting at least one of the following criteria: (1) donor left ventricular ejection fraction ≤ 50%, (2) donor-recipient predicted heart mass ratio < 0.8 or > 1.2, (3) donor age ≥ 55 years, (4) ischemic time > 4 h and (5) catecholamine index > 20. Recipients of HRDHs were divided into 3 groups according to the time of CPR (Group1: non-CPR, Group 2: less than 30 min-CPR, and Group 3: longer than 30 min CPR). RESULTS A total of 125 recipients were enrolled in this study, composing of HRDH recipients (n = 97, 78%) and non HRDH recipients (n = 28, 22%). Overall survival and the rate of freedom from cardiac events at 10 years after heart transplantation were comparable between two groups. Of 97 HRDH recipients, 54 (56%) without CPR, 22 (23%) with CPR < 30 min, and 21 (22%) with CPR ≥ 30 min were identified. One-year survival rates were not significantly different among three groups. The 1-year rate of freedom from cardiac events was not also statistically different, excluding the patients with coronary artery disease found in early postoperative period, which was thought to be donor-transmitted disease. Multivariate logistics regression for cardiac events identified that the CPR duration was not a risk factor even in HRDH-recipients. CONCLUSION The CPR duration did not affect the outcomes after heart transplantation in HRDH recipients.
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Affiliation(s)
- Yong Yang
- Department of Cardiac Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takayuki Gyoten
- Department of Cardiac Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo City, Japan
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Bunkyo City, Japan
| | - Go Ito
- Department of Cardiac Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Wirangrong Kaobhuthai
- Department of Cardiac Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Masahiko Ando
- Department of Cardiac Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Shogo Shimada
- Department of Cardiac Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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2
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Lescroart M, Kransdorf EP, Scuppa MF, Patel JK, Coutance G. Importance of Transplant Era on Post-Heart Transplant Predictive Models: A UNOS Cohort Analysis. Clin Transplant 2024; 38:e15403. [PMID: 39023089 DOI: 10.1111/ctr.15403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/14/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND The application of posttransplant predictive models is limited by their poor statistical performance. Neglecting the dynamic evolution of demographics and medical practice over time may be a key issue. OBJECTIVES Our objective was to develop and validate era-specific predictive models to assess whether these models could improve risk stratification compared to non-era-specific models. METHODS We analyzed the United Network for Organ Sharing (UNOS) database including first noncombined heart transplantations (2001-2018, divided into four transplant eras: 2001-2005, 2006-2010, 2011-2015, 2016-2018). The endpoint was death or retransplantation during the 1st-year posttransplant. We analyzed the dynamic evolution of major predictive variables over time and developed era-specific models using logistic regression. We then performed a multiparametric evaluation of the statistical performance of era-specific models and compared them to non-era-specific models in 1000 bootstrap samples (derivation set, 2/3; test set, 1/3). RESULTS A total of 34 738 patients were included, 3670 patients (10.5%) met the composite endpoint. We found a significant impact of transplant era on baseline characteristics of donors and recipients, medical practice, and posttransplant predictive models, including significant interaction between transplant year and major predictive variables (total serum bilirubin, recipient age, recipient diabetes, previous cardiac surgery). Although the discrimination of all models remained low, era-specific models significantly outperformed the statistical performance of non-era-specific models in most samples, particularly concerning discrimination and calibration. CONCLUSIONS Era-specific models achieved better statistical performance than non-era-specific models. A regular update of predictive models may be considered if they were to be applied for clinical decision-making and allograft allocation.
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Affiliation(s)
- Mickaël Lescroart
- Department of Cardiac Surgery, Institute of Cardiology, La Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne Université-Medical School, Paris, France
| | - Evan P Kransdorf
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Jignesh K Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Guillaume Coutance
- Department of Cardiac Surgery, Institute of Cardiology, La Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne Université-Medical School, Paris, France
- INSERM UMR 970, Paris Translational Research Centre for Organ Transplantation, Université de Paris, Paris, France
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3
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Simonenko M, Hansen D, Niebauer J, Volterrani M, Adamopoulos S, Amarelli C, Ambrosetti M, Anker SD, Bayes-Genis A, Gal TB, Bowen TS, Cacciatore F, Caminiti G, Cavaretta E, Chioncel O, Coats AJS, Cohen-Solal A, D'Ascenzi F, de Pablo Zarzosa C, Gevaert AB, Gustafsson F, Kemps H, Hill L, Jaarsma T, Jankowska E, Joyce E, Krankel N, Lainscak M, Lund LH, Moura B, Nytrøen K, Osto E, Piepoli M, Potena L, Rakisheva A, Rosano G, Savarese G, Seferovic PM, Thompson DR, Thum T, Van Craenenbroeck EM. Prevention and rehabilitation after heart transplantation: A clinical consensus statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a section of ESOT. Eur J Prev Cardiol 2024:zwae179. [PMID: 38894688 DOI: 10.1093/eurjpc/zwae179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 01/20/2024] [Accepted: 02/21/2024] [Indexed: 06/21/2024]
Abstract
Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus.
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Affiliation(s)
- Maria Simonenko
- Cardiopulmonary Exercise Test Research Department, Heart Transplantation Outpatient Department, V.A. Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Dominique Hansen
- REVAL and BIOMED Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | | | - Stamatis Adamopoulos
- Heart Failure and Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Cristiano Amarelli
- Department of Cardiac Surgery and Transplants, Monaldi Hospital, Azienda dei Colli, Naples, Italy
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta d'Adda (CR), Italy
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Scott Bowen
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Francesco Cacciatore
- Department of Translational Medicine, University of Naples 'Federico II', Naples, Italy
| | | | - Elena Cavaretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | | | - Alain Cohen-Solal
- Cardiology Department, University of Paris, INSERM UMRS-942, Hopital Lariboisiere, AP-HP, Paris, France
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | - Andreas B Gevaert
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Eindhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Emer Joyce
- Department of Cardiology, Mater University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Nicolle Krankel
- Universitätsmedizin Berlin Campus Benjamin Franklin Klinik für Kardiologie Charite, Berlin, Germany
| | | | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Brenda Moura
- Armed Forces Hospital, Porto, Portugal
- Centre for Health Technologies and Services Research, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Kari Nytrøen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Elena Osto
- Division of Physiology and Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria
- Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Massimo Piepoli
- Dipartimento Scienze Biomediche per la Salute, Universita' Degli Studi di Milan, Milan, Italy
- Cardiologia Universitaria, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Amina Rakisheva
- Department of Cardiology, Scientific Institution of Cardiology and Internal Diseases, Almaty, Kazakhstan
- Department of Cardiology, Kapshagai City Hospital, Almaty, Kazakhstan
| | - Giuseppe Rosano
- St. George's Hospital NHS Trust University of London, London, UK
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petar M Seferovic
- Faculty of Medicine and Heart Failure Center, University of Belgrade, Belgrade University Medical Center, Belgrade, Serbia
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School and Fraunhofer Institute for Toxicology and Experimental Research, Hannover, Germany
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
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4
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Simonenko M, Hansen D, Niebauer J, Volterrani M, Adamopoulos S, Amarelli C, Ambrosetti M, Anker SD, Bayes-Genis A, Ben Gal T, Bowen TS, Cacciatore F, Caminiti G, Cavarretta E, Chioncel O, Coats AJS, Cohen-Solal A, D’Ascenzi F, de Pablo Zarzosa C, Gevaert AB, Gustafsson F, Kemps H, Hill L, Jaarsma T, Jankowska E, Joyce E, Krankel N, Lainscak M, Lund LH, Moura B, Nytrøen K, Osto E, Piepoli M, Potena L, Rakisheva A, Rosano G, Savarese G, Seferovic PM, Thompson DR, Thum T, Van Craenenbroeck EM. Prevention and Rehabilitation After Heart Transplantation: A Clinical Consensus Statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a Section of ESOT. Transpl Int 2024; 37:13191. [PMID: 39015154 PMCID: PMC11250379 DOI: 10.3389/ti.2024.13191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/30/2024] [Indexed: 07/18/2024]
Abstract
Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus statement focuses on the importance and the characteristics of prevention and rehabilitation designed for HTx recipients.
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Affiliation(s)
- Maria Simonenko
- Cardiopulmonary Exercise Test Research Department, Heart Transplantation Outpatient Department, V. A. Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Dominique Hansen
- REVAL and BIOMED Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | | | - Stamatis Adamopoulos
- Heart Failure and Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Cristiano Amarelli
- Department of Cardiac Surgery and Transplants, Monaldi Hospital, Azienda dei Colli, Naples, Italy
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta D’Adda, Italy
| | - Stefan D. Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T. Scott Bowen
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Francesco Cacciatore
- Department of Translational Medicine, University of Naples “Federico II”, Naples, Italy
| | | | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases “Prof. C. C. Iliescu”, Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | | | - Alain Cohen-Solal
- Cardiology Department, University of Paris, INSERM UMRS-942, Hopital Lariboisiere, AP-HP, Paris, France
| | - Flavio D’Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | - Andreas B. Gevaert
- Research Group Cardiovascular Diseases, Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR) Department, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Eindhoven, Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Loreena Hill
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
- Julius Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ewa Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Emer Joyce
- Department of Cardiology, Mater University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Nicolle Krankel
- Universitätsmedizin Berlin Campus Benjamin Franklin Klinik für Kardiologie Charite, Berlin, Germany
| | | | - Lars H. Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Brenda Moura
- Armed Forces Hospital, Porto, Portugal
- Centre for Health Technologies and Services Research, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Kari Nytrøen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Elena Osto
- Division of Physiology and Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria
- Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Massimo Piepoli
- Dipartimento Scienze Biomediche per la Salute, Universita’ Degli Studi di Milan, Milan, Italy
- Cardiologia Universitaria, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Amina Rakisheva
- Department of Cardiology, Scientific Institution of Cardiology and Internal Diseases, Almaty, Kazakhstan
- Department of Cardiology, Kapshagai City Hospital, Almaty, Kazakhstan
| | - Giuseppe Rosano
- St. George’s Hospital NHS Trust University of London, London, United Kingdom
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petar M. Seferovic
- Faculty of Medicine and Heart Failure Center, University of Belgrade, Belgrade University Medical Center, Belgrade, Serbia
| | - David R. Thompson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School and Fraunhofer Institute for Toxicology and Experimental Research, Hannover, Germany
| | - Emeline M. Van Craenenbroeck
- Research Group Cardiovascular Diseases, Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR) Department, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
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5
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Fernandez Valledor A, Rubinstein G, Moeller CM, Lorenzatti D, Rahman S, Lee C, Oren D, Farrero M, Sayer GT, Uriel N. "Durable left ventricular assist devices as a bridge to transplantation in The Old and The New World". J Heart Lung Transplant 2024; 43:1010-1020. [PMID: 38360159 DOI: 10.1016/j.healun.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
Heart transplantation remains the gold standard treatment for end-stage heart failure patients without contraindications. However, limited donor availability and long wait times have created a need for left ventricular assist devices (LVAD) to be used as a bridge to transplantation in appropriately selected patients. Improvements in LVAD technology have resulted in improved short- and long-term outcomes, further supporting the use of these devices for a bridge-to-transplant (BTT) indication. LVAD utilization as BTT exhibits notable disparities worldwide, mainly due to variations in organ availability, allocation policies, and financial constraints. Although Europe has experienced a consistent increase in the use of LVAD for this purpose, the United Network for Organ Sharing 2018 policy amendment resulted in a significant reduction in the number of LVADs used for BTT in the US. To overcome this issue, modifications in the US allocation policy to consider factors such as days on device support, age, and type of complications may be necessary to potentially increase implantation rates.The authors provide an overview comparing the current state of heart transplantation in the US and Europe, with a particular focus on how distinct allocation policies and organ availability impact medical practices. Additionally, the review will examine critical aspects ranging from patient selection and pre-implantation optimization to post-transplant outcomes.
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Affiliation(s)
- Andrea Fernandez Valledor
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York
| | - Gal Rubinstein
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York
| | - Cathrine M Moeller
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York
| | - Daniel Lorenzatti
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
| | - Salwa Rahman
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York
| | - Changhee Lee
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York
| | - Daniel Oren
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York
| | - Marta Farrero
- Heart Failure and Heart Transplant Unit, Cardiovascular Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Gabriel T Sayer
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York
| | - Nir Uriel
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York.
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6
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Zhang KC, Narang N, Jasseron C, Dorent R, Lazenby KA, Belkin MN, Grinstein J, Mayampurath A, Churpek MM, Khush KK, Parker WF. Development and Validation of a Risk Score Predicting Death Without Transplant in Adult Heart Transplant Candidates. JAMA 2024; 331:500-509. [PMID: 38349372 PMCID: PMC10865158 DOI: 10.1001/jama.2023.27029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/11/2023] [Indexed: 02/15/2024]
Abstract
Importance The US heart allocation system prioritizes medically urgent candidates with a high risk of dying without transplant. The current therapy-based 6-status system is susceptible to manipulation and has limited rank ordering ability. Objective To develop and validate a candidate risk score that incorporates current clinical, laboratory, and hemodynamic data. Design, Setting, and Participants A registry-based observational study of adult heart transplant candidates (aged ≥18 years) from the US heart allocation system listed between January 1, 2019, and December 31, 2022, split by center into training (70%) and test (30%) datasets. Adult candidates were listed between January 1, 2019, and December 31, 2022. Main Outcomes and Measures A US candidate risk score (US-CRS) model was developed by adding a predefined set of predictors to the current French Candidate Risk Score (French-CRS) model. Sensitivity analyses were performed, which included intra-aortic balloon pumps (IABP) and percutaneous ventricular assist devices (VAD) in the definition of short-term mechanical circulatory support (MCS) for the US-CRS. Performance of the US-CRS model, French-CRS model, and 6-status model in the test dataset was evaluated by time-dependent area under the receiver operating characteristic curve (AUC) for death without transplant within 6 weeks and overall survival concordance (c-index) with integrated AUC. Results A total of 16 905 adult heart transplant candidates were listed (mean [SD] age, 53 [13] years; 73% male; 58% White); 796 patients (4.7%) died without a transplant. The final US-CRS contained time-varying short-term MCS (ventricular assist-extracorporeal membrane oxygenation or temporary surgical VAD), the log of bilirubin, estimated glomerular filtration rate, the log of B-type natriuretic peptide, albumin, sodium, and durable left ventricular assist device. In the test dataset, the AUC for death within 6 weeks of listing for the US-CRS model was 0.79 (95% CI, 0.75-0.83), for the French-CRS model was 0.72 (95% CI, 0.67-0.76), and 6-status model was 0.68 (95% CI, 0.62-0.73). Overall c-index for the US-CRS model was 0.76 (95% CI, 0.73-0.80), for the French-CRS model was 0.69 (95% CI, 0.65-0.73), and 6-status model was 0.67 (95% CI, 0.63-0.71). Classifying IABP and percutaneous VAD as short-term MCS reduced the effect size by 54%. Conclusions and Relevance In this registry-based study of US heart transplant candidates, a continuous multivariable allocation score outperformed the 6-status system in rank ordering heart transplant candidates by medical urgency and may be useful for the medical urgency component of heart allocation.
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Affiliation(s)
- Kevin C. Zhang
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Nikhil Narang
- Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
- Department of Medicine, University of Illinois-Chicago
| | - Carine Jasseron
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Richard Dorent
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Kevin A. Lazenby
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Mark N. Belkin
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Anoop Mayampurath
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison
| | | | - Kiran K. Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - William F. Parker
- Department of Medicine, University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
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7
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Legeai C, Coutance G, Cantrelle C, Jasseron C, Para M, Sebbag L, Battistella P, Kerbaul F, Dorent R. Waitlist Outcomes in Candidates With Rare Causes of Heart Failure After Implementation of the 2018 French Heart Allocation Scheme. Circ Heart Fail 2024; 17:e010837. [PMID: 38299331 DOI: 10.1161/circheartfailure.123.010837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/13/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND In 2018, an algorithm-based allocation system for heart transplantation (HT) was implemented in France. Its effect on access to HT of patients with rare causes of heart failure (HF) has not been assessed. METHODS In this national study, including adults listed for HT between 2018 and 2020, we analyzed waitlist and posttransplant outcomes of candidates with rare causes of HF (restrictive cardiomyopathy [RCM], hypertrophic cardiomyopathy, and congenital heart disease). The primary end point was death on the waitlist or delisting for clinical deterioration. Secondary end points included access to HT and posttransplant mortality. The cumulative incidence of waitlist mortality estimated with competing risk analysis and incidence of transplantation were compared between diagnosis groups. The association of HF cause with outcomes was determined by Fine-Gray or Cox models. RESULTS Overall, 1604 candidates were listed for HT. At 1 year postlisting, 175 patients met the primary end point and 1040 underwent HT. Candidates listed for rare causes of HF significantly differed in baseline characteristics and had more frequent score exceptions compared with other cardiomyopathies (31.3%, 32.0%, 36.4%, and 16.7% for patients with hypertrophic cardiomyopathy, RCM, congenital heart disease, and other cardiomyopathies). The cumulative incidence of death on the waitlist and probability of HT were similar between diagnosis groups (P=0.17 and 0.40, respectively). The adjusted risk of death or delisting for clinical deterioration did not significantly differ between candidates with rare and common causes of HF (subdistribution hazard ratio (HR): hypertrophic cardiomyopathy, 0.51 [95% CI, 0.19-1.38]; P=0.18; RCM, 1.04 [95% CI, 0.42-2.58]; P=0.94; congenital heart disease, 1.82 [95% CI, 0.78-4.26]; P=0.17). Similarly, the access to HT did not significantly differ between causes of HF (hypertrophic cardiomyopathy: HR, 1.18 [95% CI, 0.92-1.51]; P=0.19; RCM: HR, 1.19 [95% CI, 0.90-1.58]; P=0.23; congenital heart disease: HR, 0.76 [95% CI, 0.53-1.09]; P=0.14). RCM was an independent risk factor for 1-year posttransplant mortality (HR, 2.12 [95% CI, 1.06-4.24]; P=0.03). CONCLUSIONS Our study shows equitable waitlist outcomes among HT candidates whatever the indication for transplantation with the new French allocation scheme.
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Affiliation(s)
- Camille Legeai
- Agence de la Biomédecine, Saint Denis La Plaine Cedex, France (C.L., C.C., C.J., F.K., R.D.)
| | - Guillaume Coutance
- Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital (G.C.), Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University Medical School, France
- University of Paris, INSERM UMR 970, Paris Translational Research Centre for Organ Transplantation, France (G.C.)
| | - Christelle Cantrelle
- Agence de la Biomédecine, Saint Denis La Plaine Cedex, France (C.L., C.C., C.J., F.K., R.D.)
| | - Carine Jasseron
- Agence de la Biomédecine, Saint Denis La Plaine Cedex, France (C.L., C.C., C.J., F.K., R.D.)
| | - Marylou Para
- Department of Cardiac Surgery, Bichat Hospital (M.P.), Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University Medical School, France
| | - Laurent Sebbag
- Department of Cardiac Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France (L.S.)
| | - Pascal Battistella
- Department of Cardiology, Arnaud de Villeneuve Hospital, Montpellier, France (P.B.)
| | - François Kerbaul
- Agence de la Biomédecine, Saint Denis La Plaine Cedex, France (C.L., C.C., C.J., F.K., R.D.)
| | - Richard Dorent
- Agence de la Biomédecine, Saint Denis La Plaine Cedex, France (C.L., C.C., C.J., F.K., R.D.)
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Bitar A, Colvin MM. Beyond Tiers: Examination of the French Heart Allocation System. Circ Heart Fail 2024; 17:e011312. [PMID: 38299339 DOI: 10.1161/circheartfailure.123.011312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024]
Affiliation(s)
- Abbas Bitar
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.B., M.M.C.)
| | - Monica M Colvin
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.B., M.M.C.)
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Trivedi J, Pahwa S, Rabkin D, Gallo M, Guglin M, Slaughter MS, Abramov D. Predictors of Survival After Heart Transplant in the New Allocation System: A UNOS Database Analysis. ASAIO J 2024; 70:124-130. [PMID: 37862683 DOI: 10.1097/mat.0000000000002070] [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: 10/22/2023] Open
Abstract
Clinical predictors of posttransplant graft loss since the United Network for Organ Sharing (UNOS) heart allocation system change have not been well characterized. Single organ adult heart transplants from the UNOS database were identified (n = 10,252) and divided into a test cohort (n = 6,869, 67%) and validation cohort (n = 3,383, 33%). A Cox regression analysis was performed on the test cohort to identify recipient and donor risk factors for posttransplant graft loss. Based on the risk factors, a score (max 16) was developed to classify patients in the validation cohort into risk groups of low (≤1), mid (2-3), high (≥4) risk. Recipient factors of advanced age, Black race, recipient blood group O, diabetes, etiology of heart failure, renal dysfunction, elevated bilirubin, redo-transplantation, elevated pulmonary artery pressure, transplant with a durable ventricular assist device, or transplant on extracorporeal membrane oxygenation (ECMO) or ventilator were associated with more posttransplant graft loss. Donor factors of ischemic time and donor age were also associated with outcomes. One year graft survival for the low-, mid-, high-risk groups was 94%, 91%, and 85%, respectively. In conclusion, easily obtainable clinical characteristics at time of heart transplant can predict posttransplant outcomes in the current era.
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Affiliation(s)
- Jaimin Trivedi
- From the Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky
| | - Siddharth Pahwa
- From the Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky
| | - David Rabkin
- Department of Cardiovascular Surgery, Loma Linda University Hospital, Loma Linda, California
| | - Michele Gallo
- From the Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky
| | - Maya Guglin
- Division of Cardiovascular Disease, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark S Slaughter
- From the Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky
| | - Dmitry Abramov
- Department of Cardiovascular Medicine, Loma Linda University Hospital, Loma Linda, California
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10
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González-Costello J, Pérez-Blanco A, Delgado-Jiménez J, González-Vílchez F, Mirabet S, Sandoval E, Cuenca-Castillo J, Camino M, Segovia-Cubero J, Sánchez-Salado JC, Pérez de la Sota E, Almenar-Bonet L, Farrero M, Zataraín E, García-Cosío MD, Garrido I, Barge-Caballero E, Gómez-Bueno M, de Juan Bagudá J, Manito-Lorite N, López-Granados A, García-Guereta L, Blasco-Peiró T, Sarralde-Aguayo JA, Sobrino-Márquez M, de la Fuente-Galán L, Crespo-Leiro MG, Coll E, Gran-Ipiña F, Díaz-Molina B, Doñate L, Arribas-Leal JM, Sánchez-Vicario F, Atienza F, Rábago Juan-Aracil G, García-Quintana A, Martínez-Alpuente I, Riesgo-Gil F, Hernández-Montfort J, Oliver-Juan E, Sánchez-Rivas J, Padilla-Martínez M, Pérez-Villares JM, Miñambres E, Domínguez-Gil B. Review of the allocation criteria for heart transplant in Spain in 2023. SEC-Heart Failure Association/ONT/SECCE consensus document. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:69-78. [PMID: 37926340 DOI: 10.1016/j.rec.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/26/2023] [Indexed: 11/07/2023]
Abstract
Heart transplant (HT) remains the best therapeutic option for patients with advanced heart failure (HF). The allocation criteria aim to guarantee equitable access to HT and prioritize patients with a worse clinical status. To review the HT allocation criteria, the Heart Failure Association of the Spanish Society of Cardiology (HFA-SEC), the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) and the National Transplant Organization (ONT), organized a consensus conference involving adult and pediatric cardiologists, adult and pediatric cardiac surgeons, transplant coordinators from all over Spain, and physicians and nurses from the ONT. The aims of the consensus conference were as follows: a) to analyze the organization and management of patients with advanced HF and cardiogenic shock in Spain; b) to critically review heart allocation and priority criteria in other transplant organizations; c) to analyze the outcomes of patients listed and transplanted before and after the modification of the heart allocation criteria in 2017; and d) to propose new heart allocation criteria in Spain after an analysis of the available evidence and multidisciplinary discussion. In this article, by the HFA-SEC, SECCE and the ONT we present the results of the analysis performed in the consensus conference and the rationale for the new heart allocation criteria in Spain.
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Affiliation(s)
- José González-Costello
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain.
| | | | - Juan Delgado-Jiménez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Sonia Mirabet
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitari de Sant Pau, Barcelona, Spain
| | - Elena Sandoval
- Servicio de Cirugía Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José Cuenca-Castillo
- Servicio de Cirugía Cardiaca, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Manuela Camino
- Unidad de Trasplante Cardiaco Pediátrico, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | - Javier Segovia-Cubero
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
| | - José Carlos Sánchez-Salado
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Luis Almenar-Bonet
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Marta Farrero
- Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
| | - Eduardo Zataraín
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Dolores García-Cosío
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Iris Garrido
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Eduardo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña, A Coruña, Spain; Universidade da Coruña, A Coruña, Spain
| | - Manuel Gómez-Bueno
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
| | - Javier de Juan Bagudá
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Nicolás Manito-Lorite
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Luis García-Guereta
- Servicio de Cardiología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | - Teresa Blasco-Peiró
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Luis de la Fuente-Galán
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - María Generosa Crespo-Leiro
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña, A Coruña, Spain; Universidade da Coruña, A Coruña, Spain
| | | | - Ferrán Gran-Ipiña
- Servicio de Cardiología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Beatriz Díaz-Molina
- Servicio de Cardiología, Hospital Universitario Central de Asturias, ISPA, Oviedo, Asturias, Spain
| | - Lucía Doñate
- Servicio de Cirugía Cardíaca, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - José María Arribas-Leal
- Servicio de Cirugía Cardiovascular, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Felipe Atienza
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Antonio García-Quintana
- Servicio de Cardiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Fernando Riesgo-Gil
- Cardiology Transplant Medicine, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Londres, United Kingdom
| | - Jaime Hernández-Montfort
- Advanced Heart Disease, Recovery and Replacement Programs, Baylor Scott and White Health, Central Texas and Greater Austin, United States
| | - Eva Oliver-Juan
- Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain; Servicio de Medicina Intensiva, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Sánchez-Rivas
- Organización Nacional de Trasplantes, Madrid, Spain; Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | - Eduardo Miñambres
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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11
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Moeller CM, Valledor AF, Oren D, Rubinstein G, Sayer GT, Uriel N. Evolution of Mechanical Circulatory Support for advanced heart failure. Prog Cardiovasc Dis 2024; 82:135-146. [PMID: 38242192 DOI: 10.1016/j.pcad.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Abstract
This comprehensive review highlights the significant advancements in Left Ventricular Assist Device (LVAD) therapy, emphasizing its evolution from the early pulsatile flow systems to the cutting-edge continuous-flow devices, particularly the HeartMate 3 (HM3) LVAD. These advancements have notably improved survival rates, reduced complications, and enhanced the quality of life (QoL) for patients with advanced heart failure. The dual role of LVADs, as a bridge-to-transplantation and destination therapy is discussed, highlighting the changing trends and policies in their application. The marked reduction in hemocompatibility-related adverse events (HRAE) with the HM3 LVAD, compared to previous models signifies ongoing progress in the field. Challenges such as managing major infections are discussed, including innovative solutions like energy transfer systems aimed at eliminating external drivelines. It explores various LVAD-associated complications, including HRAE, infections, hemodynamic-related adverse events, and cardiac arrhythmias, and underscores emerging strategies for predicting post-implantation outcomes, fostering a more individualized patient care approach. Tools such as the HM3 risk score are introduced for predicting survival based on pre-implant factors, along with advanced imaging techniques for improved complication prediction. Additionally, the review highlights potential new technologies and therapies in LVAD management, such as hemodynamic ramp tests for optimal speed adjustment and advanced remote monitoring systems. The goal is to automate LVAD speed adjustments based on real-time hemodynamic measurements, indicating a shift towards more effective, patient-centered therapy. The review concludes optimistically that ongoing research and potential future innovations hold the promise of revolutionizing heart failure management, paving the way for more effective and personalized treatment modalities.
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Affiliation(s)
- Cathrine M Moeller
- Division of Cardiology, Department of Medicine, Advanced Cardiac Care, Columbia University Irving Medical Center, NY, USA
| | - Andrea Fernandez Valledor
- Division of Cardiology, Department of Medicine, Advanced Cardiac Care, Columbia University Irving Medical Center, NY, USA
| | - Daniel Oren
- Division of Cardiology, Department of Medicine, Advanced Cardiac Care, Columbia University Irving Medical Center, NY, USA
| | - Gal Rubinstein
- Division of Cardiology, Department of Medicine, Advanced Cardiac Care, Columbia University Irving Medical Center, NY, USA
| | - Gabriel T Sayer
- Division of Cardiology, Department of Medicine, Advanced Cardiac Care, Columbia University Irving Medical Center, NY, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Advanced Cardiac Care, Columbia University Irving Medical Center, NY, USA.
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12
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Al-Ani MA, Bai C, Bledsoe M, Ahmed MM, Vilaro JR, Parker AM, Aranda JM, Jeng E, Shickel B, Bihorac A, Peek GJ, Bleiweis MS, Jacobs JP, Mardini MT. Utilization of the percutaneous left ventricular support as bridge to heart transplantation across the United States: In-depth UNOS database analysis. J Heart Lung Transplant 2023; 42:1597-1607. [PMID: 37307906 DOI: 10.1016/j.healun.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Intra-aortic balloon pump (IABP) and Impella device utilization as a bridge to heart transplantation (HTx) have risen exponentially. We aimed to explore the influence of device selection on HTx outcomes, considering regional practice variation. METHODS A retrospective longitudinal study was performed on a United Network for Organ Sharing (UNOS) registry dataset. We included adult patients listed for HTx between October 2018 and April 2022 as status 2, as justified by requiring IABP or Impella support. The primary end-point was successful bridging to HTx as status 2. RESULTS Of 32,806 HTx during the study period, 4178 met inclusion criteria (Impella n = 650, IABP n = 3528). Waitlist mortality increased from a nadir of 16 (in 2019) to a peak of 36 (in 2022) per thousand status 2 listed patients. Impella annual use increased from 8% in 2019 to 19% in 2021. Compared to IABP, Impella patients demonstrated higher medical acuity and lower success rate of transplantation as status 2 (92.1% vs 88.9%, p < 0.001). The IABP:Impella utilization ratio varied widely between regions, ranging from 1.77 to 21.31, with high Impella use in Southern and Western states. However, this difference was not justified by medical acuity, regional transplant volume, or waitlist time and did not correlate with waitlist mortality. CONCLUSIONS The shift in utilizing Impella as opposed to IABP did not improve waitlist outcomes. Our results suggest that clinical practice patterns beyond mere device selection determine successful bridging to HTx. There is a critical need for objective evidence to guide tMCS utilization and a paradigm shift in the UNOS allocation system to achieve equitable HTx practice across the United States.
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Affiliation(s)
- Mohammad A Al-Ani
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
| | - Chen Bai
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
| | - Maisara Bledsoe
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Mustafa M Ahmed
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Juan R Vilaro
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Alex M Parker
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Juan M Aranda
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Eric Jeng
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Benjamin Shickel
- Department of Medicine, University of Florida, Gainesville, Florida; and the Intelligent Critical Care Center (IC3), University of Florida, Gainesville, Florida
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, Florida; and the Intelligent Critical Care Center (IC3), University of Florida, Gainesville, Florida
| | - Giles J Peek
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Mark S Bleiweis
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Mamoun T Mardini
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
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13
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Chilvers N, Dark JH. Commentary: Total ventricular mass: Too much of a good thing? J Thorac Cardiovasc Surg 2023; 166:1155-1156. [PMID: 35610072 DOI: 10.1016/j.jtcvs.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Nicholas Chilvers
- Department and Institution, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John H Dark
- Department and Institution, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
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14
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Lescroart M, Coutance G. Prioritizing the Sickest Among the Sickest: A Matter of Tact and Moderation, but the Game Is Worth the Candle. Transplantation 2023; 107:1436-1437. [PMID: 36653912 DOI: 10.1097/tp.0000000000004519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Mickaël Lescroart
- Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University Medical School, Paris, France
| | - Guillaume Coutance
- Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University Medical School, Paris, France
- Paris Translational Research Centre for Organ Transplantation, Paris Center for Cardiovascular Research - PARCC, INSERM, UMR-S970, Paris, France
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15
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Daniel L, Desiré E, Lescroart M, Jehl C, Leprince P, Varnous S, Coutance G. Practical application of the French two-score heart allocation scheme: Insights from a high-volume heart transplantation centre. Arch Cardiovasc Dis 2023; 116:210-218. [PMID: 37003914 DOI: 10.1016/j.acvd.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND In 2018, a cardiac allocation scheme based on an individual score considering the risk of death both on the waitlist and after heart transplantation was implemented in France. AIMS To analyse the practical application of the pre- and post-transplant risk score in a French high-volume heart transplantation centre. METHODS All consecutive adult patients listed for a first non-combined heart transplantation between 02 January 2018 and 30 June 2022 at our centre were included. Baseline characteristics of candidates and recipients were retrieved from the national CRISTAL registry. Both scores were calculated at listing and at transplant. RESULTS Overall, 364 patients were included. During follow-up, 257 patients (70.6%) were transplanted, and 57 (15.6%) died or were removed from the waitlist. Post-transplant 3-month survival was 84.8%. Total bilirubin and natriuretic peptides had the most important weight in the pretransplant risk score. This score had a major impact on waitlist outcomes: quartile 1 was characterized by low access to heart transplantation (58.2%) and risk of death on the waitlist (9.9%) compared with quartile 4 (heart transplantation rate 74.1%, mortality on the waiting list>20%). According to the post-transplant risk score, a minimal number of candidates were considered ineligible for heart transplantation (<1%), but 12.4% were contraindicated to at least one donor category. The number of contraindicated donor categories had a significant impact on waitlist outcomes. Although adequately calibrated, the post-transplant score had a limited discrimination (area under the curve 0.65, 95% confidence interval 0.59-0.71). CONCLUSION Our results highlight the major impact of pre- and post-transplantation risk scores on waitlist outcomes following the allocation scheme update.
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Affiliation(s)
- Lucie Daniel
- Department of cardiac and thoracic surgery, cardiology Institute, Pitié-Salpêtrière hospital, Sorbonne university medical school, AP-HP, 75013 Paris, France
| | - Eva Desiré
- Department of cardiac and thoracic surgery, cardiology Institute, Pitié-Salpêtrière hospital, Sorbonne university medical school, AP-HP, 75013 Paris, France; Inserm, UMRS 1166-ICAN, Institute of cardiometabolism and nutrition, 75013 Paris, France
| | - Mickaël Lescroart
- Department of cardiac and thoracic surgery, cardiology Institute, Pitié-Salpêtrière hospital, Sorbonne university medical school, AP-HP, 75013 Paris, France
| | - Clément Jehl
- Department of cardiac and thoracic surgery, cardiology Institute, Pitié-Salpêtrière hospital, Sorbonne university medical school, AP-HP, 75013 Paris, France
| | - Pascal Leprince
- Department of cardiac and thoracic surgery, cardiology Institute, Pitié-Salpêtrière hospital, Sorbonne university medical school, AP-HP, 75013 Paris, France; Inserm, UMRS 1166-ICAN, Institute of cardiometabolism and nutrition, 75013 Paris, France
| | - Shaida Varnous
- Department of cardiac and thoracic surgery, cardiology Institute, Pitié-Salpêtrière hospital, Sorbonne university medical school, AP-HP, 75013 Paris, France
| | - Guillaume Coutance
- Department of cardiac and thoracic surgery, cardiology Institute, Pitié-Salpêtrière hospital, Sorbonne university medical school, AP-HP, 75013 Paris, France; Inserm, UMRS-970, Paris translational research centre for organ transplantation, 75015 Paris, France.
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16
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Impact of the 2018 French two-score allocation scheme on the profile of heart transplantation candidates and recipients: Insights from a high-volume centre. Arch Cardiovasc Dis 2023; 116:54-61. [PMID: 36624026 DOI: 10.1016/j.acvd.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND In 2018, a new cardiac allograft allocation scheme, based on an individual scoring system, considering the risk of death both on the waiting list and after heart transplantation, was implemented in France. AIM To assess the impact of this new scheme on the profile of transplantation candidates and recipients. METHODS In this single-centre retrospective study, we included consecutive patients listed and/or transplanted between 01 January 2012 and 30 September 2021 at La Pitié-Salpêtrière Hospital. Baseline characteristics of patients were retrieved from the national CRISTAL registry and were compared according to the type of allocation scheme (before or after 2018). RESULTS A total of 1098 newly listed transplantation candidates and 855 transplant recipients were included. One-year mortality rates after listing and after transplantation were 12.4% and 20%, respectively. At listing, the proportion of candidates on inotropes significantly declined following the scheme update (26.3 versus 20.9%; P=0.038), reflecting a change in medical practice. At transplantation, recipients had worse kidney function (estimated glomerular filtration rate<60mL/min/1.73 m2: old scheme, 29.7%; new scheme, 46.4%; P<0.001) and were more likely to be on extracorporeal membrane oxygenation support (33.5% versus 28.1%; P=0.080) under the new scheme, reflecting the prioritization of more severe patients. Outcomes after transplantation were not significantly influenced by the allocation system. CONCLUSIONS The implementation of the 2018 French allocation scheme had a limited impact on the profile of transplantation candidates, but selected more severe patients for transplantation without significant impact on outcomes after transplantation.
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Meuwese CL, Brodie D, Donker DW. The ABCDE approach to difficult weaning from venoarterial extracorporeal membrane oxygenation. Crit Care 2022; 26:216. [PMID: 35841052 PMCID: PMC9284848 DOI: 10.1186/s13054-022-04089-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractVenoarterial extracorporeal membrane oxygenation (VA ECMO) has been increasingly applied in patients with cardiogenic shock in recent years. Nevertheless, many patients cannot be successfully weaned from VA ECMO support and 1-year mortality remains high. A systematic approach could help to optimize clinical management in favor of weaning by identifying important factors in individual patients. Here, we provide an overview of pivotal factors that potentially prevent successful weaning of VA ECMO. We present this through a rigorous approach following the relatable acronym ABCDE, in order to facilitate widespread use in daily practice.
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18
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Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant-Change of Paradigm. J Clin Med 2022; 11:jcm11237101. [PMID: 36498676 PMCID: PMC9736223 DOI: 10.3390/jcm11237101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
Despite advances in medical therapy and mechanical circulatory support (MCS), heart transplant (HT) remains the gold standard therapy for end-stage heart failure. Patients in cardiogenic shock require prompt intervention to reverse hypoperfusion and end-organ damage. When medical therapy becomes insufficient, MCS should be considered. Historically, it has been reported that critically ill patients bridged with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) directly to HT have worse outcomes. However, when the heart allocation system gives the highest priority to patients on VA-ECMO support, those patients have a higher incidence of HT and a lower incidence of death or removal from the transplant list. Moreover, patients with a short waiting time on VA-ECMO have a similar hazard of mortality to non-ECMO patients. According to the reported data, bridging with VA-ECMO directly to HT may be a solution in the selection of critically ill patients when the anticipated waiting list time is short. However, when a prolonged waiting time is expected, more durable MCS should be considered. Regardless of the favorable results of the direct bridging to HT with ECMO in selected patients, the superiority of this strategy compared to the bridge-to-bridge strategy (ECMO to durable MCS) has not been established and further studies are mandatory in order to clarify this issue.
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19
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Enhanced survival prediction using explainable artificial intelligence in heart transplantation. Sci Rep 2022; 12:19525. [PMID: 36376402 PMCID: PMC9663731 DOI: 10.1038/s41598-022-23817-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
The most limiting factor in heart transplantation is the lack of donor organs. With enhanced prediction of outcome, it may be possible to increase the life-years from the organs that become available. Applications of machine learning to tabular data, typical of clinical decision support, pose the practical question of interpretation, which has technical and potential ethical implications. In particular, there is an issue of principle about the predictability of complex data and whether this is inherent in the data or strongly dependent on the choice of machine learning model, leading to the so-called accuracy-interpretability trade-off. We model 1-year mortality in heart transplantation data with a self-explaining neural network, which is benchmarked against a deep learning model on the same development data, in an external validation study with two data sets: (1) UNOS transplants in 2017-2018 (n = 4750) for which the self-explaining and deep learning models are comparable in their AUROC 0.628 [0.602,0.654] cf. 0.635 [0.609,0.662] and (2) Scandinavian transplants during 1997-2018 (n = 2293), showing good calibration with AUROCs of 0.626 [0.588,0.665] and 0.634 [0.570, 0.698], respectively, with and without missing data (n = 982). This shows that for tabular data, predictive models can be transparent and capture important nonlinearities, retaining full predictive performance.
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20
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Hwang NC, Sivathasan C. Preoperative Evaluation and Care of Heart Transplant Candidates. J Cardiothorac Vasc Anesth 2022; 36:4161-4172. [PMID: 36028377 DOI: 10.1053/j.jvca.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 11/11/2022]
Abstract
Heart transplantation is recommended for patients with advanced heart failure refractory to medical and device therapy, and who do not have absolute contraindications. When patients become eligible for heart transplantation, they undergo comprehensive evaluation and preparation to optimize their posttransplantation outcomes. This review provides an overview of the processes that are employed to enable the candidates to be transplant-ready when donor hearts are available.
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Affiliation(s)
- Nian Chih Hwang
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore.
| | - Cumaraswamy Sivathasan
- Mechanical Cardiac Support and Heart Transplant Program, Department of Cardiothoracic Surgery, National Heart Centre, Singapore
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21
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Dussault NE, Churpek MM, Parker WF. Is it too soon to abandon all hope of useful post-transplant predictions in thoracic transplantation? Reply to: Expecting the unexpected, and prioritizing the predictable. J Heart Lung Transplant 2022; 41:1304. [PMID: 35835679 PMCID: PMC9661525 DOI: 10.1016/j.healun.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nicole E Dussault
- Department of Medicine, Duke University, Raleigh-Durham, North Carolina
| | - Matthew M Churpek
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - William F Parker
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois; Department of Public Health Sciences, University of Chicago, Chicago, Illinois.
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22
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Baudry G, Coutance G, Dorent R, Bauer F, Blanchart K, Boignard A, Chabanne C, Delmas C, D'Ostrevy N, Epailly E, Gariboldi V, Gaudard P, Goéminne C, Grosjean S, Guihaire J, Guillemain R, Mattei M, Nubret K, Pattier S, Pozzi M, Rossignol P, Vermes E, Sebbag L, Girerd N. Prognosis value of Forrester's classification in advanced heart failure patients awaiting heart transplantation. ESC Heart Fail 2022; 9:3287-3297. [PMID: 35801277 DOI: 10.1002/ehf2.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/04/2022] [Accepted: 06/03/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS The value of Forrester's perfusion/congestion profiles assessed by invasive catheter evaluation in non-inotrope advanced heart failure patients listed for heart transplant (HT) is unclear. We aimed to assess the value of haemodynamic evaluation according to Forrester's profiles to predict events on the HT waitlist. METHODS AND RESULTS All non-inotrope patients (n = 837, 79% ambulatory at listing) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 with right heart catheterization (RHC) were included. The primary outcome was a combined criteria of waitlist death, delisting for aggravation, urgent HT or left ventricular assist device implantation. Secondary outcome was waitlist death. The 'warm-dry', 'cold-dry', 'warm-wet', and 'cold-wet' profiles represented 27%, 18%, 27%, and 28% of patients, respectively. At 12 months, the respective rates of primary outcome were 15%, 17%, 25%, and 29% (P = 0.008). Taking the 'warm-dry' category as reference, a significant increase in the risk of primary outcome was observed only in the 'wet' categories, irrespectively of 'warm/cold' status: hazard ratios, 1.50; 1.06-2.13; P = 0.024 in 'warm-wet' and 1.77; 1. 25-2.49; P = 0.001 in 'cold-wet'. CONCLUSIONS Haemodynamic assessment of advanced HF patients using perfusion/congestion profiles predicts the risk of the combine endpoint of waitlist death, delisting for aggravation, urgent heart transplantation, or left ventricular assist device implantation. 'Wet' patients had the worst prognosis, independently of perfusion status, thus placing special emphasis on the cardinal prominence of persistent congestion in advanced HF.
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Affiliation(s)
- Guillaume Baudry
- Department of heart failure and transplantation, Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, 69500, Bron, France.,Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Université de Lorraine, 54500, Vandoeuvre-lès-Nancy, Nancy, France
| | - Guillaume Coutance
- Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP). Sorbonne University Medical School, Paris, France
| | - Richard Dorent
- Department of Cardiac Surgery, CHU Bichat-Claude Bernard, AP-HP, Université Paris VII, 75877, Paris, France
| | - Fabrice Bauer
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Katrien Blanchart
- Department of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France
| | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Céline Chabanne
- Department of Thoracic and Cardiovascular Surgery, CHU Pontchaillou, Inserm U1099, 35000, Rennes, France
| | - Clément Delmas
- Department of Cardiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Nicolas D'Ostrevy
- Cardiology and Cardiac Surgery Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Eric Epailly
- Department of Cardiology and Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Philippe Gaudard
- Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Céline Goéminne
- Department of Cardiac Surgery, CHU Lille, Institut Coeur Poumons, Lille, France
| | - Sandrine Grosjean
- Department of Cardiology and Cardiac Surgery, University Hospital of Dijon, Dijon, France
| | - Julien Guihaire
- Department of Cardiothoracic Surgery, Marie Lannelongue Hospital, University of Paris Sud, Inserm U999 [Pulmonary Hypertension: Pathophysiology and Novel Therapies (PAH)], 92350, Le Plessis Robinson, France
| | - Romain Guillemain
- Cardiology and Cardiac Surgery Department, European Georges Pompidou Hospital, Paris, France
| | - Mathieu Mattei
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Karine Nubret
- Department of Thoracic and Cardiovascular Surgery, Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Sabine Pattier
- Department of Cardiology and Heart Transplantation Unit, CHU de Nantes, Nantes, France
| | - Matteo Pozzi
- Department of heart failure and transplantation, Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, 69500, Bron, France
| | - Patrick Rossignol
- Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Université de Lorraine, 54500, Vandoeuvre-lès-Nancy, Nancy, France
| | - Emmanuelle Vermes
- Cardiothoracic Surgery Department, Tours University Hospital, Tours, France
| | - Laurent Sebbag
- Department of heart failure and transplantation, Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, 69500, Bron, France
| | - Nicolas Girerd
- Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Université de Lorraine, 54500, Vandoeuvre-lès-Nancy, Nancy, France
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23
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Heart Transplantation, Either Alone or Combined With Liver and Kidney, a Viable Treatment Option for Selected Patients With Severe Cardiac Amyloidosis. Transplant Direct 2022; 8:e1323. [PMID: 35747521 PMCID: PMC9208885 DOI: 10.1097/txd.0000000000001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022] Open
Abstract
Heart transplantation in cardiac amyloidosis (CA) patients is possible and generally considered for transplantation if other organs are not affected. In this study, we aimed to describe and assess outcome in patients following heart transplantations at our CA referral center. Methods We assessed all CA patients that had heart transplantations at our center between 2005 and 2018. Patients with New York Heart Association status 3 out of 4, with poor short-term prognosis due to heart failure, despite treatment, and without multiple myeloma, systemic disease, severe neuropathic/digestive comorbidities, cancer, or worsening infections were eligible for transplantation. Hearts were transplanted by bicaval technique. Standard induction and immunosuppressive therapies were used. Survival outcome of CA patients after transplantation was compared with recipients with nonamyloid pathologies in France. Results Between 2005 and 2018, 23 CA patients had heart transplants: 17 (74%) had light chain (light chain amyloidosis [AL]) and 6 (26%) had hereditary transthyretin (hereditary transthyretin amyloidosis [ATTRv]) CA. Also, 13 (57%) were male, and the mean age at diagnosis was 56.5 y (range, 47.7-62.8). Among AL patients, 13 had heart-only and 5 had heart-kidney transplantations. Among ATTRv patients, 1 had heart-only and 5 had heart-liver transplantations. The 1-y survival rate after transplantation was 78%, 70% with AL, and 100% with ATTRv. At 2 y, 74% were alive: 65% with AL and 100% with ATTRv. Conclusion After heart transplantation, French CA and nonamyloid patients have similar survival outcomes. Among CA patients, ATTRv patients have better prognosis than those with AL, possibly due to the combined heart-liver transplantation. Selected CA patients should be considered for heart transplantations.
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24
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Outcome of primary graft dysfunction rescued by venoarterial extracorporeal membrane oxygenation after heart transplantation. Arch Cardiovasc Dis 2022; 115:426-435. [DOI: 10.1016/j.acvd.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022]
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25
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Crespo-Leiro MG, Costanzo MR, Gustafsson F, Khush KK, Macdonald PS, Potena L, Stehlik J, Zuckermann A, Mehra MR. Heart transplantation: focus on donor recovery strategies, left ventricular assist devices, and novel therapies. Eur Heart J 2022; 43:2237-2246. [PMID: 35441654 DOI: 10.1093/eurheartj/ehac204] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 04/06/2022] [Indexed: 12/18/2022] Open
Abstract
Heart transplantation is advocated in selected patients with advanced heart failure in the absence of contraindications. Principal challenges in heart transplantation centre around an insufficient and underutilized donor organ pool, the need to individualize titration of immunosuppressive therapy, and to minimize late complications such as cardiac allograft vasculopathy, malignancy, and renal dysfunction. Advances have served to increase the organ donor pool by advocating the use of donors with underlying hepatitis C virus infection and by expanding the donor source to use hearts donated after circulatory death. New techniques to preserve the donor heart over prolonged ischaemic times, and enabling longer transport times in a safe manner, have been introduced. Mechanical circulatory support as a bridge to transplantation has allowed patients with advanced heart failure to avoid progressive deterioration in hepato-renal function while awaiting an optimal donor organ match. The management of the heart transplantation recipient remains a challenge despite advances in immunosuppression, which provide early gains in rejection avoidance but are associated with infections and late-outcome challenges. In this article, we review contemporary advances and challenges in this field to focus on donor recovery strategies, left ventricular assist devices, and immunosuppressive monitoring therapies with the potential to enhance outcomes. We also describe opportunities for future discovery to include a renewed focus on long-term survival, which continues to be an area that is under-studied and poorly characterized, non-human sources of organs for transplantation including xenotransplantation as well as chimeric transplantation, and technology competitive to human heart transplantation, such as tissue engineering.
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Affiliation(s)
- Maria Generosa Crespo-Leiro
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomedica A Coruña (INIBIC), Centro de Investigacion Biomedica en Red Cardiovascular (CIBERCV), As Xubias 84, 15006 A Coruña, Spain
| | | | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Mandeep R Mehra
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
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26
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Gökler J, Aliabadi-Zuckermann A, Zuckermann A, Osorio E, Knobler R, Moayedifar R, Angleitner P, Leitner G, Laufer G, Worel N. Extracorporeal Photopheresis With Low-Dose Immunosuppression in High-Risk Heart Transplant Patients-A Pilot Study. Transpl Int 2022; 35:10320. [PMID: 35401042 PMCID: PMC8983826 DOI: 10.3389/ti.2022.10320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/11/2022] [Indexed: 11/16/2022]
Abstract
In severely ill patients undergoing urgent heart transplant (HTX), immunosuppression carries high risks of infection, malignancy, and death. Low-dose immunosuppressive protocols have higher rejection rates. We combined extracorporeal photopheresis (ECP), an established therapy for acute rejection, with reduced-intensity immunosuppression. Twenty-eight high-risk patients (13 with high risk of infection due to infection at the time of transplant, 7 bridging to transplant via extracorporeal membrane oxygenation, 8 with high risk of malignancy) were treated, without induction therapy. Prophylactic ECP for 6 months (24 procedures) was initiated immediately postoperatively. Immunosuppression consisted of low-dose tacrolimus (8–10 ng/ml, months 1–6; 5–8 ng/ml, >6 months) with delayed start; mycophenolate mofetil (MMF); and low maintenance steroid with delayed start (POD 7) and tapering in the first year. One-year survival was 88.5%. Three patients died from infection (POD 12, 51, 351), and one from recurrence of cancer (POD 400). Incidence of severe infection was 17.9% (n = 5, respiratory tract). Within the first year, antibody-mediated rejection was detected in one patient (3.6%) and acute cellular rejection in four (14.3%). ECP with reduced-intensity immunosuppression is safe and effective in avoiding allograft rejection in HTX recipients with risk of severe infection or cancer recurrence.
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Affiliation(s)
- Johannes Gökler
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Emilio Osorio
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Robert Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Roxana Moayedifar
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Philipp Angleitner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerda Leitner
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Nina Worel
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
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27
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Baran DA, Jaiswal A, Hennig F, Potapov E. Temporary Mechanical Circulatory Support: Devices, Outcomes and Future Directions. J Heart Lung Transplant 2022; 41:678-691. [DOI: 10.1016/j.healun.2022.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/15/2022] [Accepted: 03/22/2022] [Indexed: 12/22/2022] Open
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28
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Hascoët S, Pontailler M, Le Pavec J, Savale L, Mercier O, Fabre D, Mussot S, Simonneau G, Jais X, Feuillet S, Stephan F, Cohen S, Bonnet D, Humbert M, Dartevelle P, Fadel E. Transplantation for pulmonary arterial hypertension with congenital heart disease: Impact on outcomes of the current therapeutic approach including a high-priority allocation program. Am J Transplant 2021; 21:3388-3400. [PMID: 33844424 DOI: 10.1111/ajt.16600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 01/25/2023]
Abstract
Patients with end-stage pulmonary arterial hypertension due to congenital heart disease have limited access to heart-lung transplantation or double-lung transplantation. We aimed to assess the effects of a high-priority allocation program established in France in 2007. We conducted a retrospective study to compare waitlist and posttransplantation outcomes before versus after implementation of the high-priority allocation program. We included 67 consecutive patients (mean age at listing, 33.2 ± 10.5 years) with pulmonary arterial hypertension due to congenital heart disease listed for heart-lung transplantation or double-lung transplantation from 1997 to 2016. At one month, the incidences of transplantation and death before transplantation were 3.5% and 24.6% in 1997-2006, 4.8% and 4.9% for patients on the regular list in 2007-2016, and 41.2% and 7.4% for patients listed under the high-priority allocation program (p < .001 and p = .0001, respectively). Overall survival was higher in patients listed in 2007-2016 (84.2% and 61.2% at 1 and 10 years vs. 36.8% and 22.1%, p = .0001). Increased incidence of transplantation, decreased waiting list mortality, and improved early and long-term outcomes were observed in patients with pulmonary arterial hypertension due to congenital heart disease listed for transplantation in the recent era, characterized by implementation of a high-priority allocation program.
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Affiliation(s)
- Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France.,UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France
| | - Margaux Pontailler
- Department of Congenital Heart Diseases, Centre de référence Malformations Cardiaques Congénitales Complexes M3C, Centre de Compétence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Universitaire Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jérôme Le Pavec
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Laurent Savale
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Pulmonology, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Olaf Mercier
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Dominique Fabre
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Sacha Mussot
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Gérald Simonneau
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Pulmonology, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Xavier Jais
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Pulmonology, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Séverine Feuillet
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Francois Stephan
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Sarah Cohen
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France
| | - Damien Bonnet
- Department of Congenital Heart Diseases, Centre de référence Malformations Cardiaques Congénitales Complexes M3C, Centre de Compétence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Universitaire Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Marc Humbert
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Pulmonology, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Philippe Dartevelle
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Elie Fadel
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
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29
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Miller PE, Mullan CW, Chouairi F, Sen S, Clark KA, Reinhardt S, Fuery M, Anwer M, Geirsson A, Formica R, Rogers JG, Desai NR, Ahmad T. Mechanical ventilation at the time of heart transplantation and associations with clinical outcomes. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:843-851. [PMID: 34389855 DOI: 10.1093/ehjacc/zuab063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/25/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022]
Abstract
AIMS The impact of mechanical ventilation (MV) at the time of heart transplantation is not well understood. In addition, MV was recently removed as a criterion from the new US heart transplantation allocation system. We sought to assess for the association between MV at transplantation and 1-year mortality. METHODS AND RESULTS We utilized the United Network for Organ Sharing database and included all adult, single organ heart transplantations from 1990 to 2019. We utilized multivariable logistic regression adjusting for demographics, comorbidities, and markers of clinical acuity. We identified 60 980 patients who underwent heart transplantation, 2.4% (n = 1431) of which required MV at transplantation. Ventilated patients were more likely to require temporary mechanical support, previous dialysis, and had a shorter median waitlist time (21 vs. 95 days, P < 0.001). At 1 year, the mortality was 33.7% (n = 484) for ventilated patients and 11.7% (n = 6967) for those not ventilated at the time of transplantation (log-rank P < 0.001). After multivariable adjustment, patients requiring MV continued to have a substantially higher 90-day [odds ratio (OR) 3.20, 95% confidence interval (CI): 2.79-3.66, P < 0.001] and 1-year mortality (OR 2.67, 95% CI: 2.36-3.03, P < 0.001). For those that survived to 90 days, the adjusted mortality at 1 year continued to be higher (OR 1.48, 95% CI: 1.16-1.89, P = 0.002). CONCLUSION We found a strong association between the presence of MV at heart transplantation and 90-day and 1-year mortality. Future studies are needed to identify which patients requiring MV have reasonable outcomes, and which are associated with substantially poorer outcomes.
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Affiliation(s)
- P Elliott Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.,Yale National Clinicians Scholar Program, New Haven, CT, USA
| | - Clancy W Mullan
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Fouad Chouairi
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sounok Sen
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Katherine A Clark
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Samuel Reinhardt
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael Fuery
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Muhammad Anwer
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Richard Formica
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA.,Section of Nephrology, Yale School of Medicine, New Haven, CT, USA
| | - Joseph G Rogers
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
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30
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Montisci A, Donatelli F, Cirri S, Coscioni E, Maiello C, Napoli C. Veno-arterial Extracorporeal Membrane Oxygenation as Bridge to Heart Transplantation: The Way Forward. Transplant Direct 2021; 7:e720. [PMID: 34258387 PMCID: PMC8270578 DOI: 10.1097/txd.0000000000001172] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/19/2022] Open
Abstract
Advanced heart failure (HF) represents a public health priority due to the increase of affected patients and the meaningful mortality. Durable mechanical circulatory support (MCS) and heart transplantation (HTx) are unique therapies for end-stage HF (ESHF), with positive early and long-term outcomes. The patients who underwent HTx have a 1-y survival of 91% and a median survival of 12-13 y, whereas the median survival of ESHF is <12 mo. Short-term MCS with veno-arterial extracorporeal membrane oxygenation (VA ECMO) can be used as a bridge to transplantation strategy. Patients bridged with VA ECMO have significantly lower survival in comparison with non-MCS bridged and left ventricular assist device-bridged patients. VA ECMO represents an effective, and sometimes unique, system to obtain rapid hemodynamic stabilization, but possible negative effects on patients' outcomes after HTx must be considered. Here, we discuss the use of VA ECMO as bridge to transplantation.
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Affiliation(s)
- Andrea Montisci
- Department of Anesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, Milan, Italy
| | - Francesco Donatelli
- Department of Cardiac Surgery, Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Silvia Cirri
- Department of Anesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, Milan, Italy
| | - Enrico Coscioni
- Department of Cardiac Surgery, AOU San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Ciro Maiello
- Cardiac Transplantation Unit, Department of Cardiac Surgery and Transplantation, Ospedali dei Colli, Naples, Italy
| | - Claudio Napoli
- Clinical Department of Internal Medicine and Specialistic Units, Regional Referring Centre for Clinical Immunology of Organ Transplantation (LIT), University Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
- IRCCS-SDN, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
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31
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Gaudriot B, Mansour A, Thibault V, Lederlin M, Cauchois A, Lelong B, Ross JT, Leurent G, Tadié JM, Revest M, Verhoye JP, Flecher E, Nesseler N. Successful heart transplantation for COVID-19-associated post-infectious fulminant myocarditis. ESC Heart Fail 2021; 8:2625-2630. [PMID: 33934560 PMCID: PMC8239812 DOI: 10.1002/ehf2.13326] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 12/19/2022] Open
Abstract
Various clinical presentations of the 2019 coronavirus disease (COVID‐19) have been described, including post‐infectious acute and fulminant myocarditis. Here, we describe the case of a young patient admitted for COVID‐19‐associated post‐infectious fulminant myocarditis. Despite optimal pharmacologic management, haemodynamic status worsened requiring support by veno‐arterial extracorporeal membrane oxygenation. Emergent heart transplantation was required at Day 11 given the absence of cardiac function improvement. The diagnosis of post‐infectious COVID‐19‐associated myocarditis was made from both pathologic examination of the explanted heart and positive SARS‐CoV‐2 serology.
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Affiliation(s)
- Baptiste Gaudriot
- Department of Anesthesia and Critical Care, University Hospital of Rennes, Rennes, F-35000, France
| | - Alexandre Mansour
- Department of Anesthesia and Critical Care, University Hospital of Rennes, Rennes, F-35000, France.,Univ Rennes, CHU de Rennes, Rennes, France
| | - Vincent Thibault
- Univ Rennes, CHU de Rennes, Rennes, France.,Department of Virology, University Hospital of Rennes, Rennes, France
| | - Mathieu Lederlin
- Univ Rennes, CHU de Rennes, Rennes, France.,Department of Radiology, University Hospital of Rennes, Rennes, France
| | - Aurélie Cauchois
- Department of Pathology, University Hospital of Rennes, Rennes, France
| | - Bernard Lelong
- Department of Cardiology, University Hospital of Rennes, Rennes, France
| | - James T Ross
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Guillaume Leurent
- Department of Cardiology, University Hospital of Rennes, Rennes, France
| | - Jean-Marc Tadié
- Univ Rennes, CHU de Rennes, Rennes, France.,Infectious Diseases and Intensive Care Unit, University Hospital of Rennes, Rennes, France
| | - Matthieu Revest
- Univ Rennes, CHU de Rennes, Rennes, France.,Infectious Diseases and Intensive Care Unit, University Hospital of Rennes, Rennes, France
| | - Jean-Philippe Verhoye
- Univ Rennes, CHU de Rennes, Rennes, France.,Thoracic and Cardiovascular Surgery, University Hospital of Rennes, University of Rennes 1, LTSI, National Institute of Health and Medical Research U1099, Rennes, France
| | - Erwan Flecher
- Univ Rennes, CHU de Rennes, Rennes, France.,Thoracic and Cardiovascular Surgery, University Hospital of Rennes, University of Rennes 1, LTSI, National Institute of Health and Medical Research U1099, Rennes, France
| | - Nicolas Nesseler
- Department of Anesthesia and Critical Care, University Hospital of Rennes, Rennes, F-35000, France.,Univ Rennes, CHU de Rennes, Inra, Inserm, Institut NUMECAN - UMR_A 1341, UMR_S 1241, Rennes, France.,Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France
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32
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Bayer F, Audry B, Antoine C, Jasseron C, Legeai C, Bastien O, Jacquelinet C. Removing administrative boundaries using a gravity model for a national liver allocation system. Am J Transplant 2021; 21:1080-1091. [PMID: 32659870 DOI: 10.1111/ajt.16214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 01/25/2023]
Abstract
Geographic disparities emerged as an increasing issue in organ allocation policies. Because of the sequential and discrete geographical models used for allocation scores, artificial regional boundaries may impede the access of candidates with the greatest medical urgency to vital organs. This article describes a continuous geographical allocation model that provides accurate organ access by introducing a multiplicative interaction between the patient's condition and the distance to the graft by using a gravity model. Patients with the most urgent need will thus have access to organs from farther away, while those in less urgent need may only have access to organs geographically closer. Compared to the previous French liver allocation scheme, the gravity model precluded transplantations for candidates with a Model for End-Stage Liver Disease (MELD) ≤ 14 for decompensated cirrhosis from 10.3% to 0.6%. Death and delisting while on the waiting list at 1 year also decreased from 30.1% to 22.4% for MELD ≥ 35. Waiting list (cumulative hazard ratio (CHR) 0.84 after adjustment) and posttransplant survival improved significantly (hazard ratio = 0.83 after adjustment). This new liver allocation system provides more equitable access to liver transplants and an efficient and safe alternative to administrative boundaries for geographical models in organ allocation.
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Affiliation(s)
- Florian Bayer
- Agence de la Biomédecine, Medical and Scientific Department, Simulation and Health Geography Units, Saint-Denis La Plaine cedex, France
| | - Benoît Audry
- Agence de la Biomédecine, Medical and Scientific Department, Simulation and Health Geography Units, Saint-Denis La Plaine cedex, France
| | - Corinne Antoine
- Agence de la Biomédecine, Direction générale médicale et scientifique, Direction Prélèvement Greffe Organes - Tissus, Pôle Stratégie Prélèvement Greffe, Saint-Denis-la-Plaine cedex, France
| | - Carine Jasseron
- Agence de la Biomédecine, Direction générale médicale et scientifique, Direction Prélèvement Greffe Organes - Tissus, Pôle Evaluation - Biostatistique, Saint-Denis-la-Plaine cedex, France
| | - Camille Legeai
- Agence de la Biomédecine, Direction générale médicale et scientifique, Direction Prélèvement Greffe Organes - Tissus, Pôle Evaluation - Biostatistique, Saint-Denis-la-Plaine cedex, France
| | - Olivier Bastien
- Agence de la Biomédecine, Medical and Scientific Department, Simulation and Health Geography Units, Saint-Denis La Plaine cedex, France
| | - Christian Jacquelinet
- Agence de la Biomédecine, Medical and Scientific Department, Simulation and Health Geography Units, Saint-Denis La Plaine cedex, France.,Inserm U1018, CESP, Villejuif, France
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33
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Coutance G, Kransdorf E, Bonnet G, Loupy A, Kobashigawa J, Patel JK. Statistical performance of 16 posttransplant risk scores in a contemporary cohort of heart transplant recipients. Am J Transplant 2021; 21:645-656. [PMID: 32713121 DOI: 10.1111/ajt.16217] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 01/25/2023]
Abstract
Accurate risk stratification of early heart transplant failure is required to avoid futile transplants and rationalize donor selection. We aimed to evaluate the statistical performance of existing risk scores on a contemporary cohort of heart transplant recipients. After an exhaustive search, we identified 16 relevant risk scores. From the UNOS database, we selected all first noncombined adult heart transplants performed between 2014 and 2017 for validation. The primary endpoint was death or retransplant during the first year posttransplant. For all scores, we analyzed their association with outcomes, sensitivity, specificity, likelihood ratios, and discrimination (concordance index and overlap of individual scores). The cohort included 9396 patients. All scores were significantly associated with the primary outcome (P < .001 for all scores). Their likelihood ratios, both negative and positive, were poor. The discriminative performance of all scores was limited, with concordance index ranging from 0.544 to 0.646 (median 0.594) and an important overlap of individual scores between patients with or without the primary endpoint. Subgroup analyses revealed important variation in discrimination according to donor age, recipient age, and the type of assist device used at transplant. Our findings raise concerns about the use of currently available scores in the clinical field.
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Affiliation(s)
- Guillaume Coutance
- Department of Cardiology, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA.,Paris Translational Research Centre for Organ Transplantation, Université de Paris, INSERM UMR 970, Paris, France
| | - Evan Kransdorf
- Department of Cardiology, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Guillaume Bonnet
- Paris Translational Research Centre for Organ Transplantation, Université de Paris, INSERM UMR 970, Paris, France
| | - Alexandre Loupy
- Paris Translational Research Centre for Organ Transplantation, Université de Paris, INSERM UMR 970, Paris, France
| | - Jon Kobashigawa
- Department of Cardiology, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Jignesh K Patel
- Department of Cardiology, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
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34
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Kumar A, Bonnell LN, Prikis M, Solomon R. Impact of age mismatch between donor and recipient on heart transplant mortality. Clin Transplant 2020; 35:e14194. [PMID: 33336373 DOI: 10.1111/ctr.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
The effect of donor-to-recipient (D-R) age mismatch in adult heart transplant population is not clearly described, and we undertook this study to determine the impact of age mismatch on mortality. Heart transplant recipients from 2000 to 2017 were identified using the United Network of Organ Sharing database. The cohort was divided into three groups: donor age within 5 years of recipient age (Group 1), donors >5 years younger than recipient (group 2), and donors >5 years older than recipients (Group 3). We also evaluated if this finding changed by recipient age. Twenty eight thousand, four hundred and eleven patients met the inclusion criteria. Compared to group 1, the adjusted hazard ratio (aHR) for mortality for group 2 was 0.91 (0.83-0.99, p value <.039) and for group 3 was 1.36 (1.21-1.52, p value <.001); however, when looking at recipient age as continuous variable, receiving a younger heart was protective only for recipients younger than 45 years of age, and receiving a heart transplant from an older donor was detrimental only in recipients aged 25-35.
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Affiliation(s)
- Abhishek Kumar
- Department of Internal Medicine, University of Vermont, Burlington, VT, USA
| | - Levi N Bonnell
- Department of General Internal Medicine Research, University of Vermont, Burlington, VT, USA
| | - Marios Prikis
- Department of Internal Medicine, University of Vermont, Burlington, VT, USA
| | - Richard Solomon
- Department of Internal Medicine, University of Vermont, Burlington, VT, USA
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35
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Affiliation(s)
- Monica M Colvin
- Cardiovascular Division, Advanced Heart Failure and Transplantation, Michigan Medicine/University of Michigan (M.M.C.)
| | - Donna M Mancini
- Cardiovascular Division, Advanced Heart Failure and Transplantation, Mount Sinai Health System (D.M.M.)
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