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Fernandez Valledor A, Moeller CM, Rubinstein G, Oren D, Rahman S, Baranowska J, Lee C, Lorenzatti D, Righini FM, Lotan D, Sayer GT, Uriel N. Durable left ventricular assist devices as a bridge to transplantation: what to expect along the way? Expert Rev Med Devices 2024; 21:829-840. [PMID: 39169616 DOI: 10.1080/17434440.2024.2393344] [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: 01/11/2024] [Revised: 07/28/2024] [Accepted: 08/13/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION The scarcity of donors coupled with the improvements in left ventricular assist devices (LVAD) technology has led to the use of LVAD as a bridge to transplantation (BTT). AREAS COVERED The authors provide an overview of the current status of LVAD BTT implantation with special focus ranging from patient selection and pre-implantation optimization to post-transplant outcomes. EXPERT OPINION 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.
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Affiliation(s)
- Andrea Fernandez Valledor
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Cathrine M Moeller
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Gal Rubinstein
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel Oren
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Salwa Rahman
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Julia Baranowska
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Changhee Lee
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel Lorenzatti
- Division of Cardiology, Montefiore Medical Center. Albert Einstein College of Medicine, New York, NY, USA
| | - Francesca Maria Righini
- Division of Cardiology, Department of Medical Biotechnologies, University of Sienna, Toscana, Italy
| | - Dor Lotan
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Gabriel T Sayer
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Nir Uriel
- Division of Cardiology, Advanced Cardiac Care, Columbia University Irving Medical Center, New York, NY, USA
- Division of Cardiology, Weill Cornell Medicine, New York, NY, USA
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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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Brahmbhatt DH, Blitzer D, Billia F, Copeland H. Acute complication posttransplant: primary allograft dysfunction. Curr Opin Organ Transplant 2023; 28:376-383. [PMID: 37678172 DOI: 10.1097/mot.0000000000001091] [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: 09/09/2023]
Abstract
PURPOSE OF REVIEW Heart transplant is the gold standard treatment for patients with end-stage heart failure, improving both quality of life and survival. Despite advances in donor and recipient management, primary graft dysfunction (PGD) remains the most common cause of morbidity and mortality in the early posttransplant period. This review summarizes recent discoveries in the underlying pathophysiology, risk prediction and management of PGD. RECENT FINDINGS The incidence of PGD appears to be rising and it is not clear whether this is due to better recognition or secular changes in transplant practice. The utilization of donation after circulatory death organs for transplant is a further consideration for the development of PGD. Organ transport systems and preservation techniques may help to prevent PGD. As some of the risk factors for developing PGD remain modifiable, we summarize the current evidence for prevention and management of PGD. SUMMARY A better understanding will allow us to appropriately manage donors and recipients to reduce the complex interactions that lead to PGD. The development of an international consortium provides the opportunity for deep phenotyping and development of contemporary risk prediction models for PGD, which may reduce the incidence and consequent early mortality associated with heart transplantation.
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Affiliation(s)
- Darshan H Brahmbhatt
- Division of Cardiology, Department of Medicine, University of Toronto
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - David Blitzer
- Department of Surgery, Division of Cardiovascular Surgery, Columbia University, New York, New York
| | - Filio Billia
- Division of Cardiology, Department of Medicine, University of Toronto
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Hannah Copeland
- Lutheran Hospital
- Indiana University School of Medicine - Fort Wayne, Fort Wayne, Indiana, USA
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