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Pulmonary Hypertension Council Year in Review

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Robert Frantz, MD
Council Chair

The field of pulmonary hypertension crosses multiple disciplines in a fashion that impressively mirrors the broad interests, expertise, and perspectives of the membership of ISHLT. Pulmonary hypertension and right ventricular failure influence prognosis of left heart failure, parenchymal lung disease, mechanical circulatory support, and outcome of heart and lung transplantation. Lung transplantation is a critical therapeutic option in pulmonary arterial hypertension, yet lung transplantation in pulmonary arterial hypertension entails unique challenges, and the Lung Allocation Score as it pertains to PAH remains imperfect. These realities represent both challenges and opportunities for ISHLT to further the understanding and management of many forms of pulmonary hypertension. In this distillation of the PH Council Report to the ISHLT Board that was presented in Montreal, I will strive to convey the progress and future directions of the PH Council for the year ahead.

The Pulmonary Hypertension Council has had another highly successful year, further solidifying the reputation of ISHLT as an outstanding venue for pulmonary hypertension content. The Montreal meeting provided a tour de force of symposia, plenary presentations, sunrise sessions and poster sessions that energized, informed and challenged the attendees to keep pushing the science forward.

In the ongoing efforts to foster solid basic science and translational research within ISHLT, Dr. Marlene Rabinovitch (Stanford University) gave a Plenary session presentation entitled "BMPR2: From Mutation to Modulation" that enhanced our understanding of the role of this pathway not only in familial PAH but in other forms of PAH. Multiple other symposia had a remarkably international and multidisciplinary array of speakers and topics, including symposia on medical and surgical approaches to chronic thromboembolic pulmonary hypertension, perioperative management of the right ventricle during lung transplantation, the role of right heart catheterization in MCS patients, and proteomics and inflammatory pathways in PAH.

PH Council successes for the past year include an important analysis of predictors of lung transplant waiting list survival in PAH patients utilizing data from the Scientific Registry of Transplant Recipients (SRTR) spearheaded by PH Council Vice Chair Dr. Mardi Gomberg-Maitland (University of Chicago), and presented in a Plenary session in Montreal. A new survival equation was developed and validated using boot-strap methodology, and outperformed the existing LAS equation. Such initiatives are having a direct impact on improving lung allocation strategies to ensure that those patients most in need receive these precious organs.

The PH Council has also proposed a Pulmonary Hypertension Masters Academy for San Diego in 2014. A comprehensive curriculum has been developed under the able guidance of PH Council Education Workforce Leader Dana McGlothlin MD (San Francisco) that addresses the educational needs of the ISHLT membership with regard to pulmonary hypertension ranging across multiple fields (PAH, PH with left heart or lung disease, mechanical support options, peri-transplant management).

An additional important initiative put forth by Teresa DeMarco MD (San Francisco) is intended to extend deliberations at the 2013 Nice WHO Pulmonary Hypertension Symposium with particular regard to WHO Group II PH (with Left heart disease). This cooperative initiative is intended to develop additional documents and research with regard to hemodynamic evaluation and predictors of outcome of heart transplant and MCS in the context of Group II PH.

I2C2 initiatives include working with Pulmonary Vascular Research Institute (PVRI) on collaborative efforts including a proposed joint ISHLT/PVRI symposium in Bad-Nauheim, Germany in 2014.

The outlook for pulmonary hypertension initiatives and educational excellence within ISHLT is as bright as ever, with an increasingly collaborative approach across ISHLT councils. All are welcome to join in the collegial and productive atmosphere of the pulmonary hypertension corner of ISHLT!

Disclosure Statement: The author has no conflicts of interest to disclose