THIS MONTH'S FOCUS:
MECHANICAL CIRCULATORY SUPPORT &
Many thanks to Emily Stimpson and Tereza Martinu for coordinating the content for this month's issue.
VINCENT'S VERITABLE SENSE:
This issue is all about getting to the truth. Science, the systematized knowledge that has been accumulated through observation, experimentation and reasoning, mandates truthfulness of the answers from testable hypotheses. In this month's Spotlight, we have our fine, energetic, resourceful, creative and truly European President's 100 Days and Program Chair's Quarterly Report, respectively. The venue in Nice is shaping up nicely. Their challenge is to assure us that the ISHLT sessions will keep our attention away from the French Riviera. Pamela Combs explains to us that VAD programs drive on with bioengineering students aboard. We are given an overview of the necessary pharmacotherapy of right ventricular failure in LVADs by Roy Lee. We are swiftly accumulating more data on the importance of Tregs and Ex vivo lung perfusion to the point we must start asking the practical and proper questions. Rebecca Shilling updates us about Tregs in lung transplantation and the promise of potentially ONE truth or the truth of ONE. Marcelo Cypel, Dirk Van Raemdonck, and Shaf Keshavjee keep us aboard the freight train on what we think is the proper path from where we are to what's next with ex vivo lung perfusion? Hopefully, the rails remain in place and we don't steam ahead without tracks. Bryan Boling and Katie Burns move us forward with ambulatory ECMO and share with us how safe it can be especially for those resistant to change and afraid to pursue such an endeavor. Erin Schumer shows us how an ISHLT International Traveling Scholarship Award provided her the opportunity to journey across the ocean to advance research on the biohybrid lung project. Finally, with a nod to our upcoming meeting in France and the dignity and grace of a pirouette in ballet we round out this issue with Tereza Martinu's adieu to Duke's Schwartz Center Rounds that grounds us in the truth and humanity of what's best for our patients.
Vincent Valentine, MD
IN THE SPOTLIGHT:
ISHLT President's Report: The First 100 Days in Office
by Hermann Reichenspurner, MD, PhD
So far, I have really enjoyed my first 100 days in office! Although my email-inbox volume increased by about 200%, I still enjoy reading them. However, I have noticed a marked change in the job since Cape Town in the late 80's, when I watched my former chief, Bruno Reichart, become President of the ISHLT. At that time, there were no emails, only some occasional phone calls or letters. Now, I receive emails at 2 a.m. in the morning and another three hours later wondering why I have not responded yet. Ideally, an ISHLT president should work simultaneously at all different time zones. I am sure that Allan Glanville can report on this as well, from his time in office, working from Sydney, Australia last year. Read more →
Program Chair's First Quarter Report
by Andreas Zuckermann, MD
What makes a good program chair? I asked myself this question a thousand times before the board officially appointed me. You never know if, or when, you may be selected for this job. Fortunately, I got the call from the incoming president way ahead of the meeting; January 2013. This is important, as you need to plan your private life as well as your normal working life at the university. Read more →
MECHANICAL CIRCULATORY SUPPORT:
VAD Programs Driving Ahead with the Inclusion of Bioengineering Students
by Pamela Combs
Due to a significant improvement in survival rates following implantation of ventricular assist devices (VADs), the number of patients with implanted VADs has increased considerably. Considering this increase in implants, the VAD team composition is evolving into a mixture that includes other members besides cardiologists, surgeons, VAD Coordinators, and perfusionists. This brief discussion will describe the three key factors to consider when transitioning a Bioengineering student into the VAD program in order to add to the program's "wholeness." Read more →
Brief Overview of Pharmacotherapy of Right Ventricular Failure in LVADs
by Roy Lee
Until recently, patients with advanced heart failure had few options other than cardiac transplantation. With advances in left ventricular assist devices (LVAD), however, these patients now have a viable, long-term alternative with the HeartMate II and Heartware. Unfortunately, right ventricular failure (RVF) is a common complication following implantation of an LVAD and can be associated with increased morbidity and mortality. The incidence of RVF post-implantation has been reported to be between 20%-50%. Risk factors include both patient characteristics and hemodynamic parameters, but definitive risk factors are unknown. Some risk factors may include gender, underlying disease state, increased central venous pressure (CVP), decreased right ventricular (RV) stroke work index, pulmonary hypertension, and signs of end organ damage. Read more →
Pirouetting with Humanity in Lung Transplantation
by Tereza Martinu, with contributions from Lynn Bowlby, MD, Shane Nolan, Lynn O'Neill, MD and Bill Taub
This text is from a recent session of Schwartz Center Rounds®, entitled There and Back Again: A Transplant Journey, which took place at Duke University Medical Center on July 9, 2014. Schwartz Center Rounds is a monthly interdisciplinary conference offering clinicians a regularly scheduled time during their fast-paced work lives to openly and honestly discuss social and emotional issues that arise in caring for patients. Schwartz Center Rounds began at Duke University in September 2012 and has generated a tremendous response from participants. An initiative of the Schwartz Center for Compassionate Healthcare, the rounds take place at 320 sites in the U.S. and U.K. including Massachusetts General Hospital, Brigham & Women's, Vanderbilt, Mount Sinai, Emory, Cleveland Clinic, UNC-Chapel Hill, and Duke University Medical Center. Read more →
Are Tregs the ONE for Lung Transplantation?
by Rebecca Shilling
The balance between infection and immunosuppression is never trickier than with the organ responsible for filtering the air we breathe and for oxygenating the body. Is it possible to flip the balance back to homeostasis and away from constant immune suppression? The normal immune homeostasis of the lung involves multiple regulatory mechanisms, from multiple cell types that are only beginning to be understood. One major mechanism is CD4+ T regulatory cells (Tregs), characterized by expression of the transcription factor Foxp3. Tregs are able to prevent activation of other T cells and are necessary to avoid autoimmunity. They are known to prevent, or delay rejection in solid organ transplant models and have been associated with improved outcomes after human lung transplant. Data from mouse models also suggest Tregs may be beneficial for inducing tolerance to lung allografts. Could they be used as therapy for human transplant recipients? The ONE Study, funded by the European Commission's Seventh Framework, hopes to start answering this important question. Read more →
Ex Vivo Lung Perfusion: Where are We ... and What's Next?
by Marcelo Cypel, Dirk Van Raemdonck, and Shaf Keshavjee
Since the inception of the first successful clinical lung transplantation in Toronto in 1983, very few innovations in the field have garnered such attention and excitement in the lung transplant community as Normothermic Ex vivo Lung Perfusion (EVLP). Stig Steen published his work in 2001 when he used EVLP for short term assessment of function of a DCD lung, which was ultimately successfully used for transplantation. Between 2001 and 2007, many experimental EVLP studies were performed in Europe again with the focus of short term lung evaluation in the DCD context. In 2007, our group in Toronto presented, at the ISHLT annual meeting in San Francisco, the first concept and feasibility of prolonged EVLP (12h) in association with an active treatment strategy (IL-10 gene therapy) to repair injured donor lungs ex vivo. Subsequent publications, demonstrated the benefits of having a period of normothermic EVLP during the lung preservation process and a seminal prospective clinical trial demonstrated the feasibility and safety of EVLP to assess and improve function of injured donor lungs or lungs from donors after cardiac death. An explosion of EVLP research has occurred since then, and EVLP became one of the major topics of our annual meetings. As expected, in parallel with this, there has been a heightened interest from industry in related technology with at least four companies producing devices for lung perfusion, each however with different characteristics. Read more →
OF SPECIAL INTEREST:
Moving Forward: Safely Walking Patients on ECMO
by Bryan Boling and Katie Burns
Venovenous extracorporeal membrane oxygenation (ECMO) is an effective and often necessary therapy for end-stage pulmonary disease patients awaiting lung transplant. Even though newer cannulation techniques, such as the use of a dual lumen cannula in the internal jugular vein, allow for greater patient mobility, ambulation of patients on ECMO remains rare. Immobility of critically ill patients, particularly those with pulmonary disease, is a significant problem, often leading to physical deconditioning, prolonged mechanical ventilation, and skin breakdown. Read more →
International Traveling Scholarship Report: Research Contributions on the Biohybrid Lung Project
by Erin Schumer
In January, 2014, I was awarded the ISHLT Travelling Scholarship Award which provided me the opportunity to spend May 2014 at the Hannover Medical School (MHH) in Hannover, Germany, contributing to research efforts on the biohybrid lung project. As a general surgery resident, my goal of becoming an academically active cardiothoracic surgeon creates a strong interest in lung transplantation and lung transplantation research. Read more →
ISHLT NEWS AND ANNOUNCEMENTS:
Links Travel Awards: Go! Write! Win!
With the support of W.O. and Joan Leach (Gadsden, Alabama, USA), Mrs. Sue Abramson (Birmingham, Alabama, USA) and Mr. Larry Imhoff (La Place, Louisiana, USA), ISHLT has been able to offer the Leach-Abramson-Imhoff Links Travel Awards to support the growth and development of our future leaders from within our society. From physicians to nurses to other health care professionals, anyone motivated enough by investigation, communication, and dissemination of new ideas for the betterment of patients with failing lungs and/or a failing heart should be rewarded for their efforts. Whether writing about conditions such as pulmonary fibrosis, cystic fibrosis, emphysema, pulmonary hypertension, and from ischemic, nonischemic to congenital heart diseases, those who work tirelessly to educate themselves, their patients and their field should not go unnoticed or unmentioned. Read more →
JHLT Impact Factors Reach New High
Hot off the press, the 2013 Impact Factors for the Journal of Heart and Lung Transplantation (JHLT) were released on July 29th, 2014:
- JHLT's Impact Factor increased from 5.11 to 5.61
- The Journal's total citations jumped from 7139 last year to 8078 this year
- Our Article Influence Score (a measure of prestige of publishing in the JHLT) has risen consistently from <1 (2010) to 1.41 this year
- We are now ranked 3rd in the category of ANY SURGICAL journal (out of 202); remain 2nd in the Transplantation category and we moved up to 17 in the Cardiovascular Category (out of 125)
Congratulations to Editor-in-Chief Mandeep Mehra, the entire editorial staff of the Journal, and the ISHLT for this impressive accomplishment.
Descartes, Bacon, Locke and Newton: The Journey of Scientific Inquiry to Truth
by Vincent Valentine
In the Editor's Corner for Volume 6 of the ISHLT Links we have immersed ourselves into 18th Century France and specifically, Voltaire. In the previous issues, we reviewed the influence his Jesuit education and the Lady Newton (the Divine Émilie) had on shaping Voltaire into what he would become; the Patriarch of the French Enlightenment. Here we examine one of his most influential works, Letters on the English (or Lettres Philosophiques in France), a series of essays drawn from his experience in England which served to define his intellectual life and attract the Divine Émilie. Read more →
"To the living we owe respect, but to the dead
we owe only the truth."
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Disclaimer: Any opinion, conclusion or recommendation published by the Links is the sole expression of the writer(s) and does not necessarily reflect the views of the ISHLT.