Today's Highlights
In the past decade, there has been a dramatic increase in the use of temporary circulatory support (TCS) to rescue patients with cardiogenic shock (CS). In the following presentations, we learn about TCS use in the global IMACS registry, TCS-associated complications, as well as patients’ outcomes once transitioned off of VA-ECMO to durable VAD.
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Clinical Outcomes by Intended Goal of Therapy in the MOMENTUM3 Clinical Trial: Analysis of the Full Cohort
Daniel Goldstein, MD
The MOMENTUM3 study is the cumulation of collaborative work that started a decade ago to develop a safe and effective mechanical cardiac device for patients with end-stage heart failure. One of the key questions in this endeavor is whether it was clinically necessary to distinguish among destination therapy (DT), Bridge to Transplant (BTT) and Bridge to Decision/Candidacy (BTD/BTC) designations. These clinical classifications have been debated in the literature as patients' comorbidities and preferences fluctuate resulting in a "meaningless" labeling.
Study Purpose: The primary purpose of the study was to conduct a pre-specified analysis of primary and secondary outcomes and adverse events in patients stratified by pre-implant strategy of BTT/BTC vs. DT. The secondary outcome was to determine the rates of transplantation vs. continuing mechanical support among these designations at 2 years. Read more
Thoracic Registry Report
Josef Stehlik, MD, MPH
The 36th Annual Transplant Registry Report focuses on predicted heart mass rather than weight and height. Thoracic transplantation volumes have remained steady with over 5500 heart and 4500 lung transplantations performed worldwide in 2017 with improving graft survival. Read more
No longer a “forgotten ventricle,” the RV now plays a central role in patients’ prognosis following LVAD implantation. In the following presentations, we learn about longitudinal assessment of RV function and a novel treatment for RV failure in LVAD patients. Read more
Two Freaky Reasons Pediatric Anticoagulation Management Could Get You
Christina VanderPluym, MD
Let’s be honest. We all hate anticoagulation and managing anticoagulation. It’s a fickle beast. It’s a fickle mistress and probably doubly so in the pediatric world.
There are two reasons pediatric ventricular assist device (VAD) therapy could get you: It’s associated with high rates of stroke and bleeding. There are multiple factors that can impact these adverse events, including patient factors, device factors, and management factors. Read more
Omega-3 Suppresses Gastrointestinal Bleeding by Reducing Angiopoietin-2 Expression in LVAD Patients
Teruhiko Imamura, MD, PhD
Gastrointestinal bleeding (GIB) in LVAD patients. We all hate it. We hate it because there’s no definitive treatment. At the moment, our options include endoscopy, blood products, proton pump inhibitors, or other intensive therapies. Another option includes stopping anticoagulation and antiplatelet therapy, which is a prospect that many of us are loathe to do due to the increased risk of thromboembolic events. However, T. Imamura et al. may offer an alternative approach that may bring us renewed hope and it involves the use of a simple, everyday ingredient…omega-3 fatty acids. Read more
Comparative Efficacy of Bortezomib and Carfilzomib Desensitization Protocols in Highly Sensitized Cardiac Transplant Candidates
Minoosh Sobhanian, PharmD
Antibodies! We all hate these pesky little critters. Specifically, we hate donor specific antibodies (DSAs). If it weren’t for them, we could much more easily transplant all our heart transplant candidates with little fear of retribution. Sadly, this is not the case. Many of our candidates have increased rates of sensitization due to factors such as LVADs, pregnancy, and blood transfusions that can negatively impact their probability of finding a suitable donor and, subsequently, their rates of rejection and survival post-transplant. Read more
Successful Utilization of Extended Criteria Donor (ECD) Hearts for Transplantation - Results of the OCS™ Heart EXPAND Trial to Evaluate the Effectiveness and Safety of the OCS Heart System to Preserve and Assess ECD Hearts for Transplantation
Jacob Schroder, MD
Two thirds of donor hearts are discarded in the United States. Therefore, strategies to improve donor utilization are critical to meet the donor heart shortage. The Organ Care System (OCS) is a portable device that can provide warm organ perfusion. The OCS expand trial is a single-arm prospective multisite trial that allowed the evaluation of donor hearts meeting extended criteria. The aim of this trial was to improve current donor heart utilization. Declined OCS hearts were based on biomarkers hemodynamic parameters or the surgeon's ultimate decision. Read more