31st Annual Meeting & Scientific Sessions
◊ San Diego ◊

Thursday, April 14, 2011
Volume 7, Issue 2
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Welcome to the 2011 Meeting and Scientific Sessions

From the President – Welcome to this 31st Annual Meeting of the Society – the biggest and best ever. Program Chair Robin Pierson and his colleagues have assembled the most comprehensive and exciting range of attractions, with an abundance for every aspect of our membership's interests.
     Not only will our minds be stimulated, we will be reinvigorated by the California sunshine.
     Please take this opportunity to participate in your Society. The Councils are the drivers of the Society moving into the future. Please come to the Opening Plenary, and the Business meeting on Friday, to learn of new developments and initiatives.
     Finally, and perhaps most importantly, enjoy the social gatherings. I welcome you to make new friends and cement old alliances, throughout the Meeting and at the Gala on Friday.

From the Program Chair – Welcome to the 31st Annual ISHLT meeting and San Diego's Bayfront Hilton. With the highest-ever number of abstract submissions and registration running at record levels, this ISHLT meeting promises to be the biggest and best to date.
     This is truly YOUR meeting. The Scientific Programs' educational offerings were designed largely by you, starting with the Pre-Meeting Symposia and continuing with Sunrise Symposia, Mid-Day Symposia, and ever-popular debates. The concurrent scientific sessions are comprised entirely of your work—those abstracts judged particularly meritorious by a jury of your peers. The Plenary Sessions feature invited lectures by several of our Society's leaders, pioneers and innovators in the several disciplines spanned by our diverse membership.
     On behalf of the ISHLT Board, I extend my personal heart-felt thanks to the ISHLT membership for their guidance and inspiration in putting together the meeting's featured educational offerings. I wish to particularly recognize the abstract reviewers and Program Committee members who donated their precious time and unique expertise to help us fashion coherent, high-quality concurrent sessions and cutting-edge Symposia. We hope you will find this year's Program professionally enriching, and entertaining!

Welcome to San Diego!!

The Future Is Coming

Given the shortage of available organs for transplantation, alternative strategies are being investigated to treat patients with end-stage thoracic organ failure. Friday's Mid-Day Symposium 5: Future Therapies for End-Stage Thoracic Organ Failure will report some of these solutions. Presentations will include, "Regeneration of Bioartificial Airways/Lungs," by Dr. Thomas K. Waddell, and "Regenerative Therapy for Pulmonary Hypertension," by Dr. Duncan J. Stewart. The session will then conclude with, "Is There a Future for Engineered Heart and Lung?" by Dr. Doris Taylor.

This issue of the conference coverage newsletter was supported by a grant from:

A "Great Debate": On-Pump vs. Off-Pump Lung Transplantation

Yesterday's Pre-Meeting Symposium 14, Extracorporeal Support in Lung Transplantation, which was chaired by Dr. Hermann Reichenspurner and Dr. Joseph Zwischenberger, presented contrasting views on the use of extracorporeal support devices in lung transplantation.
     The session was divided into three parts. First, two presentations discussed advantages and disadvantages of off-pump versus on-pump lung transplantation. Dr. Bryan Meyers, who preferentially performs lung transplantations without extracorporeal support, emphasized hemodynamic and respiratory techology to avoid CPB. From his standpoint, reduced bleeding, and transfusions risk, as well as complications of cannulation and CPB-associated inflammation, are the main reasons to avoid the "pump".
     An advocate of "on-pump" lung transplantation, Dr. Alberto Pochettino illustrated different possibilities of surgical accesses to perform bilateral lung transplantations and mentioned that one of the main advantages of CPB is that both recipient lungs can be removed prior to the implantation of the donor lungs. Especially in CF patients, he feels this approach is important to prevent pneumonia and infections caused by not removing the second native lung prior to the first donor lung implant when lungs are transplanted off-pump.
     The second part of the symposium focused on cardiopulmonary bypass strategies for double lung transplantation. Drs. Abbas Ardehali and Steven Clark showed in their presentations that an advantage of on-pump transplantation is to enable controlled reperfusion of the transplanted lung. Pulmonary pressures are thus easier to control, and modifiy perfusate with, for example, a depletion of leukocytes, is possible.
     Dr. Clemens Aigner reported on the Vienna experience with the use of the ECMO during lung transplantation and stated that 90% of last year's bi-lateral lung transplantation in Vienna had been performed using ECMO. He reporterd that use of the ECMO in the postoperative period was of great benefit to stabilize unstable patients and a major advantage of this approach.
     The session concluded with presentation of additional ECMO applications before and after lung transplantation. Dr. Martin Strueber presented the Cardiohelp device, a new development, based on the ECMO system, which not only enables the oxygenation and CO2 removal, but also allows the possibility of circulatory support. Finally, Dr. David Mason and Dr. Yoshida Toyoda elaborated advantages of the venovenous ECMO application relative to veno-arterial implantation.
     All the presenters agreed that, despite the controversy on whether or not to use extracorporeal support in situations where the surgeon had a choice, yesterday's symposium made clear that the careful selection of patients is essential to achieve good results in lung transplantation.

When Is "Too Soon" For A VAD?
Pre-Meeting Symposium 11: When Does "Less Sick" = "Sick Enough" for MCS?

This year's symposia highlighted the emerging idea that early VAD implantation yields better results. The session began with Dr. Randall C. Starling reporting on the estimated number of potential VAD candidates in the United States as approximately 100,000 in 2008. He also emphasized that this number will only increase with the aging population and the growing number of heart failure patients. Dr. Stuart D. Russell then commented on the utility of exercise testing in the beta-blocker era. Eldrin F. Lewis concluded that quality of life, in addition to survival, should be taken into account when considering a patient for VAD placement. In her presentation, "Should Inotropic Therapy Come Before VAD?" Debra L. Isaac concluded with a simple, if provacative answer: "not necessarily". Dr. Lee R. Goldberg then discussed the "tipping point" for VAD referral, and underscored the need to look at the entire patient picture when deciding when to proceed with VAD implant (see Risky Business below). Dr. Acker then presented, "Is There a Different Threshold for VAD When Transplant is not an Option?" He stressed that destination VAD placement should have a lower threshold compared to BTT, the need to avoid patients "too sick for transplant," and that it should be an elective procedure. The symposium concluded with a look at regulatory perspectives by Ileana L. Pina.

Experts Evaluate the Management of Right Ventricular Failure
in LVAD Candidates

Yesterday's Pre-Meeting Symposium 17: Management of the Failing Right Ventricle at the Time of MCS Implant, took a critical look at right ventricular failure in LVAD candidates. The first talk, by Dr. Guy A. MacGowan, evaluated multiple modalities for assessing right ventricular function in prospective LVAD patients. He suggested the use of bedside echocardiography for risk stratification and procedure planning. Dr. Robert L. Kormos then reported on BiVAD outcomes from the INTERMACS. He concluded that although an increase in mortality was seen with BiVAD support compared to LVAD alone, he attributed this to inherent patient illness. The symposium continued with "Current TAH/Paracorporeal BiVAD Support Options," by Dr. Pascal Leprince. He discussed the relative advantages and drawbacks of multiple modalities of biventricular support, ranging from ECMO to paracorporeal PVAD to total artificial heart implantation. Dr. Carmelo Milano described the effect of tricuspid valve regurgitation on patients requiring LVAD support, and the possible benefit of tricuspid valve repair during LVAD implantation. Dr. Vivek Rao then discussed which patients were appropriate for temporary versus longterm RVAD support. The session concluded with Dr. Roland Hetzer, who presented experience with novel continuous flow devices for biventricular failure support.

Risk Stratification on Your Mobile Device?
Pre-Meeting Symposium 1: Risky Business! Heart Failure, Transplant, and Mechanical Circulatory Support

Risk stratification in patients undergoing lung transplantation is very important, not only to select suitable patients but also to achieve good survival and organ function. Pre-Meeting Symposium 1: Risky Business! Heart failure, Transplant, and Mechanical Circulatory Support, was chaired by Drs. Joseph Rogers and Axel Rahmel. The speakers focused on ways to allocate recipients risk assessment and life expectancy with competing options.

• In the first presentation, which was given by Dr. Wayne Levy, the Seattle Heart Failure Model was presented, giving easy access to mean life expectancies. This model is even available as an application for the Apple® iPhone.
• Dr. Brad Dyke provided more information on sources of risk and data and mentioned specifically the SRTR website: www.srtr.org.
• Dr. Rahmel discussed the assessment of transplant risk in Europe, using data about survival after lung transplantation and explained differences in allocation policies between different European countries.
• The importance of finding the right "window" to implant mechanical cardiac support (MCS) to minimize death and operative risk was illustrated in a presentation by Dr. Katherine Lietz.
• Dr. Keith Aaronson focused his talk: "Assessing the risk of what?" on the importance of using the right model to predict survival.
• From the view of a patient, Dr. David Naftel explained that ratios and scores don't really help a patient to understand his chances or risks. Clearly presented information on individual patient survival probabilities would be more useful, not only for patients but also surgeons and other involved medical personal.
• The session ended with by two case presentations given by Drs. Chetan Patel and Alexander Stephanenko. In both reported cases, where risk scores were successfully used, in one patient with mechanical aortal valve repair that received a continuous LVAD and another HIT-positive patient receiving the Heart Mate II.

"Risky Business" showed in an interesting way how important it is to stratify risk in individual patients using powerful available tools to predict survival and to make the right decisions from among the medical and surgical treatment options.