ISHLT issues new guidelines for care of mechanical circulatory support device patients
(Elsevier Health Sciences) The International Society for Heart and Lung Transplantation convened an international panel of experts in all aspects of mechanical circulatory support care (MCS), a rapidly growing technology to treat advanced heart failure. They developed practice guidelines to provide a common framework for the care and treatment of MCS patients. The Executive Summary of these guidelines is published in the February issue of The Journal of Heart and Lung Transplantation and is freely available.
END-STAGE HEART FAILURE (HF) results from a myriad of etiologies and represents a major financial and healthcare burden.1 Since 1983, nearly 150,000 pediatric and adult heart transplants have been reported to the International Society for Heart and Lung Transplantation (ISHLT) Registry, with medical advancements in perioperative care resulting in improved patient outcomes over time.2 This paper aims to assess outcomes within the field of heart transplantation. The authors will focus on historical context, current demographics, indications, and contraindications for transplantation.
Right-sided heart failure develops in lung transplantation candidates on prolonged peripheral extracorporeal membrane oxygenation support and is a major determinant of mortality. The use of central venoarterial extracorporeal membrane oxygenation for bridging of right-sided heart failure to lung transplantation was evaluated.
Systolic heart failure (HF) is a progressive disease characterized by adverse remodeling from ischemia (ischemic cardiomyopathy, ICM) or a multitude of other causes termed non-ischemic cardiomyopathy (NICM). To accurately characterize the myocardial transcriptome in advanced HF using RNA-sequencing (RNAseq) and identify gene signatures that predict HF phenotypes.
Current data regarding early and late right heart failure (RHF) post-LVAD is confounded by small populations and variable definitions of RHF. In 2014, a new INTERMACS (IM) definition of RHF was introduced. Based on this contemporary definition, we sought to investigate the epidemiology and natural history of RHF after LVAD.
LImited mechanical support options exist for patients in biventricular heart failure. Post-transplant outcomes in those bridged with BiVAD HVADs and Total Artificial Heart (TAH) have not been well described. We sought to examine post heart transplant outcomes of this cohort in a national registry.
Leg muscle strength (LMS) could be an index of frailty in patients with heart failure. However, its prognostic value in patients with acute decompensated heart failure (ADHF) is not well investigated. We hypothesized that impaired LMS was independently associated with poor clinical outcome in patients with ADHF.
Multiorgan Dysfunction Syndrome (MOD) contributes to adverse outcomes in advanced heart failure (AdHF) patients after mechanical circulatory support (MCS) implantation and is associated with aberrant Peripheral Blood Mononuclear Cells (PBMC) activity. We hypothesize that a subset of previously reported 12 preoperative differentially expressed genes (DEGs) correlating with both, Functional Recovery Potential (FRP) (28 genes) and One Year Survival (1YS) (105 genes) [Bondar 2017], could directly predict FRP-related 1YS after MCS surgery.
Cardiac resynchronization therapy (CRT) improves quality of life and survival in patients with heart failure, but it has not been rigorously investigated in LVAD patients. Furthermore, the effects of different pacing strategies on hemodynamics in LVAD recipients is unknown.
We present the full study cohort of the first prospective study evaluating outcomes with right ventricular (RV) vs biventricular (BiV) pacing in LVAD patients.
Exercise-induced left bundle branch block (LBBB) is rarely observed in exercise testing, and usually implies a worse prognosis. Cardiac resynchronization therapy (CRT) is well validated in patients with heart failure with reduced ejection fraction (HFrEF) and LBBB. Although the indications of CRT do not include exercise-induced LBBB, the functional impairment secondary to dynamic electromechanical dyssynchrony could potentially be improved with CRT.