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Silvestry S, Leacche M, Meyer DM, Shudo Y, Kawabori M, Mahesh B, Zuckermann A, D’Alessandro D, Schroder J. Outcomes in Heart Transplant Recipients by Bridge to Transplant Strategy When Using the SherpaPak Cardiac Transport System. ASAIO J 2024; 70:388-395. [PMID: 38300893 PMCID: PMC11057488 DOI: 10.1097/mat.0000000000002137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
The last several years have seen a rise in use of mechanical circulatory support (MCS) to bridge heart transplant recipients. A controlled hypothermic organ preservation system, the SherpaPak Cardiac Transport System (SCTS), was introduced in 2018 and has grown in utilization with reports of improved posttransplant outcomes. The Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN)-Heart registry is an international, multicenter registry assessing outcomes after transplant using the SCTS. This analysis examines outcomes in recipients bridged with various MCS devices in the GUARDIAN-Heart Registry. A total of 422 recipients with donor hearts transported using SCTS were included and identified. Durable ventricular assist devices (VADs) were used exclusively in 179 recipients, temporary VADs or intra-aortic balloon pump (IABP) in 197, and extracorporeal membrane oxygenation (ECMO) in 14 recipients. Average ischemic times were over 3.5 hours in all cohorts. Severe primary graft dysfunction (PGD) posttransplant increased across groups (4.5% VAD, 5.1% temporary support, 21.4% ECMO), whereas intensive care unit (ICU) length of stay (18.2 days) and total hospital stay (39.4 days) was longer in the ECMO cohort than the VAD and IABP groups. A comparison of outcomes of MCS bridging in SCTS versus traditional ice revealed significantly lower rates of both moderate/severe right ventricular (RV) dysfunction and severe PGD in the SCTS cohort; however, upon propensity matching only the reductions in moderate/severe RV dysfunction were statistically significant. Use of SCTS in transplant recipients with various bridging strategies results in excellent outcomes.
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Affiliation(s)
- Scott Silvestry
- From the Department of Cardiothoracic Surgery, AdventHealth Transplant Institute, Orlando, Florida
| | - Marzia Leacche
- Division of Cardiothoracic Surgery, Corewell Health (Formerly Spectrum Health), Grand Rapids, Michigan
| | - Dan M. Meyer
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Masashi Kawabori
- Cardiovascular Center, Department of Surgery, Tufts Medical Center, Boston Massachusetts
| | - Balakrishnan Mahesh
- Division of Cardiac Surgery, Heart & Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andreas Zuckermann
- Department for Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - David D’Alessandro
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jacob Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
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Lerman JB, Patel CB, Casalinova S, Nicoara A, Holley CL, Leacche M, Silvestry S, Zuckermann A, D'Alessandro DA, Milano CA, Schroder JN, DeVore AD. Early Outcomes in Patients With LVAD Undergoing Heart Transplant via Use of the SherpaPak Cardiac Transport System. Circ Heart Fail 2024:e010904. [PMID: 38602105 DOI: 10.1161/circheartfailure.123.010904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/08/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Heart transplant (HT) in recipients with left ventricular assist devices (LVADs) is associated with poor early post-HT outcomes, including primary graft dysfunction (PGD). As complicated heart explants in recipients with LVADs may produce longer ischemic times, innovations in donor heart preservation may yield improved post-HT outcomes. The SherpaPak Cardiac Transport System is an organ preservation technology that maintains donor heart temperatures between 4 °C and 8 °C, which may minimize ischemic and cold-induced graft injuries. This analysis sought to identify whether the use of SherpaPak versus traditional cold storage was associated with differential outcomes among patients with durable LVAD undergoing HT. METHODS Global Utilization and Registry Database for Improved Heart Preservation-Heart (NCT04141605) is a multicenter registry assessing post-HT outcomes comparing 2 methods of donor heart preservation: SherpaPak versus traditional cold storage. A retrospective review of all patients with durable LVAD who underwent HT was performed. Outcomes assessed included rates of PGD, post-HT mechanical circulatory support use, and 30-day and 1-year survival. RESULTS SherpaPak (n=149) and traditional cold storage (n=178) patients had similar baseline characteristics. SherpaPak use was associated with reduced PGD (adjusted odds ratio, 0.56 [95% CI, 0.32-0.99]; P=0.045) and severe PGD (adjusted odds ratio, 0.31 [95% CI, 0.13-0.75]; P=0.009), despite an increased total ischemic time in the SherpaPak group. Propensity matched analysis also noted a trend toward reduced intensive care unit (SherpaPak 7.5±6.4 days versus traditional cold storage 11.3±18.8 days; P=0.09) and hospital (SherpaPak 20.5±11.9 days versus traditional cold storage 28.7±37.0 days; P=0.06) lengths of stay. The 30-day and 1-year survival was similar between groups. CONCLUSIONS SherpaPak use was associated with improved early post-HT outcomes among patients with LVAD undergoing HT. This innovation in preservation technology may be an option for HT candidates at increased risk for PGD. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04141605.
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Affiliation(s)
- Joseph B Lerman
- Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC. (J.B.L., C.B.P., S.C., C.L.H., A.D.D.)
| | - Chetan B Patel
- Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC. (J.B.L., C.B.P., S.C., C.L.H., A.D.D.)
| | - Sarah Casalinova
- Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC. (J.B.L., C.B.P., S.C., C.L.H., A.D.D.)
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, NC. (S.C., A.N., C.A.M., J.N.S.)
| | - Alina Nicoara
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, NC. (S.C., A.N., C.A.M., J.N.S.)
| | - Christopher L Holley
- Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC. (J.B.L., C.B.P., S.C., C.L.H., A.D.D.)
| | - Marzia Leacche
- Division of Cardiothoracic Surgery, Corewell Health, Grand Rapids, MI (M.L.)
| | - Scott Silvestry
- Department of Cardiothoracic Surgery, AdventHealth Transplant Institute, Orlando, FL (S.S.)
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Austria (A.Z.)
| | - David A D'Alessandro
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston (D.A.D.)
| | - Carmelo A Milano
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, NC. (S.C., A.N., C.A.M., J.N.S.)
| | - Jacob N Schroder
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, NC. (S.C., A.N., C.A.M., J.N.S.)
| | - Adam D DeVore
- Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC. (J.B.L., C.B.P., S.C., C.L.H., A.D.D.)
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Moayedifar R, Shudo Y, Kawabori M, Silvestry S, Schroder J, Meyer DM, Jacobs JP, D'Alessandro D, Zuckermann A. Recipient Outcomes With Extended Criteria Donors Using Advanced Heart Preservation: An Analysis of the GUARDIAN-Heart Registry. J Heart Lung Transplant 2024; 43:673-680. [PMID: 38163452 DOI: 10.1016/j.healun.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The prevalence of end-stage heart failure and patients who could benefit from heart transplantation requires an expansion of the donor pool, relying on the transplant community to continually re-evaluate and expand the use of extended criteria donor organs. Introduction of new technologies such as the Paragonix SherpaPak Cardiac Transport System aids in this shift. We seek to analyze the impact of the SherpaPak system on recipient outcomes who receive extended criteria organs in the GUARDIAN-Heart Registry. METHODS Between October 2015 and December 2022, 1,113 adults from 15 US centers receiving donor hearts utilizing either SherpaPak (n = 560) or conventional ice storage (ice, n = 453) were analyzed from the GUARDIAN-Heart Registry using summary statistics. A previously published set of criteria was used to identify extended criteria donors, which included 193 SherpaPak and 137 ice. RESULTS There were a few baseline differences among recipients in the 2 cohorts; most notably, IMPACT scores, distance traveled, and total ischemic time were significantly greater in SherpaPak, and significantly more donor hearts in the SherpaPak cohort had >4 hours total ischemia time. Posttransplant mechanical circulatory support utilization (SherpaPak 22.3% vs ice 35.0%, p = 0.012) and new extracorporeal membrane oxygenation/ventricular assist device (SherpaPak 7.8% vs ice 15.3%, p = 0.033) was significantly reduced, and the rate of severe primary graft dysfunction (SherpaPak 6.2% vs ice 13.9%, p = 0.022) was significantly reduced by over 50% in hearts preserved using SherpaPak. One-year survival between cohorts was similar (SherpaPak 92.9% vs ice 89.6%, p = 0.27). CONCLUSIONS This subgroup analysis demonstrates that SherpaPak can be safely used to utilize extended criteria donors with low severe PGD rates.
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Affiliation(s)
- Roxana Moayedifar
- Department for Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Masashi Kawabori
- Cardiovascular Center, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Scott Silvestry
- Department of Cardiothoracic Surgery, AdventHealth Transplant Institute, Orlando, Florida
| | - Jacob Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Dan M Meyer
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Jeffrey P Jacobs
- Congenital Heart Center, Division of Cardiovascular Surgery, UF Health Shands Hospital, Gainesville, Florida
| | - David D'Alessandro
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Andreas Zuckermann
- Department for Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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Halloran PF, Madill-Thomsen K, Aliabadi-Zuckermann AZ, Cadeiras M, Crespo-Leiro MG, Depasquale EC, Deng M, Gökler J, Hall S, Jamil A, Kim DH, Kobashigawa J, Macdonald P, Melenovsky V, Patel J, Potena L, Shah K, Stehlik J, Zuckermann A. Redefining the molecular rejection states in 3230 heart transplant biopsies: Relationships to parenchymal injury and graft survival. Am J Transplant 2024:S1600-6135(24)00241-7. [PMID: 38527588 DOI: 10.1016/j.ajt.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
The first-generation Molecular Microscope (MMDx) system for heart transplant endomyocardial biopsies used expression of rejection-associated transcripts (RATs) to diagnose not only T cell-mediated rejection (TCMR) and antibody-mediated rejection (ABMR) but also acute injury. However, the ideal system should detect rejection without being influenced by injury, to permit analysis of the relationship between rejection and parenchymal injury. To achieve this, we developed a new rejection classification in an expanded cohort of 3230 biopsies: 1641 from INTERHEART (ClinicalTrials.gov NCT02670408), plus 1589 service biopsies added to improve the power of the machine learning algorithms. The new system used 6 rejection classifiers instead of RATs and generated 7 rejection archetypes: No rejection, 48%; Minor, 24%; TCMR1, 2.3%; TCMR2, 2.7%; TCMR/mixed, 2.7%; early-stage ABMR, 3.9%; and fully developed ABMR, 16%. Using rejection classifiers eliminated cross-reactions with acute injury, permitting separate assessment of rejection and injury. TCMR was associated with severe-recent injury and late atrophy-fibrosis and rarely had normal parenchyma. ABMR was better tolerated, seldom producing severe injury, but in later biopsies was often associated with atrophy-fibrosis, indicating long-term risk. Graft survival and left ventricular ejection fraction were reduced not only in hearts with TCMR but also in hearts with severe-recent injury and atrophy-fibrosis, even without rejection.
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Affiliation(s)
- Philip F Halloran
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | | | | | - Martin Cadeiras
- Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Marisa G Crespo-Leiro
- Advanced Heart Failure and Heart Transplant Unit, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Mario Deng
- Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Johannes Gökler
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Aayla Jamil
- Baylor Scott & White Health, Dallas, Texas, USA
| | - Daniel H Kim
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jon Kobashigawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Peter Macdonald
- The Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jignesh Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Keyur Shah
- Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Josef Stehlik
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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D'Alessandro D, Schroder J, Meyer DM, Vidic A, Shudo Y, Silvestry S, Leacche M, Sciortino CM, Rodrigo ME, Pham SM, Copeland H, Jacobs JP, Kawabori M, Takeda K, Zuckermann A. Impact of controlled hypothermic preservation on outcomes following heart transplantation. J Heart Lung Transplant 2024:S1053-2498(24)01530-4. [PMID: 38503386 DOI: 10.1016/j.healun.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/09/2024] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Severe primary graft dysfunction (PGD) is a major cause of early mortality after heart transplant, but the impact of donor organ preservation conditions on severity of PGD and survival has not been well characterized. METHODS Data from US adult heart-transplant recipients in the Global Utilization and Registry Database for Improved Heart Preservation-Heart Registry (NCT04141605) were analyzed to quantify PGD severity, mortality, and associated risk factors. The independent contributions of organ preservation method (traditional ice storage vs controlled hypothermic preservation) and ischemic time were analyzed using propensity matching and logistic regression. RESULTS Among 1,061 US adult heart transplants performed between October 2015 and December 2022, controlled hypothermic preservation was associated with a significant reduction in the incidence of severe PGD compared to ice (6.6% [37/559] vs 10.4% [47/452], p = 0.039). Following propensity matching, severe PGD was reduced by 50% (6.0% [17/281] vs 12.1% [34/281], respectively; p = 0.018). The Kaplan-Meier terminal probability of 1-year mortality was 4.2% for recipients without PGD, 7.2% for mild or moderate PGD, and 32.1%, for severe PGD (p < 0.001). The probability of severe PGD increased for both cohorts with longer ischemic time, but donor hearts stored on ice were more likely to develop severe PGD at all ischemic times compared to controlled hypothermic preservation. CONCLUSIONS Severe PGD is the deadliest complication of heart transplantation and is associated with a 7.8-fold increase in probability of 1-year mortality. Controlled hypothermic preservation significantly attenuates the risk of severe PGD and is a simple yet highly effective tool for mitigating post-transplant morbidity.
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Affiliation(s)
- David D'Alessandro
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Jacob Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Dan M Meyer
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Andrija Vidic
- Department of Cardiovascular Medicine University of Kansas Health System, Kansas City, Kansas
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Scott Silvestry
- Department of Cardiothoracic Surgery, AdventHealth Transplant Institute, Orlando, Florida
| | - Marzia Leacche
- Division of Cardiothoracic Surgery, Corewell Health (formerly Spectrum Health), Grand Rapids, Michigan
| | | | - Maria E Rodrigo
- Department of Cardiology, MedStar Health, Washington, District of Columbia
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Hannah Copeland
- Department of Cardiothoracic Surgery, Lutheran Health, Fort Wayne, Indiana
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Congenital Heart Center, UF Health Shands Hospital, Gainesville, Florida
| | - Masashi Kawabori
- Department of Surgery, Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Koji Takeda
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - Andreas Zuckermann
- Department for Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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Halloran PF, Madill-Thomsen K, Mackova M, Aliabadi-Zuckermann AZ, Cadeiras M, Crespo-Leiro MG, Depasquale EC, Deng M, Gökler J, Hall SA, Kim DH, Kobashigawa J, Macdonald P, Potena L, Shah K, Stehlik J, Zuckermann A, Reeve J. Molecular states associated with dysfunction and graft loss in heart transplants. J Heart Lung Transplant 2024; 43:508-518. [PMID: 38042442 DOI: 10.1016/j.healun.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/23/2023] [Accepted: 11/21/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND We explored the changes in gene expression correlating with dysfunction and graft failure in endomyocardial biopsies. METHODS Genome-wide microarrays (19,462 genes) were used to define mRNA changes correlating with dysfunction (left ventricular ejection fraction [LVEF] ≤ 55) and risk of graft loss within 3 years postbiopsy. LVEF data was available for 1,013 biopsies and survival data for 779 patients (74 losses). Molecular classifiers were built for predicting dysfunction (LVEF ≤ 55) and postbiopsy 3-year survival. RESULTS Dysfunction is correlated with dedifferentiation-decreased expression of normal heart transcripts, for example, solute carriers, along with increased expression of inflammation genes. Many genes with reduced expression in dysfunction were matrix genes such as fibulin 1 and decorin. Gene ontology (GO) categories suggested matrix remodeling and inflammation, not rejection. Genes associated with the risk of failure postbiopsy overlapped dysfunction genes but also included genes affecting microcirculation, for example, arginase 2, which reduces NO production, and endothelin 1. GO terms also reflected increased glycolysis and response to hypoxia, but decreased VEGF and angiogenesis pathways. T cell-mediated rejection was associated with reduced survival and antibody-mediated rejection with relatively good survival, but the main determinants of survival were features of parenchymal injury. Both dysfunction and graft loss were correlated with increased biopsy expression of BNP (gene NPPB). Survival probability classifiers divided hearts into risk quintiles, with actuarial 3-year postbiopsy survival >95% for the highest versus 50% for the lowest. CONCLUSIONS Dysfunction in transplanted hearts reflects dedifferentiation, decreased matrix genes, injury, and inflammation. The risk of short-term loss includes these changes but is also associated with microcirculation abnormalities, glycolysis, and response to hypoxia.
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Affiliation(s)
- Philip F Halloran
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | | | - Martina Mackova
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | - Mario Deng
- Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Johannes Gökler
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Daniel H Kim
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Peter Macdonald
- The Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Keyur Shah
- Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Josef Stehlik
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Jeff Reeve
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Haberbusch M, Reil J, Uyanik-Ünal K, Schukro C, Zuckermann A, Moscato F. Decoding cardiac reinnervation from cardiac autonomic markers: A mathematical model approach. J Heart Lung Transplant 2024:S1053-2498(24)00041-X. [PMID: 38360162 DOI: 10.1016/j.healun.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/26/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Although cardiac autonomic markers (CAMs) are commonly used to assess cardiac reinnervation in heart-transplant patients, their relationship to the degree of sympathetic and vagal cardiac reinnervation is not well understood yet. To study this relationship, we applied a mathematical model of the cardiovascular system and its autonomic control. METHODS By simulating varying levels of sympathetic and vagal efferent sinoatrial reinnervation, we analyzed the induced changes in CAMs including resting heart rate (HR), bradycardic and tachycardic HR response to Valsalva maneuver, root mean square of successive differences between normal heartbeats (RMSSD), low-frequency (LF), high-frequency (HF), and total spectral power (TSP). RESULTS For assessment of vagal cardiac reinnervation levels >20%, resting HR (ρ = 0.99, p < 0.05), RMSSD (ρ = 0.97, p < 0.05), and TSP (ρ = 0.96, p < 0.05) may be equally suitable as HF-power (ρ = 0.97, p < 0.05). To assess sympathetic reinnervation, LF/HF ratio (ρ = 0.87, p < 0.05) and tachycardic response to Valsalva maneuver (ρ = 0.9, p < 0.05) may be more suitable than LF-power (ρ = 0.77, p < 0.05). CONCLUSIONS Our model reports mechanistic relationships between CAMs and levels of efferent autonomic sinoatrial reinnervation. The results indicate differences in the suitability of these markers to assess vagal and sympathetic reinnervation. Although our analysis is purely conceptual, the developed model can help to gain important insights into the genesis of CAMs and their relationship to efferent sinoatrial reinnervation and, thus, provide indications for clinical study evaluation.
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Affiliation(s)
- Max Haberbusch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria.
| | - Julius Reil
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Keziban Uyanik-Ünal
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Schukro
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesco Moscato
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
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8
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Ryz S, Menger J, Veraar C, Datler P, Mouhieddine M, Zingher F, Geilen J, Skhirtladze-Dworschak K, Ankersmit HJ, Zuckermann A, Tschernko E, Dworschak M. Identifying High-Risk Patients for Severe Pulmonary Complications after Cardiosurgical Procedures as a Target Group for Further Assessment of Lung-Protective Strategies. J Cardiothorac Vasc Anesth 2024; 38:445-450. [PMID: 38129207 DOI: 10.1053/j.jvca.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/31/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES It remains unclear whether intraoperative lung-protective strategies can reduce the rate of respiratory complications after cardiac surgery, partly because low-risk patients have been studied in the past. The authors established a screening model to easily identify a high-risk group for severe pulmonary complications (ie, pneumonia or acute respiratory distress syndrome) that may be the ideal target population for the assessment of the potential benefits of such measures. DESIGN Retrospective observational trial. SETTING Departments of cardiac surgery and cardiac anesthesia of a university hospital. PARTICIPANTS Consecutive patients undergoing cardiac surgery on cardiopulmonary bypass and subsequent treatment at a dedicated cardiosurgical intensive care unit between January 2019 and March 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 2,572 patients undergoing surgery, 84 (3.3%) developed pneumonia/acute respiratory distress syndrome that significantly affected the outcome (ie, longer ventilatory support [66% vs 11%], higher reintubation rate [39% vs 3%]), prolonged length of intensive care unit [33 ± 36 vs 4 ± 10 days] and hospital stay [10 ± 15 vs 6 ± 7 days], and higher in-hospital [43% vs 9%] as well as 30-day [7% vs 3%] mortality). The screening model for severe pulmonary complications included left ventricular ejection fraction <52%, EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) >5.9, cardiopulmonary bypass time >123 minutes, left ventricular assist device or aortic repair surgery, and bronchodilatory therapy. A cutoff for the predicted risk of 2.5% showed optimal sensitivity and specificity, with an area under the receiver operating characteristic curve of 0.82. CONCLUSIONS The authors suggest that future research on intraoperative lung-protective measures focuses on this high-risk population, primarily aiming to mitigate severe forms of postoperative pulmonary dysfunction associated with poor outcomes and increased resource consumption.
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Affiliation(s)
- Sylvia Ryz
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Menger
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Cecilia Veraar
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Philip Datler
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Mohamed Mouhieddine
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Florentina Zingher
- Division of General Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Geilen
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Keso Skhirtladze-Dworschak
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Edda Tschernko
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Dworschak
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
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9
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Shudo Y, Leacche M, Copeland H, Silvestry S, Pham SM, Molina E, Schroder JN, Sciortino CM, Jacobs JP, Kawabori M, Meyer DM, Zuckermann A, D’Alessandro DA. A Paradigm Shift in Heart Preservation: Improved Post-transplant Outcomes in Recipients of Donor Hearts Preserved With the SherpaPak System. ASAIO J 2023; 69:993-1000. [PMID: 37678260 PMCID: PMC10602216 DOI: 10.1097/mat.0000000000002036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Traditional ice storage has been the historic standard for preserving donor's hearts. However, this approach provides variability in cooling, increasing risks of freezing injury. To date, no preservation technology has been reported to improve survival after transplantation. The Paragonix SherpaPak Cardiac Transport System (SCTS) is a controlled hypothermic technology clinically used since 2018. Real-world evidence on clinical benefits of SCTS compared to conventional ice cold storage (ICS) was evaluated. Between October 2015 and January 2022, 569 US adults receiving donor hearts preserved and transported either in SCTS (n = 255) or ICS (n = 314) were analyzed from the Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN-Heart) registry. Propensity matching and a subgroup analysis of >240 minutes ischemic time were performed to evaluate comparative outcomes. Overall, the SCTS cohort had significantly lower rates of severe primary graft dysfunction (PGD) ( p = 0.03). When propensity matched, SCTS had improving 1-year survival ( p = 0.10), significantly lower rates of severe PGD ( p = 0.011), and lower overall post-transplant MCS utilization ( p = 0.098). For patients with ischemic times >4 hours, the SCTS cohort had reduced post-transplant MCS utilization ( p = 0.01), reduced incidence of severe PGD ( p = 0.005), and improved 30-day survival ( p = 0.02). A multivariate analysis of independent risk factors revealed that compared to SCTS, use of ice results in a 3.4-fold greater chance of severe PGD ( p = 0.014). Utilization of SCTS is associated with a trend toward increased post-transplant survival and significantly lower severe PGD and MCS utilization. These findings fundamentally challenge the decades-long status quo of transporting donor hearts using ice.
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Affiliation(s)
- Yasuhiro Shudo
- From the Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Marzia Leacche
- Division of Cardiothoracic Surgery, Corewell Health (formerly Spectrum Health), Grand Rapids, Michigan
| | - Hannah Copeland
- Department of Cardiothoracic Surgery, Lutheran Health, Fort Wayne, Indiana
| | - Scott Silvestry
- Department of Cardiothoracic Surgery, AdventHealth Transplant Institute, Orlando, Florida
| | - Si M. Pham
- Department of Cardiovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ezequiel Molina
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (current affiliation: Piedmont Heart Institute, Atlanta, Georgia)
| | - Jacob N. Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Jeffrey P. Jacobs
- Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, Congenital Heart Center, UF Health Shands Hospital, Gainesville, Florida
| | - Masashi Kawabori
- Cardiovascular Center, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Dan M. Meyer
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Andreas Zuckermann
- Department for Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - David A. D’Alessandro
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston Massachusetts
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10
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Moayedi Y, Truby LK, Foroutan F, Han J, Guzman J, Angleitner P, Sabatino M, Felius J, van Zyl JS, Rodenas-Alesina E, Fan CP, DeVore AD, Miller R, Potena L, Zuckermann A, Farrero M, Chih S, Farr M, Hall S, Ross HJ, Khush KK. The International Consortium on Primary Graft Dysfunction: Redefining Clinical Risk Factors in the Contemporary Era of Heart Transplantation. J Card Fail 2023:S1071-9164(23)00382-2. [PMID: 37907150 DOI: 10.1016/j.cardfail.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Primary Graft Dysfunction (PGD) is the leading cause of morbidity and mortality early after heart transplant (HT). The International Consortium on PGD is a multicenter collaboration dedicated to identifying the clinical risk factors for PGD in the contemporary era of HT. The objectives of the current report were to 1) assess the incidence of severe PGD in an international cohort, 2) evaluate the performance of the most validated PGD risk tool, the RADIAL score, in a contemporary cohort, and 3) redefine clinical risk factors for severe PGD in the current era of HT. METHODS This is a retrospective, observational study of consecutive adult HT recipients between 2010 and 2020 in 10 centers in the United States, Canada, and Europe. Patients with severe PGD were compared to those without severe PGD (comprising those with no, mild and moderate PGD). The RADIAL score was calculated for each transplant recipient. The discriminatory power of the RADIAL score was evaluated using receiver operating characteristic (ROC) analysis and its calibration was assessed by plotting the percentage of PGD predicted versus observed. To identify clinical risk factors associated with severe PGD, we performed multivariable mixed-effects logistic regression modeling to account for among-center variability. RESULTS A total of 2,746 patients have been enrolled in the registry to date, including 2,015 (73.4%) from North America, and 731 (26.6%) from Europe. 215 participants (7.8%) met the criteria for severe PGD. There was an increase in the incidence of severe PGD over the study period (p-value for trend by difference sign test = 0.004). The Kaplan Meier estimate for 1-year survival was 75.7% [95%CI 69.4-80.9%] in patients with severe PGD as compared to 94.4% [95% CI 93.5-95.2%] in those without severe PGD (log-rank p-value <0.001). The RADIAL score performed poorly in our contemporary cohort and was not associated with severe PGD with an AUC of 0.53 (95%CI 0.48-0.58). In the multivariable regression model, acute preoperative dialysis (OR 2.41, 95% CI 1.31 - 4.43), durable LVAD support (OR 1.77, 95% CI 1.13 - 2.77), and total ischemic time (OR 1.20 for each additional hour, 95% CI 1.02 - 1.41) were associated with an increased risk of severe PGD. CONCLUSIONS Our consortium has identified an increasing incidence of PGD in the modern transplant era. We identified contemporary risk factors for this early post-transplant complication, which confers a high mortality risk. These results may enable the identification of patients at high risk for developing severe PGD in order to inform peri-transplant donor and recipient management practices.
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Affiliation(s)
- Y Moayedi
- Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Canada
| | - L K Truby
- UT Southwestern Medical Center, Dallas, USA
| | - F Foroutan
- Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Canada
| | - J Han
- University of Chicago, Chicago, USA
| | - J Guzman
- Hospital Clinic, Barcelona, Spain
| | | | | | - J Felius
- Baylor Medical Center, Dallas, USA
| | | | - E Rodenas-Alesina
- Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Canada
| | - C-P Fan
- Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Canada
| | - A D DeVore
- Duke University Medical Center, Durham, USA
| | - R Miller
- University of Calgary, Calgary, Canada
| | - L Potena
- University of Bologna, Bologna, Italy
| | | | | | - S Chih
- Ottawa Heart, Ottawa, Canada
| | - M Farr
- UT Southwestern Medical Center, Dallas, USA
| | - S Hall
- Baylor Medical Center, Dallas, USA
| | - H J Ross
- UT Southwestern Medical Center, Dallas, USA
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11
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Singh TP, Cherikh WS, Hsich E, Lewis A, Perch M, Kian S, Hayes D, Potena L, Stehlik J, Zuckermann A, Cogswell R. Graft survival in primary thoracic organ transplant recipients: A special report from the International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2023; 42:1321-1333. [PMID: 37549773 PMCID: PMC10901564 DOI: 10.1016/j.healun.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Affiliation(s)
- Tajinder P Singh
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Wida S Cherikh
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Eileen Hsich
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Alexandra Lewis
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Michael Perch
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Shaina Kian
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Don Hayes
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Luciano Potena
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Josef Stehlik
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Andreas Zuckermann
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Rebecca Cogswell
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois..
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12
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Mucha J, Cho A, Weijler AM, Muckenhuber M, Hofmann AG, Wahrmann M, Heinzel A, Linhart B, Gattinger P, Valenta R, Berlakovich G, Zuckermann A, Jaksch P, Oberbauer R, Wekerle T. Prospective assessment of pre-existing and de novo anti-HLA IgE in kidney, liver, lung and heart transplantation. Front Immunol 2023; 14:1179036. [PMID: 37731514 PMCID: PMC10507692 DOI: 10.3389/fimmu.2023.1179036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/31/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Antibody mediated rejection (ABMR) is a major factor limiting outcome after organ transplantation. Anti-HLA donor-specific antibodies (DSA) of the IgG isotype are mainly responsible for ABMR. Recently DSA of the IgE isotype were demonstrated in murine models as well as in a small cohort of sensitized transplant recipients. In the present study, we aimed to determine the frequency of pre-existing and de novo anti-HLA IgE antibodies in a cohort of 105 solid organ transplant recipients. Methods We prospectively measured anti-HLA IgE antibodies in a cohort of kidney (n=60), liver, heart and lung (n=15 each) transplant recipients before and within one-year after transplantation, employing a single-antigen bead assay for HLA class I and class II antigens. Functional activity of anti-HLA IgE antibodies was assessed by an in vitro mediator release assay. Antibodies of the IgG1-4 subclasses and Th1 and Th2 cytokines were measured in anti-HLA IgE positive patients. Results Pre-existing anti-HLA IgE antibodies were detected in 10% of renal recipients (including 3.3% IgE-DSA) and in 4.4% of non-renal solid organ transplant recipients (heart, liver and lung cohort). Anti-HLA IgE occurred only in patients that were positive for anti-HLA IgG, and most IgE positive patients had had a previous transplant. Only a small fraction of patients developed de novo anti-HLA IgE antibodies (1.7% of kidney recipients and 4.4% of non-renal recipients), whereas no de novo IgE-DSA was detected. IgG subclass antibodies showed a distinct pattern in patients who were positive for anti-HLA IgE. Moreover, patients with anti-HLA IgE showed elevated Th2 and also Th1 cytokine levels. Serum from IgE positive recipients led to degranulation of basophils in vitro, demonstrating functionality of anti-HLA IgE. Discussion These data demonstrate that anti-HLA IgE antibodies occur at low frequency in kidney, liver, heart and lung transplant recipients. Anti-HLA IgE development is associated with sensitization at the IgG level, in particular through previous transplants and distinct IgG subclasses. Taken together, HLA specific IgE sensitization is a new phenomenon in solid organ transplant recipients whose potential relevance for allograft injury requires further investigation.
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Affiliation(s)
- Jasmin Mucha
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Ara Cho
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Anna Marianne Weijler
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Moritz Muckenhuber
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Amun Georg Hofmann
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Markus Wahrmann
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Andreas Heinzel
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Birgit Linhart
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Pia Gattinger
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Gabriela Berlakovich
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Jaksch
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Rainer Oberbauer
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Thomas Wekerle
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
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13
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Moser PT, Schernthaner R, Loewe C, Strassl A, Denzinger F, Faby S, Wels M, Nizhnikava V, Uyanik-Uenal K, Zuckermann A, Stelzmueller ME, Beitzke D. Evaluation of perivascular fat attenuation with coronary CT angiography in cardiac transplantation patients: an imaging biomarker candidate for prediction of cardiac mortality and re-transplantation. Eur Radiol 2023; 33:6299-6307. [PMID: 37072507 PMCID: PMC10415448 DOI: 10.1007/s00330-023-09614-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVES In cardiac transplant recipients, non-invasive allograft surveillance for identifying patients at risk for graft failure remains challenging. The fat attenuation index (FAI) of the perivascular adipose tissue in coronary computed tomography angiography (CCTA) predicts outcomes in coronary artery disease in non-transplanted hearts; however, it has not been evaluated in cardiac transplant patients. METHODS We followed 39 cardiac transplant patients with two or more CCTAs obtained between 2010 and 2021. We performed FAI measurements around the proximal 4 cm segments of the left anterior descending (LAD), right coronary artery (RCA), and left circumflex artery (LCx) using a previously validated methodology. The FAI was analyzed at a threshold of - 30 to - 190 Hounsfield units. RESULTS FAI measurements were completed in 113 CCTAs, obtained on two same-vendor CT models. Within each CCTA, the FAI values between coronary vessels were strongly correlated (RCA and LAD R = 0.67 (p < 0.0001), RCA and LCx R = 0.58 (p < 0.0001), LAD and LCx R = 0.67 (p < 0.0001)). The FAIs of each coronary vessel between the patient's first and last CCTA completed at 120 kV were also correlated (RCA R = 0.73 (p < 0.0001), LAD R = 0.81 (p < 0.0001), LCx R = 0.55 (p = 0.0069). Finally, a high mean FAI value of all three coronary vessels at baseline (mean ≥ - 71 HU) was predictive of cardiac mortality or re-transplantation, however, not predictive of all cause-mortality. CONCLUSION High baseline FAI values may identify a higher-risk cardiac transplant population; thus, FAI may support the implementation of CCTA in post-transplant surveillance. KEY POINT • Perivascular fat attenuation measured with coronary CT is feasible in cardiac transplant patients and may predict cardiac mortality or need for re-transplantation.
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Affiliation(s)
- Philipp T Moser
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rüdiger Schernthaner
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Klinikum Landstrasse, Vienna, Austria
| | - Christian Loewe
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Strassl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Volha Nizhnikava
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
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14
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Barten MJ, Sax B, Schopka S, Amarelli C, Epailly E, Natali B, Teszák T, Gökler J, Borchert K, Theil J, Ingram A, Zuckermann A. European multicenter study on the real-world use and clinical impact of extracorporeal photopheresis after heart transplantation. J Heart Lung Transplant 2023; 42:1131-1139. [PMID: 37037751 DOI: 10.1016/j.healun.2023.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/14/2023] [Accepted: 03/03/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Aim of this study was to describe the real-world use of extracorporeal photopheresis (ECP) and assess its impact on clinical outcomes in the modern era of heart transplantation. METHODS Seven transplant centers from 5 European countries participated in this retrospective, observational, single-arm chart review study. All patients received ECP after heart transplantation in 2015 or later. Data were extracted from medical records between November 2020 and December 2021. RESULTS Overall, 105 patients were enrolled and followed for an average of 2 years after initiation of ECP. Reasons to start ECP were acute cellular rejection (35.2%), rejection prevention (32.4%), mixed rejection (18.1%), and antibody-mediated rejection (14.3%). Rejection ISHLT grades improved from start to end of ECP treatment in 92% of patients treated with ECP for rejection. Of patients who started ECP to prevent rejection, 88% remained free from any rejection despite a reduction of calcineurin inhibitors. Overall survival was 95%, and no deaths were related to ECP. Safety events occurred in 18 patients, of which 13 experienced complications with venous access. CONCLUSIONS This study, the largest European ECP study in heart transplantation, demonstrates that ECP can effectively be used to treat different rejection types and to prevent rejection in the modern era of immunosuppression. Patients with rejections who have received ECP have shown high response as measured by histological improvements in ISHLT classification. A high percentage of patients in the prevention group remained free from rejection despite reduction in immunosuppression, in particular calcineurin inhibitors.
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Affiliation(s)
- Markus J Barten
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Balázs Sax
- Heart and Vascular Center, Semmelweis University Budapest, Budapest, Hungary
| | - Simon Schopka
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Cristiano Amarelli
- Department of Cardiovascular Surgery and Transplant, Azienda dei Colli, Monaldi Hospital, Naples, Italy
| | - Eric Epailly
- Department of Cardiovascular Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Benedetta Natali
- Department of Cardiac Surgery, Siena University Hospital, Siena, Italy
| | - Tímea Teszák
- Heart and Vascular Center, Semmelweis University Budapest, Budapest, Hungary
| | - Johannes Gökler
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Andy Ingram
- Mallinckrodt Pharmaceuticals, Staines-Upon-Thames, UK
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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15
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Balcar L, Semmler G, Scheiner B, Stättermayer AF, Ćosić S, Schwabl P, Kazem N, Mandorfer M, Hülsmann M, Zuckermann A, Reiberger T. Clinical course of congestive hepatopathy pre/post heart transplantation. Wien Klin Wochenschr 2023:10.1007/s00508-023-02231-2. [PMID: 37378679 DOI: 10.1007/s00508-023-02231-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND AND AIMS Heart failure (HF) might lead to increased hepatic venous pressure, thereby impairing hepatic blood outflow and subsequently inducing congestive hepatopathy. We aimed to evaluate prevalence of congestive hepatopathy in patients undergoing heart transplantation (HTX) as well as their post-transplant course. METHODS Patients undergoing HTX from 2015-2020 at the Vienna General Hospital were included (n = 205). Congestive hepatopathy was defined by hepatic congestion on abdominal imaging and hepatic injury. Laboratory parameters, ascites severity, and clinical events were assessed and post-HTX outcomes evaluated. RESULTS At listing, 104 (54%) patients showed hepatic congestion, 97 (47%) hepatic injury, and 50 (26%) had ascites. Congestive hepatopathy was diagnosed in 60 (29%) patients, who showed more often ascites, lower serum sodium and cholinesterase activity, and higher hepatic injury markers. Mean albumin-bilirubin (ALBI)-score as well as (modified)-model for end-stage liver disease (MELD)-scores were higher in patients with congestive hepatopathy. Median levels of laboratory parameters/scores normalised after HTX, and ascites resolved in most patients with congestive hepatopathy (n = 48/56, 86%). The post-HTX (median follow-up 55.1 months) survival was 87% and liver-related events were rare (3%). Severe ascites, low cholinesterase, and MELD/MELD-XI were associated with ascites persistence/death 1‑year after HTX. Age, male sex, and severe ascites were the only independent predictors of post-HTX mortality. Both ALBI and MELD-scores were robust indicators of post-HTX survival when measured 4 weeks after HTX (ALBI log-rank test p < 0.001; MELD log-rank test p = 0.012). CONCLUSION Congestive hepatopathy and ascites were mostly reversible after HTX. Liver-related scores and ascites improve prognostication in patients after HTX.
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Affiliation(s)
- Lorenz Balcar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Georg Semmler
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Albert Friedrich Stättermayer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Ćosić
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Philipp Schwabl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Niema Kazem
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Martin Hülsmann
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
- Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria.
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16
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Kerbel T, Uyanik-Ünal K, Mach M, Bartunek A, Gökler J, Osorio E, Bartko P, Zuckermann A, Andreas M. Transcatheter tricuspid valve edge-to-edge repair after a heart transplant: a single-centre experience with a novel therapy†. Eur J Cardiothorac Surg 2023; 63:ezad199. [PMID: 37255327 PMCID: PMC10287900 DOI: 10.1093/ejcts/ezad199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/28/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES Tricuspid regurgitation (TR) in patients who had heart transplants is associated with poor outcome. The increased risk for surgical and postoperative complications might be reduced in these vulnerable patients by transcatheter therapies. METHODS All patients with a prior heart transplant (HTX) undergoing transcatheter edge-to-edge repair in the tricuspid position (T-TEER) were prospectively enrolled in an institutional registry. RESULTS Seven patients who had heart transplants (5/7 female) at a mean age of 53 [48; 64] and median TRI-SCORE of 14 [7; 22] underwent T-TEER to treat symptomatic TR ≥ IV in an elective (n = 6) and urgent (n = 1) setting, respectively. The median time from HTX to T-TEER was 13 years. A total of 2 (n = 4) and 3 (n = 3) clips were implanted with a technical success in 6/7 (one single- device detachment). TR reduction was effective and durable within a median echocardiographic follow-up time of 10 months (TR baseline vs last follow-up: P = 0.03). Further, significant right ventricular remodelling (right ventricular end-diastolic diameter: 50 mm-36 mm, P = 0.02), decrease in the inferior vena cava diameter (24 mm-18 mm, P = 0.04) and in the gamma-glutamyl-transferase (255 U/l-159 U/l, P = 0.04) was found. Four of 7 patients were free of cardiovascular death (n = 1, 267 days after T-TEER), cardiac redo surgery (n = 1) and heart failure hospitalization (n = 2) and had no further clinical signs of right heart failure. CONCLUSIONS T-TEER after HTX is feasible and effective regarding TR reduction in a short-term follow-up. The initial results may pave the way for a novel approach in TR management in patients having HTX.
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Affiliation(s)
- Tillmann Kerbel
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | | | - Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | - Anna Bartunek
- Division of Cardiothoracic and Vascular Anesthesia, Medical University of Vienna, Austria
| | - Johannes Gökler
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | - Emilio Osorio
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | - Philipp Bartko
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | | | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Austria
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Zuckermann A, Jacobs J, Shudo Y, Meyer D, Silvestry S, Leacche M, Sciortino C, Rodrigo M, Pham S, Takeda K, Copeland H, Vidic A, Kawabori M, Boston U, Bustamante-Munguira J, Esteve AE, Venkateswaran R, Schroder J, D'Alessandro D. Validating the 2014 Consensus Primary Graft Definition: An Analysis on the 1,056 Patients from the Multi-Center Guardian Registry. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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18
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Moayedifar R, Shudo Y, Kawabori M, Silvestry S, Schroder J, Meyer D, D'Alessandro D, Zuckermann A. Recipient Outcomes with Extended Criteria Donors: An Analysis of the Guardian Heart Registry. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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19
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Han J, Moayedi Y, Truby L, Foroutan F, Bofarull JG, Saha S, Angleitner P, Sabatino M, Henricksen E, Luikart H, van Zyl J, Tremblay-Gravel M, Noly P, Segovia-Cubero J, Alesina ER, Potena L, Takeda K, Felius J, Clarke B, DeVore A, Kim G, Miller R, Zuckermann A, Farr M, Crespo-Leiro M, Hall S, Torres MF, Fan C, Ross H, Khush K, Chih S. Incidence and Predictors of Vasoplegia after Heart Transplantation: Results from the International PGD Consortium. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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20
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Boston U, Zuckermann A, Stukov Y, Schroder J, Shudo Y, Bustamante-Munguira J, Leacche M, Silvestry S, Kawabori M, Takeda K, Jacobs J. Outcomes in Children and Young Adults with Congenital Heart Disease Undergoing Transplant: A Subgroup Analysis of the Guardian Heart Registry. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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21
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Aliabadi-Zuckermann A, Osorio-Jaramillo E, Knosalla C, Gummert J, Szabo G, Wittmann F, Yeter R, Schramm R, Goekler J, Hennig F, Morshuis M, Zuckermann A. Custodiol-N versus Custodiol: Results from a Prospective Randomised Single Blind, Multicenter Phase Iii Trial in Patients Undergoing Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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22
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Atteneder C, Moayedifar R, Koren D, Fischer G, Nackenhorst M, Böhmig G, Laufer G, Zuckermann A. CD 38 Antibody Daratumumab in Allosensitized Recipients for Cardiac Transplantation - A Case Series. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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23
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Jacobs J, Boston U, Stukov Y, Schroder J, Bustamante-Munguira J, Zuckermann A. Pediatric Experience Using the Sherpapak Cardiac Transport System: A Subgroup Analysis of the Guardian Heart Registry. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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24
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Schoeberl AK, Zuckermann A, Kaider A, Aliabadi-Zuckermann A, Uyanik-Uenal K, Laufer G, Goekler J. Absolute Lymphocyte Count as a Marker for Cytomegalovirus Infection After Heart Transplantation. Transplantation 2023; 107:748-752. [PMID: 36228318 DOI: 10.1097/tp.0000000000004360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies indicate an association between reduced absolute lymphocyte count (ALC) and cytomegalovirus (CMV) infection after solid organ transplantation and have therefore highlighted the potential of ALC as a simple tool to predict CMV infection in transplant patients. This study aimed to examine the utility of ALC as a valuable marker for CMV infection in heart transplant patients. METHODS Clinical information and ALC data of all adult patients who received orthotopic heart transplantation at the Medical University of Vienna between January 2004 and May 2019 were collected. We performed a multivariable Cox regression model that incorporates repeated measurements of ALC as a time-varying continuous factor in 2 ways, first as continuous logarithmic factor considering a 50% decrease of ALC levels and second as binary factor using a threshold of 610 cells/μL. RESULTS One hundred fifty-eight (39%) patients developed CMV infection over the course of 2 y. Patients with lymphopenia were shown to be at higher risk of developing CMV infection both in the continuous approach (HR [per 50% reduction] 1.29; confidence interval [CI], 1.09-1.53; P = 0.003) and the binary approach with a cutoff of 610 cells/μL (HR 1.74; CI, 1.20-2.51; P = 0.003). CONCLUSIONS This study demonstrated a strong association between reduced ALC and the development of CMV infection after heart transplantation. ALC value monitoring could provide an additional tool to assess individualized CMV risk after solid organ transplantation.
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Affiliation(s)
- Armin-Kai Schoeberl
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kaider
- Department of Clinical Biometrics, Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
| | | | | | - Guenther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Goekler
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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25
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Borik-Heil L, Endler G, Parson W, Zuckermann A, Schnaller L, Uyanik-Ünal K, Jaksch P, Böhmig G, Cejka D, Staufer K, Hielle-Wittmann E, Rasoul-Rockenschaub S, Wolf P, Sunder-Plassmann R, Geusau A. Cumulative UV Exposure or a Modified SCINEXA™-Skin Aging Score Do Not Play a Substantial Role in Predicting the Risk of Developing Keratinocyte Cancers after Solid Organ Transplantation-A Case Control Study. Cancers (Basel) 2023; 15:cancers15030864. [PMID: 36765822 PMCID: PMC9913211 DOI: 10.3390/cancers15030864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
The risk of keratinocyte cancer is determined by intrinsic and extrinsic factors, which also influence skin aging. Few studies have linked skin aging and UV exposure with the incidence of non-melanoma skin cancer (NMSC). We evaluated signs of actinic skin damage and aging, individual UV burden, and melanocortin-1 receptor (MC1R) variants. A total of 194 organ transplant recipients (OTR) who suffered from NMSC were compared to 194 tumor-free controls matched for gender, age, type of transplanted organ, post-transplantation (TX) period, and immunosuppressive therapy. Compared with the cases, the controls scored higher in all skin aging scores and there were no differences in UV burden except for intentional whole-body UV exposure for specific UV scenarios and periods of life in favor of cases. The number of NMSCs correlated with all types of skin aging scores, the extent of intentional sun exposure, older age, longer post-TX period, shorter interval from TX to first NMSC, and specific MC1R risk groups. Multivariable models revealed a 7.5-fold risk of developing NMSC in individuals with actinic keratosis; 4.1- or 3.6-fold in those with green or blue eyes, respectively; and a 1.9-fold increased risk in the MC1R medium- + high-risk group. In the absence of skin aging contributing to NMSC development, certain MC1R risk types may identify OTR at risk for high tumor burden.
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Affiliation(s)
- Liliane Borik-Heil
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Endler
- Department of Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Walther Parson
- Institute of Legal Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Forensic Science Program, The Pennsylvania State University, University Park, PA 16801, USA
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Lisa Schnaller
- Institute of Legal Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Keziban Uyanik-Ünal
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Peter Jaksch
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Böhmig
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria
| | - Daniel Cejka
- Department of Nephrology, Ordensklinikum Barmherzige Schwestern Linz, 4020 Linz, Austria
| | - Katharina Staufer
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, 1090 Vienna, Austria
| | - Elisabeth Hielle-Wittmann
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, 1090 Vienna, Austria
| | - Susanne Rasoul-Rockenschaub
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, 1090 Vienna, Austria
| | - Peter Wolf
- Department of Dermatology, Medical University of Graz, 8036 Graz, Austria
| | | | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40400-77690
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26
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Copeland H, Knezevic I, Baran DA, Rao V, Pham M, Gustafsson F, Pinney S, Lima B, Masetti M, Ciarka A, Rajagopalan N, Torres A, Hsich E, Patel JK, Goldraich LA, Colvin M, Segovia J, Ross H, Ginwalla M, Sharif-Kashani B, Farr MA, Potena L, Kobashigawa J, Crespo-Leiro MG, Altman N, Wagner F, Cook J, Stosor V, Grossi PA, Khush K, Yagdi T, Restaino S, Tsui S, Absi D, Sokos G, Zuckermann A, Wayda B, Felius J, Hall SA. Donor heart selection: Evidence-based guidelines for providers. J Heart Lung Transplant 2023; 42:7-29. [PMID: 36357275 PMCID: PMC10284152 DOI: 10.1016/j.healun.2022.08.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023] Open
Abstract
The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.
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Affiliation(s)
- Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery Lutheran Hospital, Fort Wayne, Indiana; Indiana University School of Medicine-Fort Wayne, Fort Wayne, Indiana.
| | - Ivan Knezevic
- Transplantation Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David A Baran
- Department of Medicine, Division of Cardiology, Sentara Heart Hospital, Norfolk, Virginia
| | - Vivek Rao
- Peter Munk Cardiac Centre Toronto General Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael Pham
- Sutter Health California Pacific Medical Center, San Francisco, California
| | - Finn Gustafsson
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sean Pinney
- University of Chicago Medicine, Chicago, Illinois
| | - Brian Lima
- Medical City Heart Hospital, Dallas, Texas
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Civilisation Diseases and Regenerative Medicine, University of Information Technology and Management, Rzeszow, Poland
| | | | - Adriana Torres
- Los Cobos Medical Center, Universidad El Bosque, Bogota, Colombia
| | | | | | | | | | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Heather Ross
- University of Toronto, Toronto, Ontario, Canada; Sutter Health California Pacific Medical Center, San Francisco, California
| | - Mahazarin Ginwalla
- Cardiovascular Division, Palo Alto Medical Foundation/Sutter Health, Burlingame, California
| | - Babak Sharif-Kashani
- Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MaryJane A Farr
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luciano Potena
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | | | | | | | | | | | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kiran Khush
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Susan Restaino
- Division of Cardiology Columbia University, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Steven Tsui
- Department of Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniel Absi
- Department of Cardiothoracic and Transplant Surgery, University Hospital Favaloro Foundation, Buenos Aires, Argentina
| | - George Sokos
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Brian Wayda
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Joost Felius
- Baylor Scott & White Research Institute, Dallas, Texas; Texas A&M University Health Science Center, Dallas, Texas
| | - Shelley A Hall
- Texas A&M University Health Science Center, Dallas, Texas; Division of Transplant Cardiology, Mechanical Circulatory Support and Advanced Heart Failure, Baylor University Medical Center, Dallas, Texas
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27
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Guzman Bofarull J, Han J, Moayedi Y, Truby LK, Foroutan F, Miller R, Potena L, Zuckermann A, Chih S, Farr M, Hall S, Ross HJ, Khush K, Farrero M. Predictors of early renal dysfunction after heart transplantation: a report from the International Consortium on Primary Graft Dysfunction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Renal dysfunction is a common complication after heart transplantation (HT). Renal replacement therapy (RRT) after HT has been associated with increased risk of death. Long-term renal dysfunction is associated mainly to immunosuppressive therapy but is also strongly related to post-transplant renal failure. Predictors of early renal dysfunction after HT have not been clearly identified.
Purpose
We aimed to define predictors of early renal dysfunction after HT.
Methods
Our consortium includes 10 centers in the US, Canada and Europe. We collected data on all consecutive single-organ HT recipients from 2010 to 2020. The primary outcome was early renal dysfunction (ERD), defined as a composite of need for RRT or creatinine ≥2.5 mg/dL 24 hours after HT. We assessed the incidence of early renal dysfunction and performed univariate and multivariate analyses to identify the recipient and transplant characteristics associated with its development.
Results
We included 2,764 HT recipients: 282 (10.2%) presented early renal dysfunction and 2482 (89.8%) did not. Recipients who presented postoperative renal dysfunction were more frequently male, Caucasian, with previous sternotomy, higher baseline creatinine, longer ischemic time and worse donor LVEF. They were also more likely to be under RRT, intravenous inotropes or ECMO support and there was more incidence of severe primary graft dysfunction (PGD) (Table 1). Multi-variable logistic regression demonstrated that the strongest predictors for post-transplant renal dysfunction were development of severe PGD (OR 5.26, 2.88–9.62, p<0,001) and RRT prior to HT (OR 5.80, 2.93–11.5, p<0.001). Other predictors were male sex, previous sternotomy, long ischemic time and need for inotropes prior to HT.
Conclusions
Early renal dysfunction is a common complication after HT with an incidence around 10% in a large and contemporary cohort. The presence of PGD and need for RRT pre-transplant were the strongest predictors for its development. Interestingly, emergent transplantation or need for MCS were not independently associated with ERD. Further studies are needed to identify patients at high risk of early and late kidney dysfunction that may benefit from combined transplantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - J Han
- Stanford University Medical Center , Stanford , United States of America
| | - Y Moayedi
- University of Toronto , Toronto , Canada
| | - L K Truby
- Duke University Medical Center , Durham , United States of America
| | - F Foroutan
- University of Toronto , Toronto , Canada
| | - R Miller
- University of Calgary , Calgary , Canada
| | - L Potena
- University of Bologna , Bologna , Italy
| | | | - S Chih
- Ottawa Heart Institute , Ottawa , Canada
| | - M Farr
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - S Hall
- Baylor University Medical Center , Dallas , United States of America
| | - H J Ross
- University of Toronto , Toronto , Canada
| | - K Khush
- Stanford University Medical Center , Stanford , United States of America
| | - M Farrero
- Hospital Clinic of Barcelona , Barcelona , Spain
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28
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Sinning C, Huntgeburth M, Fukushima N, Tompkins R, Huh J, Tataneo S, Diller GP, Chen YS, Zengin E, Magnussen C, Kaemmerer AS, Cho YH, Blankenberg S, Rickers C, Harig F, Weyand M, Hübler M, von Kodolitsch Y, Oto Ö, Zuckermann A, Kirchhof P, Baumgartner H, Reichenspurner H, Kobashigawa J, Kaemmerer H, Niwa K. Treatment of advanced heart failure in adults with congenital heart disease: a narrative review and clinical cases. Cardiovasc Diagn Ther 2022; 12:727-743. [PMID: 36329959 PMCID: PMC9622410 DOI: 10.21037/cdt-22-230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/16/2022] [Indexed: 10/01/2023]
Abstract
BACKGROUND AND OBJECTIVE The number of adults with congenital heart disease (ACHD) is increasing worldwide. Almost all congenital cardiac lesions can be successfully treated due to the progress in neonatal surgery and pediatric cardiology with a high likelihood of surviving until adulthood. However, ACHD frequently develop sequelae related to the initial cardiac anomaly. Heart failure (HF) is one of the most common complications associated with a high morbidity and mortality. METHODS The authors did search the PubMed database regarding relevant content covering publications up to March 2022. Relevant manuscripts were classified according to the impact factor of the journal, being a guideline manuscript, a position paper by a society or a comprehensive review of the current literature. KEY CONTENT AND FINDINGS Optimal HF treatment remains an unmet need in ACHD. In particular, advanced HF therapy with cardiac resynchronization therapy, ventricular assist devices or organ transplantation is still very different and more specific in ACHD compared to non-ACHD. This review aims to compile international views and evidence from the literatures on the treatment of advanced HF in ACHD. Current challenges, but also the success of different treatment strategies in ACHD are illustrated by clinical cases. CONCLUSIONS The main finding of the review is that data is still scarce regarding ACHD with advanced HF and international efforts to collect data regarding these patients needed to improve the current standard of care.
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Affiliation(s)
- Christoph Sinning
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Michael Huntgeburth
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka University, Osaka, Japan
| | - Rose Tompkins
- The Guerin Family Congenital Heart Program, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - June Huh
- Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Shigeru Tataneo
- Section of Adult Congenital Heart Disease, Chiba Cerebral and Cardiovascular Center, Ichihara, Chiba, Japan
| | - Gerhard-Paul Diller
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Germany
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Elvin Zengin
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Ann-Sophie Kaemmerer
- Department of Cardiac Surgery, Friedrich-Alexander University, Erlangen-Nurnberg, Germany
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University, Seoul, South Korea
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Carsten Rickers
- Adult Congenital Heart Disease Section, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Frank Harig
- Department of Cardiac Surgery, Friedrich-Alexander University, Erlangen-Nurnberg, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, Friedrich-Alexander University, Erlangen-Nurnberg, Germany
| | - Michael Hübler
- Department of Pediatric Cardiac Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Öztekin Oto
- Dokuz Eylul University Hospital air Esref Cad, İzmir, Turkey
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
- Institute of Cardiovacsular Sciences and SWBH and UHB NHS Trusts, Birmingham, UK
| | - Helmut Baumgartner
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Jon Kobashigawa
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Koichiro Niwa
- Department of Cardiology, Cardiovascular Center, St. Luke’s International Hospital, Tokyo, Japan
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Hsich E, Singh TP, Cherikh WS, Harhay MO, Hayes D, Perch M, Potena L, Sadavarte A, Lindblad K, Zuckermann A, Stehlik J. The International thoracic organ transplant registry of the international society for heart and lung transplantation: Thirty-ninth adult heart transplantation report-2022; focus on transplant for restrictive heart disease. J Heart Lung Transplant 2022; 41:1366-1375. [PMID: 36031520 DOI: 10.1016/j.healun.2022.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Eileen Hsich
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Tajinder P Singh
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Wida S Cherikh
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Michael O Harhay
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Don Hayes
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Michael Perch
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Luciano Potena
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Aparna Sadavarte
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Kelsi Lindblad
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Andreas Zuckermann
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Josef Stehlik
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois.
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- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
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30
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Skhirtladze-Dworschak K, Felli A, Aull-Watschinger S, Jung R, Mouhieddine M, Zuckermann A, Tschernko E, Dworschak M, Pataraia E. The Impact of Nonconvulsive Status Epilepticus after Cardiac Surgery on Outcome. J Clin Med 2022; 11:jcm11195668. [PMID: 36233535 PMCID: PMC9572147 DOI: 10.3390/jcm11195668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Neurological complications after heart surgery are associated with tremendous morbidity and mortality. Nonconvulsive status epilepticus (NCSE), which can only be verified by EEG, may cause secondary brain damage. Its frequency and its impact on outcomes after cardiac surgery is still unclear. We collected the neurological files and clinical data of all our patients after heart surgery who, in the course of their ICU stay, had been seen by a neurologist who ordered an EEG. Within 18 months, 1457 patients had cardiac surgery on cardiopulmonary bypass. EEG was requested for 89 patients. Seizures were detected in 39 patients and NCSE was detected in 11 patients. Open heart surgery was performed in all 11 NSCE patients, of whom eight showed concomitant brain insults. None had a history of epilepsy. Despite the inhibition of seizure activity with antiseizure medication, clinical improvement was only noted in seven NCSE patients, three of whom were in cerebral performance category 2 and four in category 3 at hospital discharge. The four patients without neurological benefit subsequently died in the ICU. The occurrence of NCSE after open cardiac surgery is significant and frequently associated with brain injury. It seems prudent to perform EEG studies early to interrupt seizure activity and mitigate secondary cerebral injury.
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Affiliation(s)
- Keso Skhirtladze-Dworschak
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, General Hospital Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Alessia Felli
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anesthesia and Intensive Care Medicine, Medical University of Vienna, A-1090 Vienna, Austria
| | | | - Rebekka Jung
- Department of Neurology, Medical University of Vienna, A-1090 Vienna, Austria
| | - Mohamed Mouhieddine
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, General Hospital Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, A-1090 Vienna, Austria
| | - Edda Tschernko
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, General Hospital Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Martin Dworschak
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, General Hospital Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40400-41090; Fax: +43-1-40400-41100
| | - Ekaterina Pataraia
- Department of Neurology, Medical University of Vienna, A-1090 Vienna, Austria
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31
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Mrak D, Sieghart D, Simader E, Tobudic S, Radner H, Mandl P, Göschl L, Koblischke M, Hommer N, Wagner A, Mayer M, Schubert L, Hartl L, Kozbial K, Hofer P, Kartnig F, Hummel T, Kerschbaumer A, Deimel T, Puchner A, Gudipati V, Thalhammer R, Munda P, Uyanik-Ünal K, Zuckermann A, Novacek G, Reiberger T, Garner-Spitzer E, Reindl-Schwaighofer R, Kain R, Winkler S, Smolen JS, Stiasny K, Fischer GF, Perkmann T, Haslacher H, Zeitlinger M, Wiedermann U, Aberle JH, Aletaha D, Heinz LX, Bonelli M. Heterologous vector versus homologous mRNA COVID-19 booster vaccination in non-seroconverted immunosuppressed patients: a randomized controlled trial. Nat Commun 2022; 13:5362. [PMID: 36097029 PMCID: PMC9467419 DOI: 10.1038/s41467-022-33036-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022] Open
Abstract
Impaired response to COVID-19 vaccination is of particular concern in immunosuppressed patients. To determine the best vaccination strategy for this vulnerable group we performed a single center, 1:1 randomized blinded clinical trial. Patients who failed to seroconvert upon two mRNA vaccinations (BNT162b2 or mRNA-1273) are randomized to receive either a third dose of the same mRNA or the vector vaccine ChAdOx1 nCoV-19. Primary endpoint is the difference in SARS-CoV-2 spike antibody seroconversion rate between vector and mRNA vaccinated patients four weeks after the third dose. Secondary outcomes include cellular immune responses. Seroconversion rates at week four are significantly higher in the mRNA (homologous vaccination, 15/24, 63%) as compared to the vector vaccine group (heterologous vaccination, 4/22, 18%). SARS-CoV-2-specific T-cell responses are reduced but could be increased after a third dose of either vector or mRNA vaccine. In a multivariable logistic regression analysis, patient age and vaccine type are associated with seroconversion. No serious adverse event is attributed to COVID-19 booster vaccination. Efficacy and safety data underline the importance of a booster vaccination and support the use of a homologous mRNA booster vaccination in immunosuppressed patients.Trial registration: EudraCT No.: 2021-002693-10.
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Affiliation(s)
- Daniel Mrak
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Daniela Sieghart
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Simader
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Selma Tobudic
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Helga Radner
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Lisa Göschl
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Nikolaus Hommer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Angelika Wagner
- Institute of Specific Prophylaxis and Tropical Medicine, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Margareta Mayer
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Lorenz Schubert
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Lukas Hartl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Karin Kozbial
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Philipp Hofer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Felix Kartnig
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Hummel
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Deimel
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Antonia Puchner
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Venugopal Gudipati
- Institute of Hygiene and Applied Immunology, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Renate Thalhammer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Petra Munda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Keziban Uyanik-Ünal
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Gottfried Novacek
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Erika Garner-Spitzer
- Institute of Specific Prophylaxis and Tropical Medicine, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Roman Reindl-Schwaighofer
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Renate Kain
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Stefan Winkler
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Josef S Smolen
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Karin Stiasny
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Gottfried F Fischer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ursula Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Judith H Aberle
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Leonhard X Heinz
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
| | - Michael Bonelli
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
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Singh TP, Cherikh WS, Hsich E, Harhay MO, Hayes D, Perch M, Potena L, Sadavarte A, Zuckermann A, Stehlik J. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Twenty-fifth Pediatric Heart Transplantation Report — 2022; Focus on Infant Heart Transplantation. J Heart Lung Transplant 2022; 41:1357-1365. [DOI: 10.1016/j.healun.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022] Open
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Hayes D, Cherikh WS, Harhay MO, Perch M, Hsich E, Potena L, Sadavarte A, Zehner A, Singh TP, Zuckermann A, Stehlik J. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Twenty-fifth Pediatric Lung Transplantation Report — 2022; Focus on Pulmonary Vascular Diseases. J Heart Lung Transplant 2022; 41:1348-1356. [DOI: 10.1016/j.healun.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/25/2022] [Indexed: 10/16/2022] Open
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McGlothlin D, Granton J, Klepetko W, Beghetti M, Rosenzweig EB, Corris P, Horn E, Kanwar M, McRae K, Roman A, Tedford R, Badagliacca R, Bartolome S, Benza R, Caccamo M, Cogswell R, Dewachter C, Donahoe L, Fadel E, Farber HW, Feinstein J, Franco V, Frantz R, Gatzoulis M, Hwa (Anne) Goh C, Guazzi M, Hansmann G, Hastings S, Heerdt P, Hemnes A, Herpain A, Hsu CH, Kerr K, Kolaitis N, Kukreja J, Madani M, McCluskey S, McCulloch M, Moser B, Navaratnam M, Radegran G, Reimer C, Savale L, Shlobin O, Svetlichnaya J, Swetz K, Tashjian J, Thenappan T, Vizza CD, West S, Zuckerman W, Zuckermann A, De Marco T. ISHLT CONSENSUS STATEMENT: Peri-operative Management of Patients with Pulmonary Hypertension and Right Heart Failure Undergoing Surgery. J Heart Lung Transplant 2022; 41:1135-1194. [DOI: 10.1016/j.healun.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022] Open
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35
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Schaefer AK, Kiss A, Oszwald A, Nagel F, Acar E, Aliabadi-Zuckermann A, Hackl M, Zuckermann A, Kain R, Jakubowski A, Ferdinandy P, Hallström S, Podesser BK. Single Donor Infusion of S-Nitroso-Human-Serum-Albumin Attenuates Cardiac Isograft Fibrosis and Preserves Myocardial Micro-RNA-126-3p in a Murine Heterotopic Heart Transplant Model. Transpl Int 2022; 35:10057. [PMID: 35497886 PMCID: PMC9045410 DOI: 10.3389/ti.2022.10057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/17/2022] [Indexed: 11/17/2022]
Abstract
Objectives: Cold ischemia and subsequent reperfusion injury are non-immunologic cornerstones in the development of graft injury after heart transplantation. The nitric oxide donor S-nitroso-human-serum-albumin (S-NO-HSA) is known to attenuate myocardial ischemia-reperfusion (I/R)-injury. We assessed whether donor preservation with S-NO-HSA affects isograft injury and myocardial expression of GATA2 as well as miR-126-3p, which are considered protective against vascular and endothelial injury. Methods: Donor C57BL/6 mice received intravenous (0.1 μmol/kg/h) S-NO-HSA (n = 12), or 0.9% saline (control, n = 11) for 20 min. Donor hearts were stored in cold histidine-tryptophan-α-ketoglutarate-N solution for 12 h and underwent heterotopic, isogenic transplantation, except 5 hearts of each group, which were analysed immediately after preservation. Fibrosis was quantified and expression of GATA2 and miR-126-3p assessed by RT-qPCR after 60 days or immediately after preservation. Results: Fibrosis was significantly reduced in the S-NO-HSA group (6.47% ± 1.76 vs. 11.52% ± 2.16; p = 0.0023; 12 h-S-NO-HSA-hHTX vs. 12 h-control-hHTX). Expression of miR-126-3p was downregulated in all hearts after ischemia compared to native myocardium, but the effect was significantly attenuated when donors received S-NO-HSA (1 ± 0.27 vs. 0.33 ± 0.31; p = 0.0187; 12 h-S-NO-HSA-hHTX vs. 12 h-control-hHTX; normalized expression to U6 snRNA). Conclusion: Donor pre-treatment with S-NO-HSA lead to reduced fibrosis and preservation of myocardial miR-126-3p and GATA2 levels in murine cardiac isografts 60 days after transplantation.
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Affiliation(s)
- Anne-Kristin Schaefer
- Ludwig Boltzmann Institute for Cardiovascular Research, Center for Biomedical Research, Medical University of Vienna, Vienna, Austria.,Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Attila Kiss
- Ludwig Boltzmann Institute for Cardiovascular Research, Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - André Oszwald
- Department of Pathology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Felix Nagel
- Ludwig Boltzmann Institute for Cardiovascular Research, Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Eylem Acar
- Ludwig Boltzmann Institute for Cardiovascular Research, Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | | | | | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Renate Kain
- Department of Pathology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andrzej Jakubowski
- Department of Pharmacology, Jagiellonian University Medical College, Kraków, Poland.,Department of Anesthesiology and Intensive Care, Małopolska Orthopedic and Rehabilitation Hospital, Kraków, Poland
| | - Peter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Seth Hallström
- Division of Physiological Chemistry, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Bruno K Podesser
- Ludwig Boltzmann Institute for Cardiovascular Research, Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
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Laggner M, Oberndorfer F, Golabi B, Bauer J, Zuckermann A, Hacker P, Lang I, Skoro-Sajer N, Gerges C, Taghavi S, Jaksch P, Mildner M, Ankersmit HJ, Moser B. EGR1 Is Implicated in Right Ventricular Cardiac Remodeling Associated with Pulmonary Hypertension. Biology 2022; 11:biology11050677. [PMID: 35625405 PMCID: PMC9138384 DOI: 10.3390/biology11050677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022]
Abstract
Background: Pulmonary hypertension (PH) is a vasoconstrictive disease characterized by elevated mean pulmonary arterial pressure (mPAP) at rest. Idiopathic pulmonary arterial hypertension (iPAH) and chronic thromboembolic pulmonary hypertension (CTEPH) represent two distinct subtypes of PH. Persisting PH leads to right ventricular (RV) hypertrophy, heart failure, and death. RV performance predicts survival and surgical interventions re-establishing physiological mPAP reverse cardiac remodeling. Nonetheless, a considerable number of PH patients are deemed inoperable. The underlying mechanism(s) governing cardiac regeneration, however, remain largely elusive. Methods: In a longitudinal approach, we profiled the transcriptional landscapes of hypertrophic RVs and recovered hearts 3 months after surgery of iPAH and CTEPH patients. Results: Genes associated with cellular responses to inflammatory stimuli and metal ions were downregulated, and cardiac muscle tissue development was induced in iPAH after recovery. In CTEPH patients, genes related to muscle cell development were decreased, and genes governing cardiac conduction were upregulated in RVs following regeneration. Intriguingly, early growth response 1 (EGR1), a profibrotic regulator, was identified as a major transcription factor of hypertrophic RVs in iPAH and CTEPH. A histological assessment confirmed our biocomputational results, and suggested a pivotal role for EGR1 in RV vasculopathy. Conclusion: Our findings improved our understanding of the molecular events driving reverse cardiac remodeling following surgery. EGR1 might represent a promising candidate for targeted therapy of PH patients not eligible for surgical treatment.
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Affiliation(s)
- Maria Laggner
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria; (M.L.); (J.B.); (S.T.); (P.J.); (H.J.A.)
- Applied Immunology Laboratory, Medical University of Vienna, 1090 Vienna, Austria
| | - Felicitas Oberndorfer
- Clinical Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Bahar Golabi
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (B.G.); (M.M.)
| | - Jonas Bauer
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria; (M.L.); (J.B.); (S.T.); (P.J.); (H.J.A.)
| | - Andreas Zuckermann
- Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Philipp Hacker
- Department of Oral and Maxillofacial Surgery, University Hospital St. Poelten, 3100 St. Poelten, Austria;
| | - Irene Lang
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (I.L.); (N.S.-S.); (C.G.)
| | - Nika Skoro-Sajer
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (I.L.); (N.S.-S.); (C.G.)
| | - Christian Gerges
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (I.L.); (N.S.-S.); (C.G.)
| | - Shahrokh Taghavi
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria; (M.L.); (J.B.); (S.T.); (P.J.); (H.J.A.)
| | - Peter Jaksch
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria; (M.L.); (J.B.); (S.T.); (P.J.); (H.J.A.)
| | - Michael Mildner
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (B.G.); (M.M.)
| | - Hendrik Jan Ankersmit
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria; (M.L.); (J.B.); (S.T.); (P.J.); (H.J.A.)
- Applied Immunology Laboratory, Medical University of Vienna, 1090 Vienna, Austria
| | - Bernhard Moser
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria; (M.L.); (J.B.); (S.T.); (P.J.); (H.J.A.)
- Correspondence:
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37
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Crespo-Leiro MG, Costanzo MR, Gustafsson F, Khush KK, Macdonald PS, Potena L, Stehlik J, Zuckermann A, Mehra MR. Heart transplantation: focus on donor recovery strategies, left ventricular assist devices, and novel therapies. Eur Heart J 2022; 43:2237-2246. [PMID: 35441654 DOI: 10.1093/eurheartj/ehac204] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 04/06/2022] [Indexed: 12/18/2022] Open
Abstract
Heart transplantation is advocated in selected patients with advanced heart failure in the absence of contraindications. Principal challenges in heart transplantation centre around an insufficient and underutilized donor organ pool, the need to individualize titration of immunosuppressive therapy, and to minimize late complications such as cardiac allograft vasculopathy, malignancy, and renal dysfunction. Advances have served to increase the organ donor pool by advocating the use of donors with underlying hepatitis C virus infection and by expanding the donor source to use hearts donated after circulatory death. New techniques to preserve the donor heart over prolonged ischaemic times, and enabling longer transport times in a safe manner, have been introduced. Mechanical circulatory support as a bridge to transplantation has allowed patients with advanced heart failure to avoid progressive deterioration in hepato-renal function while awaiting an optimal donor organ match. The management of the heart transplantation recipient remains a challenge despite advances in immunosuppression, which provide early gains in rejection avoidance but are associated with infections and late-outcome challenges. In this article, we review contemporary advances and challenges in this field to focus on donor recovery strategies, left ventricular assist devices, and immunosuppressive monitoring therapies with the potential to enhance outcomes. We also describe opportunities for future discovery to include a renewed focus on long-term survival, which continues to be an area that is under-studied and poorly characterized, non-human sources of organs for transplantation including xenotransplantation as well as chimeric transplantation, and technology competitive to human heart transplantation, such as tissue engineering.
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Affiliation(s)
- Maria Generosa Crespo-Leiro
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomedica A Coruña (INIBIC), Centro de Investigacion Biomedica en Red Cardiovascular (CIBERCV), As Xubias 84, 15006 A Coruña, Spain
| | | | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Mandeep R Mehra
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
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38
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Gökler J, Aliabadi-Zuckermann A, Zuckermann A, Osorio E, Knobler R, Moayedifar R, Angleitner P, Leitner G, Laufer G, Worel N. Extracorporeal Photopheresis With Low-Dose Immunosuppression in High-Risk Heart Transplant Patients-A Pilot Study. Transpl Int 2022; 35:10320. [PMID: 35401042 PMCID: PMC8983826 DOI: 10.3389/ti.2022.10320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/11/2022] [Indexed: 11/16/2022]
Abstract
In severely ill patients undergoing urgent heart transplant (HTX), immunosuppression carries high risks of infection, malignancy, and death. Low-dose immunosuppressive protocols have higher rejection rates. We combined extracorporeal photopheresis (ECP), an established therapy for acute rejection, with reduced-intensity immunosuppression. Twenty-eight high-risk patients (13 with high risk of infection due to infection at the time of transplant, 7 bridging to transplant via extracorporeal membrane oxygenation, 8 with high risk of malignancy) were treated, without induction therapy. Prophylactic ECP for 6 months (24 procedures) was initiated immediately postoperatively. Immunosuppression consisted of low-dose tacrolimus (8–10 ng/ml, months 1–6; 5–8 ng/ml, >6 months) with delayed start; mycophenolate mofetil (MMF); and low maintenance steroid with delayed start (POD 7) and tapering in the first year. One-year survival was 88.5%. Three patients died from infection (POD 12, 51, 351), and one from recurrence of cancer (POD 400). Incidence of severe infection was 17.9% (n = 5, respiratory tract). Within the first year, antibody-mediated rejection was detected in one patient (3.6%) and acute cellular rejection in four (14.3%). ECP with reduced-intensity immunosuppression is safe and effective in avoiding allograft rejection in HTX recipients with risk of severe infection or cancer recurrence.
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Affiliation(s)
- Johannes Gökler
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Emilio Osorio
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Robert Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Roxana Moayedifar
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Philipp Angleitner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerda Leitner
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Nina Worel
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
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Haberbusch M, Reil J, Uyanik-Uenal K, Zuckermann A, Podesser B, Moscato F. Relationship Between Cardiac Autonomic Markers and Degree of Cardiac Reinnervation in Heart Transplant Patients: Insights from a Mathematical Model. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Barten M, Sax B, Schopka S, Epailly E, Maccherini M, Amarelli C, Theil J, Borchert K, Behlke S, Ingram A, Zuckermann A. Real World Use of Extracorporeal Photopheresis After Heart Transplantation - Clinical Outcomes from a Seven Centre European Study. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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41
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Jacobs J, Schroder J, Boston U, Zuckermann A. First Report of Pediatric Outcomes from the GUARDIAN Registry: Multi-Center Analysis of Advanced Organ Preservation for Pediatric Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Moayedi Y, Foroutan F, Truby L, Han J, Angleitner P, Guzman J, Sabatino M, Felius J, Zafar H, Law D, Van Zyl J, Tremblay-Gravel M, Segovia J, Devore A, Kim G, Lasarte MR, Knezevic I, Noly P, Farr M, Zuckermann A, Potena L, Ferrero M, Miller R, Fan S, Chih S, Hall S, Khush K, Ross H. Using Machine Learning to Develop a Contemporary Primary Graft Dysfunction Prediction Model: The International Consortium on PGD. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Truby L, Moayedi Y, Foroutan F, Han J, Guzman J, Farrero M, Zafar H, Felius J, van Zyl J, Hall S, Law D, Chih S, Angleitner P, Sabatino M, DeVore A, Miller R, Potena L, Zuckermann A, Ross H, Khush K, Farr M. Bridge to Transplant with Durable Left Ventricular Assist Device is Associated with Primary Graft Dysfunction Following Heart Transplantation: A Report from the International Consortium on Primary Graft Dysfunction. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Sadeh B, Ugolini S, Wever-Pinzon O, Potapov E, Selzman C, Bader F, Zuckermann A, Gomez-Mesa JE, Shah K, Alharethi R, Barragán PM, Hanff T, Goldreich LA, Farrero M, Macdonald P, Drakos S, Mehra M, Stehlik J. Large Variation in Heart Transplant Selection Practices During the COVID-19 Pandemic. J Heart Lung Transplant 2022. [PMCID: PMC8988480 DOI: 10.1016/j.healun.2022.01.1780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose A growing proportion of transplant donors and recipients have a history of COVID infection. Transplant societies issued guidelines to support decisions regarding donor selection and recipient activation after COVID infection, but outcome data are still limited. This study sought to characterize heterogeneity in current clinical practice and opinions regarding cardiac donation after recipient or donor COVID infection. Methods An online survey was distributed to heart transplant clinicians through a professional society message board and social media. Responses were collected between September 29 and October 18, 2021. Results 204 healthcare professionals from diverse geographic regions (North and South America, Europe, Middle East, Asia and Australia) completed the survey, including 143 (70%) transplant cardiologists, 42 (21%) cardiac surgeons and 19 (9%) other heart transplant clinicians. 80% of clinicians felt COVID vaccine should be mandatory before transplant. There was significant variation in clinical practice for donor acceptance and recipient management, including several scenarios directly addressed by society guidelines - see Figure 1 for a sample of responses. Conclusion There is significant variation in the clinical approach to common scenarios following donor or recipient COVID infection. This reflects continued uncertainty with post-transplant outcomes impacted by pre-transplant COVID infection. Granular outcome data are needed to better inform clinical decisions.
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Moayedifar R, Angleitner P, Gökler J, Osorio E, Horvat J, Atteneder C, Aliabadi-Zuckermann A, Laufer G, Zuckermann A. Austrian Analysis of the GUARDIAN Registry: Heart Transplant Effects in Europe from the Global Pandemic. J Heart Lung Transplant 2022. [PMCID: PMC9364676 DOI: 10.1016/j.healun.2022.01.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Purpose Methods Results Conclusion
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Opfermann P, Felli A, Schlömmer C, Dworschak M, Bevilacqua M, Mouhieddine M, Zimpfer D, Zuckermann A, Steinlechner B. A Prospective Observational Study on Multiplate®-, ROTEM®- and Thrombin Generation Examinations Before and Early After Implantation of a Left Ventricular Assist Device (LVAD). Front Med (Lausanne) 2022; 9:760816. [PMID: 35280873 PMCID: PMC8914262 DOI: 10.3389/fmed.2022.760816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/20/2022] [Indexed: 12/11/2022] Open
Abstract
Background Heart failure patients are frequently on coagulation-active medications before LVAD implantation and perioperative bleeding is a frequent complication after left ventricular assist device (LVAD) implantation. The role of point-of-care coagulation tests in assessing bleeding risk for LVAD implantation and the early postoperative time course of these tests is not well established. Methods We prospectively enrolled 25 patients with terminal heart failure undergoing LVAD implantation. Study related TRAP-, ASPI- and ADP- tests of Multiplate® platelet aggregometry, ROTEM® rotational thromboelastometry (INTEM, EXTEM, FIBTEM), thrombin generation assay and conventional laboratory studies were measured at 11 predefined time-points during the first 21 postoperative days. We examined if preoperative TRAP-, ASPI-, ADP- and ROTEM values are correlated with estimated total blood loss (primary outcome parameter) during the first 21 days after LVAD implantation and compared the baseline values of these measurements between patients with a bleeding event to those without. We performed Spearman's correlation and non-parametric tests for paired and non-paired comparisons. Results 7 out of 25 (28%) patients experienced a bleeding event of which 4 required surgical revision. Of the preoperatively performed measurements the TRAP test [Spearman's Rho (ρ) = −0.5, p = 0.01], INTEM CFT (ρ = 0.72, p < 0.001), INTEM alpha (−0.7, p < 0.001), EXTEM MCF (ρ = −0.63; p < 0.001), EXTEM alpha (ρ = −0.67; p < 0.001), FIBTEM MCF (ρ = −0.41; p = 0.042), Fibrinogen (Clauss) (ρ = −0.5; p = 0.011), Anti-thrombin activity (ρ = −0.49; p = 0.013) and platelet count (ρ = −0.42; p = 0.034) were significantly correlated to total blood loss. Patients undergoing a surgical bleeding revision had significantly reduced values in TRAP—[31.5 IQR (17.25–43.5U) vs. 69 IQR (52.5–87U); p = 0.004], ASPI—[16.5 IQR (5.5–35.7U) vs. 39 IQR (24.5–62.5U); p = 0.038], ADP—[30 IQR (22–69U) vs. 12.5 IQR (8.7–21.5U); p = 0.01], EXTEM MCF—[63 IQR (57.7–63.7) vs. 67 IQR (65–75.5); p = 0.019] and EXTEM alpha [74 IQR (68.75–74) vs. 79 IQR (78–80.5); p = 0.002] values before LVAD implantation. Conclusion Multiplate® and ROTEM® measurements before LVAD implantation may identify LVAD candidates with platelet dysfunction and alterations of the primary hemostasis and could guide anesthetists and intensive care practitioners in bleeding risk stratification and in the perioperative clinical management.
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Affiliation(s)
- Philipp Opfermann
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Alessia Felli
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Christine Schlömmer
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Martin Dworschak
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Michele Bevilacqua
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Mohamed Mouhieddine
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Barbara Steinlechner
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
- *Correspondence: Barbara Steinlechner
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47
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Holaubek C, Winter F, Lesjak A, Aliabadi-Zuckermann A, Opfermann P, Urbanek B, Schlömmer C, Mouhieddine M, Zuckermann A, Steinlechner B. Perioperative Risk Factors for Intensive Care Unit Readmissions and Mortality After Cardiac Surgery. J Cardiothorac Vasc Anesth 2021; 36:2339-2343. [PMID: 34879925 DOI: 10.1053/j.jvca.2021.10.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to identify perioperative risk factors associated with intensive care unit readmission and in-hospital death after cardiac surgery. DESIGN Retrospective analysis using a multivariate regression model to identify independent risk factors for intensive care unit [ICU] readmission and in-hospital mortality. SETTING The study was carried out in a single tertiary-care hospital. PARTICIPANTS This was an analysis of 2,789 adult patients. INTERVENTIONS All patients underwent cardiac surgery and were admitted to the intensive care unit perioperatively at the General Hospital Vienna. MEASUREMENTS AND MAIN RESULTS Among the 2,789 patients included in the analysis, 167 (6%) were readmitted to the intensive care unit during the same hospital stay. Preoperative risk factors associated with ICU readmission included end-stage renal failure (odds ratio [OR] 2.80, 95% CI: 1.126-6.964), arrhythmia (OR 1.59, 95% CI: 1.019-2.480), chronic obstructive pulmonary disease (OR 1.51, 95% CI: 1.018-2.237), age >80 (OR 2.55, 95% CI: 1.189-5.466), and European System for Cardiac Operative Risk Evaluation II >8 (OR 1.40, 95% CI: 1.013-1.940). Readmitted patients were more likely to die than nonreadmitted patients (OR 5.3, 95% CI: 3.284-8.558). In-hospital mortality in readmitted patients was 19.2%, whereas that in the nonreadmitted study population was 5.1%. CONCLUSION Preoperative risk assessment is crucial for identifying cardiac surgery patients at risk of ICU readmission and in-hospital death. The potentially modifiable risk factors pinpointed by this study call for the optimization of care before surgery and after ICU discharge.
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Affiliation(s)
- Caroline Holaubek
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Fabian Winter
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Anita Lesjak
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Philipp Opfermann
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Bernhard Urbanek
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Christine Schlömmer
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Mohamed Mouhieddine
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Barbara Steinlechner
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.
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48
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Stehlik J, Christie JD, Goldstein DR, Amarelli C, Bertolotti A, Chambers DC, Dorent R, Gonzalez-Vilchez F, Parameshwar J, Perch M, Zuckermann A, Coll E, Levy RD, Atik FA, Gomez-Mesa JE, Moayedi Y, Peled-Potashnik Y, Schultz G, Cherikh W, Danziger-Isakov L. The evolution of the ISHLT transplant registry. Preparing for the future. J Heart Lung Transplant 2021; 40:1670-1681. [PMID: 34657795 DOI: 10.1016/j.healun.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Jason D Christie
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel R Goldstein
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Cristiano Amarelli
- Department of Cardiac Surgery and Transplants, Monaldi, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Alejandro Bertolotti
- Transplant Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | | | - Richard Dorent
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine Cedex, France
| | - Francisco Gonzalez-Vilchez
- Servicio de Cardiología. Hospital Universitario Marques de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - Jayan Parameshwar
- NHS Blood and Transplant and Advanced Heart Failure and Heart Transplant Service, Royal Papworth Hospital, Cambridge, UK
| | - Michael Perch
- Department of Cardiology, Heartcenter Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Robert D Levy
- Department of Medicine, Vancouver General Hospital, Vancouver, Canada
| | - Fernando A Atik
- Instituto de Cardiologia do Distrito Federal, Brasília, Brazil
| | - Juan Esteban Gomez-Mesa
- Juan Gomez - Cardiology service, Fundación Valle del Lili and Universidad Icesi, Cali, Colombia
| | - Yasbanoo Moayedi
- Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Yael Peled-Potashnik
- Cardiothoracic and Vascular Center, Yael Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Greg Schultz
- International Society for Heart and Lung Transplantation, Addison, Texas
| | - Wida Cherikh
- United Network for Organ Sharing, Richmond, Virginia
| | - Lara Danziger-Isakov
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
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49
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Hayes D, Harhay MO, Cherikh WS, Chambers DC, Perch M, Khush KK, Hsich E, Potena L, Sadavarte A, Booker S, Singh TP, Zuckermann A, Stehlik J. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Twenty-fourth pediatric lung transplantation report - 2021; Focus on recipient characteristics. J Heart Lung Transplant 2021; 40:1023-1034. [PMID: 34561022 DOI: 10.1016/j.healun.2021.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Don Hayes
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Michael O Harhay
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Wida S Cherikh
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Daniel C Chambers
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Michael Perch
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Kiran K Khush
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Eileen Hsich
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Luciano Potena
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Aparna Sadavarte
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Sarah Booker
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Tajinder P Singh
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Andreas Zuckermann
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Josef Stehlik
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, Texas.
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Sinning C, Zengin E, Diller GP, Onorati F, Castel MA, Petit T, Chen YS, Lo Rito M, Chiarello C, Guillemain R, Coniat KNL, Magnussen C, Knappe D, Becher PM, Schrage B, Smits JM, Metzner A, Knosalla C, Schoenrath F, Miera O, Cho MY, Bernhardt A, Weimann J, Goßling A, Terzi A, Amodeo A, Alfieri S, Angeli E, Ragni L, Napoleone CP, Gerosa G, Pradegan N, Rodrigus I, Dumfarth J, de Pauw M, François K, Van Caenegem O, Ancion A, Van Cleemput J, Miličić D, Moza A, Schenker P, Thul J, Steinmetz M, Warnecke G, Ius F, Freyt S, Avsar M, Sandhaus T, Haneya A, Eifert S, Saeed D, Borger M, Welp H, Ablonczy L, Schmack B, Ruhparwar A, Naito S, Hua X, Fluschnik N, Nies M, Keil L, Senftinger J, Ismaili D, Kany S, Csengeri D, Cardillo M, Oliveti A, Faggian G, Dorent R, Jasseron C, Blanco AP, Márquez JMS, López-Vilella R, García-Álvarez A, López MLP, Rocafort AG, Fernández ÓG, Prieto-Arevalo R, Zatarain-Nicolás E, Blanchart K, Boignard A, Battistella P, Guendouz S, Houyel L, Para M, Flecher E, Gay A, Épailly É, Dambrin C, Lam K, Ka-Lai CH, Cho YH, Choi JO, Kim JJ, Coats L, Crossland DS, Mumford L, Hakmi S, Sivathasan C, Fabritz L, Schubert S, Gummert J, Hübler M, Jacksch P, Zuckermann A, Laufer G, Baumgartner H, Giamberti A, Reichenspurner H, Kirchhof P. Study design and rationale of the pAtients pResenTing with cOngenital heaRt dIseAse Register (ARTORIA-R). ESC Heart Fail 2021; 8:5542-5550. [PMID: 34510806 PMCID: PMC8712832 DOI: 10.1002/ehf2.13574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 01/03/2023] Open
Abstract
Aim Due to improved therapy in childhood, many patients with congenital heart disease reach adulthood and are termed adults with congenital heart disease (ACHD). ACHD often develop heart failure (HF) as a consequence of initial palliative surgery or complex anatomy and subsequently require advanced HF therapy. ACHD are usually excluded from trials evaluating heart failure therapies, and in this context, more data about heart failure trajectories in ACHD are needed to guide the management of ACHD suffering from HF. Methods and results The pAtients pResenTing with cOngenital heaRt dIseAse Register (ARTORIA‐R) will collect data from ACHD evaluated or listed for heart or heart‐combined organ transplantation from 16 countries in Europe and the Asia/Pacific region. We plan retrospective collection of data from 1989–2020 and will include patients prospectively. Additional organizations and hospitals in charge of transplantation of ACHD will be asked in the future to contribute data to the register. The primary outcome is the combined endpoint of delisting due to clinical worsening or death on the waiting list. The secondary outcome is delisting due to clinical improvement while on the waiting list. All‐cause mortality following transplantation will also be assessed. The data will be entered into an electronic database with access to the investigators participating in the register. All variables of the register reflect key components important for listing of the patients or assessing current HF treatment. Conclusion The ARTORIA‐R will provide robust information on current management and outcomes of adults with congenital heart disease suffering from advanced heart failure.
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Affiliation(s)
- Christoph Sinning
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Elvin Zengin
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | | | - Francesco Onorati
- Divisione Ospedaliero Universitaria Cardiochirurgia Verona, Verona, Italy
| | - María-Angeles Castel
- Heart Failure and Heart Transplantation Unit, Cardiology Department, ICCV, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | - Thibault Petit
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne, Newcastle Upon Tyne, UK
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Carmelina Chiarello
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Romain Guillemain
- Chirurgie cardio vasculaire, Hôpital Européen Georges-Pompidou HEGP, Paris, France
| | - Karine Nubret-Le Coniat
- Programme de transplantation et d'assistance cardiaque adulte et pédiatrique au CHU de Bordeaux, Haut Lévêque Hospital, Pessac, France
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Dorit Knappe
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Peter Moritz Becher
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Andreas Metzner
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Centre of Cardiovascular Research DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Charité University Medicine Berlin, Corporate Member of Freie University Berlin, Humboldt-University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Centre of Cardiovascular Research DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Mi-Young Cho
- Department of Congenital Heart Surgery/Pediatric Heart Surgery German Heart Center Berlin, Berlin, Germany
| | - Alexander Bernhardt
- German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Alina Goßling
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | | | - Antonio Amodeo
- Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Sara Alfieri
- Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Emanuela Angeli
- Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio - Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
| | - Luca Ragni
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Gino Gerosa
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, University of Padova, Padova, Italy
| | - Nicola Pradegan
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, University of Padova, Padova, Italy
| | - Inez Rodrigus
- Department of Cardiac Surgery, Universitair Ziekenhuis Antwerpen, Antwerpen, Belgium
| | - Julia Dumfarth
- Department of Cardiac Surgery, University of Innsbruck, Innsbruck, Austria
| | - Michel de Pauw
- Department of Cardiology, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Katrien François
- Department of Cardiovascular Surgery, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Olivier Van Caenegem
- Division of Cardiovascular Intensive Care and Heart Transplantation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Arnaut Ancion
- Department of Cardiology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Johan Van Cleemput
- Department of Cardiology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Davor Miličić
- Department of Cardiology, Medical Faculty University of Zagreb, Zagreb, Croatia
| | - Ajay Moza
- Department of Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany
| | - Peter Schenker
- Department of Surgery, University Hospital Bochum, Bochum, Germany
| | - Josef Thul
- Department of Pediatric Cardiology, University Hospital Giessen/Marburg, Giessen, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology, University Hospital Göttingen, Göttingen, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Susanne Freyt
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tim Sandhaus
- Department of Cardiovascular Surgery, University Hospital Jena, Jena, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sandra Eifert
- Department of Cardiovascular Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Diyar Saeed
- Department of Cardiovascular Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Cardiovascular Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Henryk Welp
- Department of Cardiac Surgery, University Hospital Münster, Münster, Germany
| | - László Ablonczy
- Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Shiho Naito
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Xiaoqin Hua
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Nina Fluschnik
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Moritz Nies
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Laura Keil
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Juliana Senftinger
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Djemail Ismaili
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Shinwan Kany
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Dora Csengeri
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | | | | | - Giuseppe Faggian
- Divisione Ospedaliero Universitaria Cardiochirurgia Verona, Verona, Italy
| | | | | | | | | | - Raquel López-Vilella
- Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ana García-Álvarez
- Heart Failure and Heart Transplantation Unit, Cardiology Department, ICCV, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | - María Luz Polo López
- Cirugia Cardiovascular, Servicio de Cirugia Cardiovascular Infantil y de Cardiopatías Congénitas, Hospital Universitario La Paz, Madrid, Spain
| | - Alvaro Gonzalez Rocafort
- Cirugia Cardiovascular, Servicio de Cirugia Cardiovascular Infantil y de Cardiopatías Congénitas, Hospital Universitario La Paz, Madrid, Spain
| | - Óscar González Fernández
- Heart Failure and Transplant Unit, Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Raquel Prieto-Arevalo
- Department of Cardiology, Gregorio Marañon University Hospital CIBER-CV, Madrid, Spain
| | | | | | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Pascal Battistella
- Department of Cardiology, Montpellier University Hospital, Montpellier Cedex 5, France
| | - Soulef Guendouz
- Département de Cardiologie, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Lucile Houyel
- M3C-Necker Enfants malades, AP-HP, Université de Paris, Paris, France
| | - Marylou Para
- Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France
| | - Erwan Flecher
- Division of Thoracic and Cardiovascular Surgery, Rennes University Hospital, Rennes, France
| | - Arnaud Gay
- Thoracic and Cardiovascular Surgery Department, Rouen University Hospital, Rouen, France
| | - Éric Épailly
- Department of Cardiac Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Camille Dambrin
- Service de Cardiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Kaitlyn Lam
- Department of Cardiology, Fiona Stanly Hospital, Perth, Australia
| | - Cally Ho Ka-Lai
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University, Seoul, South Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Jae-Joong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Louise Coats
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne, Newcastle Upon Tyne, UK.,Congenital Heart Disease Research Group, Population Health Sciences Institute Newcastle University, Newcastle upon Tyne, UK
| | - David Steven Crossland
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne, Newcastle Upon Tyne, UK.,Congenital Heart Disease Research Group, Population Health Sciences Institute Newcastle University, Newcastle upon Tyne, UK
| | | | - Samer Hakmi
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Cumaraswamy Sivathasan
- Department of Cardiothoracic Surgery, Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Larissa Fabritz
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,Institute of Cardiovacsular Sciences and SWBH and UHB NHS Trusts, Birmingham, UK.,Department of Cardiology, University Hospital Birmingham, Birmingham, UK
| | - Stephan Schubert
- Center for Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michael Hübler
- German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Pediatric Cardiac Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Peter Jacksch
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Helmut Baumgartner
- Department of Cardiology III, University Hospital Münster, Münster, Germany
| | - Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Hermann Reichenspurner
- German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Institute of Cardiovacsular Sciences and SWBH and UHB NHS Trusts, Birmingham, UK
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