The Safety and Late Hemodynamics of Donor Cardiac Undersizing in Heart Transplantation.

Background: Predicted heart mass ratio (PHMr) has become the standard donor-recipient size matching method in heart transplantation. While utilization of small PHMr hearts is associated with increased one-year mortality, the underlying mechanisms and time horizon of mortality remain uncertain.

Methods: A single institution analysis of isolated heart transplant recipients (01/2019-7/2022) was performed (N=334).

Rejection in the setting of combined Heart and Liver Transplantation.

Introduction: Each year the number of combined heart-liver transplants (HLT) increases, with two distinct patient populations proceeding down this pathway. The first are patients with congenital heart disease (CHD), most commonly single ventricle patients palliated with Fontan. The second group are those with long standing congestive hepatopathy, amyloidosis, hemochromatosis, or alcohol induced myopathies and liver disease.

Denial for Advanced Heart Failure Therapies Due to Psychosocial Stressors: Who Comes Back?

Background: Psychosocial evaluations to assess candidacy for advanced heart failure therapies are not standardized across institutions, potentially contributing to disparities in approval for advanced therapies. Remediation rates of psychosocial stressors among patients with advanced HF and reconsideration for advanced therapies have not been well-described.

Methods And Results: We performed a retrospective, single-center study of 647 adults evaluated for heart transplant and ventricular assist device implantation between 2014 and 2020, of whom 89 (14%) were denied for psychosocial stressors, including caregiver, substance use, housing, financial, or mental health concerns.

Early Assessment of Cardiac Allograft Vasculopathy Risk Among Recipients of Hepatitis C Virus-infected Donors in the Current Era.

Background: Transplantation of hearts from hepatitis C virus (HCV)-positive donors has increased substantially in recent years following development of highly effective direct-acting antiviral therapies for treatment and cure of HCV. Although historical data from the pre-direct-acting antiviral era demonstrated an association between HCV-positive donors and accelerated cardiac allograft vasculopathy (CAV) in recipients, the relationship between the use of HCV nucleic acid test-positive (NAT+) donors and the development of CAV in the direct-acting antiviral era remains unclear.

Methods And Results: We performed a retrospective, single-center observational study comparing coronary angiographic CAV outcomes during the first year after transplant in 84 heart transplant recipients of HCV NAT+ donors and 231 recipients of HCV NAT- donors.

Outcomes of Heart Transplant Donation After Circulatory Death.

Background: Heart transplantation using donation after circulatory death (DCD) allografts is increasingly common, expanding the donor pool and reducing transplant wait times. However, data remain limited on clinical outcomes.

Objectives: We sought to compare 6-month and 1-year clinical outcomes between recipients of DCD hearts, most of them recovered with the use of normothermic regional perfusion (NRP), and recipients of donation after brain death (DBD) hearts.

Disparities in Practice Patterns by Sex, Race, and Ethnicity in Patients Referred for Advanced Heart Failure Therapies.

Advanced heart failure (HF) therapies improve survival in patients with stage D HF. We sought to evaluate differences by race/ethnicity and sex in advanced HF therapy referrals and decision-making across a multicenter survey. We performed a retrospective analysis of patients referred for evaluation for advanced HF therapies at 9 centers (n = 515) across the United States.

Early Blood Pressure Variables Associated With Improved Outcomes in VA-ECLS: The ELSO Registry Analysis.

Background: As utilization of veno-arterial extracorporeal life support (VA-ECLS) in treatment of cardiogenic shock (CS) continues to expand, clinical variables that guide clinicians in early recognition of myocardial recovery and therefore, improved survival, after VA-ECLS are critical. There remains a paucity of literature on early postinitiation blood pressure measurements that predict improved outcomes.

Objectives: The objective of this study is to help identify early blood pressure variables associated with improved outcomes in VA-ECLS.

Practices of Referring Patients to Advanced Heart Failure Centers.

Background: Therapies for advanced heart failure (AHF) improve the likelihood of survival in a growing population of patients with stage D heart failure (HF). Successful implementation of these therapies is dependent upon timely and appropriate referrals to AHF centers.

Methods: We performed a retrospective analysis of patients referred to 9 AHF centers for evaluation for AHF therapies.

Successful Treatment of Steroid-Refractory Checkpoint Inhibitor Myocarditis with Globulin Derived-Therapy: A Case Report and Literature Review.

Immune checkpoint inhibitor (ICI) monoclonal antibody drugs are an important interface of immunology and cancer biology with the intended goal to create cancer specific treatments with less systemic toxicity. Recognition of immune-related adverse events is critical and these include significant cardiovascular toxicity and myocarditis. Compared with other immune-related events, ICI associated myocarditis is rare but is associated with high mortality.

Sustained Improvement in Diastolic Reserve Following Percutaneous Pericardiotomy in a Porcine Model of Heart Failure With Preserved Ejection Fraction.

Background: Heart failure with preserved ejection fraction is increasing in prevalence, but few effective treatments are available. Elevated left ventricular (LV) diastolic filling pressures represent a key therapeutic target. Pericardial restraint contributes to elevated LV end-diastolic pressure, and acute studies have shown that pericardiotomy attenuates the rise in LV end-diastolic pressure with volume loading.

Injectable conductive hydrogel restores conduction through ablated myocardium.

Introduction: Therapies for substrate-related arrhythmias include ablation or drugs targeted at altering conductive properties or disruption of slow zones in heterogeneous myocardium. Conductive compounds such as carbon nanotubes may provide a novel personalizable therapy for arrhythmia treatment by allowing tissue homogenization.

Methods: A nanocellulose carbon nanotube-conductive hydrogel was developed to have conduction properties similar to normal myocardium.

Mortality in Patients With Right Bundle-Branch Block in the Absence of Cardiovascular Disease.

Background Right bundle-branch block (RBBB) occurs in 0.2% to 1.3% of people and is considered a benign finding.

Reversible cardiac dysfunction in severe COVID-19 infection, mechanisms and case report.

A previously healthy 49-year-old male patient presented with COVID-19 infection and required mechanical ventilation and extracorporeal membrane oxygenation due to severe hypoxemia. Echocardiography showed cardiac dysfunction with an apical sparing strain pattern, which rapidly normalized within a week. Apical sparing myocardial strain in patients with COVID-19 infection may suggest reverse-type stress cardiomyopathy.

Three-Dimensional Printed Biopatches With Conductive Ink Facilitate Cardiac Conduction When Applied to Disrupted Myocardium.

Background: Reentrant ventricular arrhythmias are a major cause of sudden death in patients with structural heart disease. Current treatments focus on electrically homogenizing regions of scar contributing to ventricular arrhythmia with ablation or altering conductive properties using antiarrhythmic drugs. The high conductivity of carbon nanotubes may allow restoration of conduction in regions where impaired electrical conduction results in functional abnormalities.

Quantifying electrical interactions between cardiomyocytes and other cells in micropatterned cell pairs.

Micropatterning is a powerful technique to control cell shape and position on a culture substrate. In this chapter, we describe the method to reproducibly create large numbers of micropatterned heterotypic cell pairs with defined size, shape, and length of cell-cell contact. These cell pairs can be utilized in patch clamp recordings to quantify electrical interactions between cardiomyocytes and non-cardiomyocytes.

Management of ventricular arrhythmias in patients with ventricular assist devices.

Purpose Of Review: To summarize the available evidence concerning the occurrence and treatment of ventricular arrhythmias in patients supported with long-term ventricular assist devices (VADs).

Recent Findings: Approximately one-third of left ventricular assist device-supported patients experience significant ventricular arrhythmias, with higher rates in certain patient subsets. Ventricular arrhythmias are associated with both increased mortality and morbidity in VAD-supported patients.

Free vascularized fibular grafting preserves athletic activity level in patients with osteonecrosis.

Athletic patients with osteonecrosis of the femoral head have few desirable therapeutic options that preserve athletic ability. Because these patients are usually young and healthy, any procedure that avoids total hip arthroplasty would be most desirable. This study prospectively evaluated 15 patients (19 hips) who presented with an average age of 28.

An evidence-based review of a single surgeon's experience with endoscopic carpal tunnel release.

Although introduced more than 20 years ago, endoscopic carpal tunnel release (ECTR) continues to generate debate and controversy among surgeons. This review examines a single surgeon's technique for ECTR over the past 13 years to better understand the effects of a surgeon's experience on outcomes. A retrospective review was performed on a case series of 129 patients ages 25 to 89 years old who underwent an ECTR at Duke University.

Transcriptomic biomarkers of cardiovascular disease.

Transcriptomics is the study of how our genes are regulated and expressed in different biological settings. Technical advances now enable quantitative assessment of all expressed genes (ie, the entire "transcriptome") in a given tissue at a given time. These approaches provide a powerful tool for understanding complex biological systems and for developing novel biomarkers.

Cardiac fibroblast paracrine factors alter impulse conduction and ion channel expression of neonatal rat cardiomyocytes.

Aims: The pathological proliferation of cardiac fibroblasts (CFs) in response to heart injury results in fibrosis, which correlates with arrhythmia generation and heart failure. Here we systematically examined the effect of fibroblast-derived paracrine factors on electrical propagation in cardiomyocytes.

Methods And Results: Neonatal rat cardiac monolayers were exposed for 24 h to media conditioned by CFs.

Structural coupling of cardiomyocytes and noncardiomyocytes: quantitative comparisons using a novel micropatterned cell pair assay.

Well-controlled studies of the structural and functional interactions between cardiomyocytes and other cells are essential for understanding heart pathophysiology and for the further development of safe and efficient cell therapies. We established a novel in vitro assay composed of a large number of individual micropatterned cell pairs with reproducible shape, size, and region of cell-cell contact. This assay was applied to quantify and compare the frequency of expression and distribution of electrical (connexin43) and mechanical (N-cadherin) coupling proteins in 5,000 cell pairs made of cardiomyocytes (CMs), cardiac fibroblasts (CFs), skeletal myoblasts (SKMs), and mesenchymal stem cells (MSCs).

Angiogenesis therapies for cardiovascular disease.

Purpose Of Review: The purpose was to summarize the findings of the proangiogenic clinical trials using protein and gene therapy, with analysis of the problems and an interpretation of the results.

Recent Findings: Recent findings include several new large clinical trials, using both gene and protein therapies. There has been development of new basic science concepts, especially with regard to endothelial activation and stabilization of newly formed microvessels.