Do vasoactive medications impact donor hearts clinical outcomes in pediatric heart transplantation?

Objectives: There is limited data examining donor vasopressor and/or inotrope medications (vasoactives) on pediatric orthotopic heart transplant (OHT) outcomes. We aim to evaluate the effects of vasoactives on pediatric OHT outcomes.

Methods: The United Network for Organ Sharing database was retrospectively reviewed from January 2000 to March 2018 for donor hearts.

Does donor treatment with inotropes and/or vasopressors impact post-transplant outcomes?

Purpose: The purpose was to evaluate the effects of the most commonly used cardiac donor inotropes/vasopressors on subsequent post-heart transplant survival.

Methods: Adult heart transplant recipients from January 2000 to June 2022 were identified in the United Network for Organ Sharing (UNOS) database. Exclusion criteria included: multiorgan transplants, donor age < 15, and recipient age < 18.

Donor Utilization in the Recent Era: Effect of Sex, Drugs, and Increased Risk.

Background: Heart transplantation volumes have increased in recent years, yet less than a third of donors are typically accepted for transplantation. Whether donor sex, donor drug use, or perception of increased risk affects utilization for transplantation is unclear.

Methods: The United Network for Organ Sharing database was queried for donors from January 1, 2007, to December 31, 2017.

Functional status of heart transplant recipients predicts survival.

Introduction: Recipient functional status prior to transplantation can significantly impact post-transplant survival.

Methods: The United Network for Organ Sharing database was queried for adult heart transplants including data on functional capacity and from February 1, 2005 to March 1, 2021; there were 32 875 cases included. The four functional categories studied were based on adult daily activities of living and were separated into total assistance required, some assistance required, no assistance required, and near death.

Ischemic time and patient outcomes after the 2018 UNOS donor heart allocation system change.

Background: The allocation system for heart donors in the United States changed on October 18, 2018. The typical distance from donor hospitals to recipient hospitals has increased as has the ischemic time. We investigated patient outcomes with the new allocation system and the differential effects of ischemic time under both the old and new allocation schemas.

"It Works." Every heart transplant program should have one.

The total artificial heart (TAH) provides full biventricular cardiac replacement, pulsatile perfusion at flows of 7-9 L/min at low filling pressures. This allows organs that are failing to recover and for the potential cardiac recipient to become a better transplant candidate. Postimplant patients are mobile and able to go through physical rehabilitation in a hospital or at home.

Better together: a reappraisal of heterotopic heart transplantation.

Heterotopic heart transplantation (HHT) is rare in the modern era. When used as a biologic left ventricular assist, HHT provides pulsatile flow, supports the left ventricle with a physiologic cardiac output, responds to humoral stimuli, and with modern immunosuppression may offer long-term untethered survival. This study was undertaken to compare survival of HHT with orthotopic heart transplantation (OHT) to assess its viability in the modern era.

Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety.

Background: The opioid crisis has led to an increase in available donor hearts, although questions remain about the long-term outcomes associated with the use of these organs. Prior studies have relied on historical information without examining the toxicology results at the time of organ offer. The objectives of this study were to examine the long-term survival of heart transplants in the recent era, stratified by results of toxicological testing at the time of organ offer as well as comparing the toxicology at the time of donation with variables based on reported history.

Total Artificial Heart Update.

The SynCardia Total Artificial Heart (TAH, SynCardia Systems, Tucson, AZ) is the only biventricular cardiac replacement approved for bridge to transplantation by the U.S. Food and Drug Administration (FDA) and which carries the European Union CE mark.

The effects of increased donor support time from organ donation referral to donor procurement on heart transplant recipient survival.

Introduction: Given the known deleterious cardiac effects of brain death (BD) physiology, we hypothesized that time from cardiac donation referral to procurement (donor support time [DST]), would negatively impact cardiac transplant recipient survival.

Methods: The United Network for Organ Sharing database was queried from 2007 to 2018, identifying 22,593 donor hearts for analysis. Multivariate logistic models for 30-day and 1-year survival, as well as Cox models for overall survival and posttransplant rejection, were used to assess adjusted outcomes.

Looking at cardiac transplantation through a 20-year retrospective study-invited commentary.

The authors present an excellent large cohort review and complete analysis of long-term heart transplant survival including multiple institutions. Most studies on long-term heart transplant survival have single-center institutional experience. The authors present a comprehensive national review of the United Network for Organ Sharing Database (UNOS).

Does pediatric heart transplant survival differ with various cardiac preservation solutions?

Background: Few studies directly compare outcomes between the most commonly used preservation solutions in pediatric heart transplantation in a large cohort of recipients. The purpose of this study is to investigate the effect of cardiac preservation solution on survival in pediatric heart transplant recipients.

Methods: The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from 01/2004-03/2018 for pediatric donor hearts.

Venoarterial extracorporeal membrane oxygenation is a viable option as a bridge to heart transplant.

Objective: Venoarterial extracorporeal membrane oxygenation is a rescue therapy for patients in cardiogenic shock. We hypothesize that patients bridged to heart transplant with extracorporeal membrane oxygenation have decreased survival.

Methods: The United Network of Organ Sharing database was retrospectively reviewed from January 1, 1999, to March 31, 2018, for heart transplant recipients.

Donor heart and lung procurement: A consensus statement.

Heart and lung procurements are multiphased processes often accompanied by an array of complex logistics. Approaches to donor evaluation and management, organ procurement, and organ preservation vary among individual procurement teams. Because early graft failure remains a major cause of mortality in contemporary thoracic organ transplant recipients, we sought to establish some standardization in the procurement process.

What Number Are We?

Background In 2007, the United Network for Organ Sharing changed the way centers were notified of possible organ donors. In the new system, a donor sequence number (DSN) was provided signifying the position of a recipient on the list for a particular donor. Whether high DSN donors have equivalent outcomes is unknown.

The Effect of Cardiac Preservation Solutions on Heart Transplant Survival.

Background: Limited data exist that compare the predominant cardiac preservation solutions (CPSs).

Materials And Methods: The United Network for Organ Sharing database was retrospectively reviewed from January 1, 2004 to March 31, 2018, for donor hearts. Of 34,614 potential donors, 21,908 remained after applying the exclusion criteria.

Anticoagulation and Antiplatelet Strategies After On-X Mechanical Aortic Valve Replacement.

Background: The burden oral anticoagulation is a limitation of mechanical valve prostheses.

Objectives: The aim of this study was to test whether patients could be safely managed with dual-antiplatelet therapy (DAPT) (aspirin 325 mg and clopidogrel 75 mg) or lower warfarin after On-X mechanical aortic valve replacement (mAVR).

Methods: PROACT (Prospective Randomized On-X Anticoagulation Trial) (n = 576) is a multicenter (41 sites) noninferiority trial.

Cardiac and pulmonary donor procurement.

Purpose Of Review: Within the United States, donor heart and lung procurement varies between institutions and among surgeons within the same institution sometimes. The purpose of this article is to review the history of donor heart and lung procurement, the surgical techniques, and pitfalls.

Recent Findings: The current article covers the important intraoperative evaluation of the donor heart and lungs at the procurement hospital and the surgical pitfalls that can be prevented to ensure good procurement of donor heart and lungs.

Total Artificial Heart Implantation after Excision of Right Ventricular Angiosarcoma.

Primary cardiac sarcomas, although rare, are aggressive and lethal, requiring thorough surgical resection and adjuvant chemotherapy for the best possible outcome. We report the case of a 32-year-old woman who underwent total artificial heart implantation for right-sided heart failure caused by right ventricular angiosarcoma. For the first several weeks in intensive care, the patient recovered uneventfully.

First North American 50 cc Total Artificial Heart Experience: Conversion from a 70 cc Total Artificial Heart.

The 70 cc total artificial heart (TAH) has been utilized as bridge to transplant (BTT) for biventricular failure. However, the utilization of 70 cc TAH has been limited to large patients for the low output from the pulmonary as well as systemic vein compression after chest closure. Therefore, the 50 cc TAH was developed by SynCardia (Tucson, AZ) to accommodate smaller chest cavity.

Results with SynCardia total artificial heart beyond 1 year.

Mechanical circulatory support devices have been increasingly used for long-term support. We reviewed outcomes in all patients supported with a SynCardia total artificial heart (TAH) for more than 1 year to assess its safety in long-term support. As of December 2011, all 47 patients who received the TAH from 10 centers worldwide were included in this retrospective study.