JHLT Open最新文献

{"title":"Downward hyperinflation of the native lung after right single lung transplantation for COPD: A case report highlighting diaphragmatic mobility","authors":"Shin Tanaka ,&nbsp;Tsuyoshi Ryuko ,&nbsp;Yasuaki Tomioka ,&nbsp;Kazuhiko Shien ,&nbsp;Ken Suzawa ,&nbsp;Kentaroh Miyoshi ,&nbsp;Mikio Okazaki ,&nbsp;Seiichiro Sugimoto ,&nbsp;Shinichi Toyooka","doi":"10.1016/j.jhlto.2025.100268","DOIUrl":"10.1016/j.jhlto.2025.100268","url":null,"abstract":"<div><div>A 60-year-old male with COPD underwent right single lung transplantation. Despite progressive hyperinflation of the native left lung, the transplanted lung maintained function, as downward expansion of the left lung displaced the diaphragm without compressing the mediastinum. This suggests diaphragm mobility, aided by the absence of the liver beneath the left diaphragm, contributes to favorable outcomes in right single lung transplantation by preventing mechanical compression of the transplanted lung.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"8 ","pages":"Article 100268"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cryoanalgesia in Lung Transplantation – A Systematic Review and Meta-analysis","authors":"Felipe S. Passos MD ,&nbsp;Pedro B. Bregion MS ,&nbsp;Rachid E. Oliveira MD ,&nbsp;Thierry Siemeni MD ,&nbsp;Ricardo E. Treml MD, DESAIC ,&nbsp;Bernardo M. Pessoa MD ,&nbsp;Hristo Kirov MD ,&nbsp;Torsten Doenst MD, PhD ,&nbsp;Shaf Keshavjee MD, FRCSC ,&nbsp;Tulio Caldonazo MD","doi":"10.1016/j.jhlto.2025.100263","DOIUrl":"10.1016/j.jhlto.2025.100263","url":null,"abstract":"<div><h3>Background</h3><div>Lung transplantation is a crucial treatment for end-stage lung diseases. However, postoperative pain management remains a significant challenge. Therefore, this study aims to examine the implications of adoption cryoanalgesia on lung transplantation pain control protocol.</div></div><div><h3>Methods</h3><div>Three databases were searched for studies comparing cryoanalgesia versus standard of care analgesia in patients after lung transplantation. The primary outcome was opioid consumption throughout the entire hospitalization, at postoperative day (POD) 7 and at POD 14 addressed with Morphine Milligram Equivalents (MME). The secondary outcomes were maximum reported pain score at POD 7, hospital length of stay (LOS) and time until extubation. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated for continuous outcomes.</div></div><div><h3>Results</h3><div>A total of 5 studies encompassing 485 patients undergoing lung transplantation were included, of whom 228 underwent cryoanalgesia. Compared to standard of care, cryoanalgesia demonstrated significant reduction in opioid consumption at POD 7 (MD: −96.79 MME, 95% CI −183.40 to −10.18, p=0.03), at POD 14 (MD −225,26 MME; 95% CI −366.58 to −83.94; p&lt;0.01) and throughout the entire hospitalization (MD: −307.76 MME, 95% CI −461.72 to −153.79, p&lt;0.01). In addition, there was a significant reduction in pain scores in the cryoanalgesia group (MD: −1.10 points, 95% CI −1.77 to −0.43, p&lt;0.01). However, no significant differences were found regarding hospital LOS or time until extubation.</div></div><div><h3>Conclusions</h3><div>This meta-analysis indicates that cryoanalgesia effectively reduces opioid requirements and pain levels in lung transplant patients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"8 ","pages":"Article 100263"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143835157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pre- and post-operative protocol for assessment of voice and swallowing function in patients undergoing heart or lung transplantation","authors":"Rebecca Black BApSc, Speech Pathologist(SP) ,&nbsp;Duy Duong Nguyen MD PhD ,&nbsp;Anna Miles PhD ,&nbsp;Daniel Novakovic MBBS, FRACS, MPH ,&nbsp;Marshall Plit Prof., MBBS, FRACP, PhD ,&nbsp;Peter MacDonald Prof. MBBS, FRACP, PhD, MD, FCANZ ,&nbsp;Catherine Madill BAppSc (SP), BA, PhD","doi":"10.1016/j.jhlto.2025.100261","DOIUrl":"10.1016/j.jhlto.2025.100261","url":null,"abstract":"<div><h3>Background</h3><div>Oropharyngeal dysphagia and laryngeal dysfunction are complications of lung and heart transplantation. However, there is a lack of understanding around pre-operative function and an absence of standardized assessment protocols. We aimed to trial a pre- and post-operative protocol for assessing voice and swallowing function.</div></div><div><h3>Method</h3><div>A prospective, longitudinal study of 14 adults undergoing investigation for lung or heart transplantation was conducted at a tertiary referral hospital. Patients were assessed pre-surgery and up to 6 months afterwards. The protocol involved phonation tasks with auditory-perceptual and acoustic analysis, videolaryngostroboscopy, a flexible endoscopic examination of swallowing and patient reported quality of life measures. Risk factors and clinical outcomes were extracted from patient records.</div></div><div><h3>Results</h3><div>Patient self-reports of swallowing and voice difficulties were elevated pre-operatively. No evidence of swallowing difficulty was observed under endoscopic examination pre-transplant (Penetration-Aspiration Scale score &lt;2; no accumulated secretions) and only one patient presented with incomplete glottic closure. Auditory perceptual ratings revealed voices were largely within the healthy range at baseline. One out of five patients presented with severe dysphonia post-operatively. Completion of evaluation measures prior to transplantation was 79% but post- operative rates were low due to feasibility challenges with follow up in this complex population.</div></div><div><h3>Conclusion</h3><div>Novel evidence of self-reported pre-transplant voice and swallowing changes indicate value in baseline screening. Discrepancies between patient-report and instrumental assessment results highlight the need for multi-faceted evaluation. Large cohort studies are needed to determine the salient evaluation measures and time points for voice and swallowing assessment in this population.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"8 ","pages":"Article 100261"},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Omentoplasty for ventricular assist device infections: Encouraging outcomes","authors":"Ahmed M. El Banayosy MD ,&nbsp;Susan George DNP, APRN,&nbsp;David W. Vanhooser MD,&nbsp;Hendra Setiadi PhD,&nbsp;Daniel R. Freno MD,&nbsp;Marshall T. Bell MD,&nbsp;Craig C. Elkins MD,&nbsp;Mircea R. Mihu MD,&nbsp;Douglas A. Horstmanshof MD,&nbsp;Aly El Banayosy MD,&nbsp;James W. Long MD, PhD","doi":"10.1016/j.jhlto.2025.100264","DOIUrl":"10.1016/j.jhlto.2025.100264","url":null,"abstract":"<div><h3>Background</h3><div>LVAD infections are associated with substantial morbidity and mortality. We explored the impact of surgical Omentoplasty (OMP) added to Incision and Debridement (I&amp;D) plus Antibiotic therapy (AB) on survival and infection-related readmissions in patients with LVAD infections.</div></div><div><h3>Methods</h3><div>Thirty-three patients with deep LVAD-specific infections were studied over a period of 12 years. Survival and readmissions for recurrent infection in subjects receiving I&amp;D and ABs alone (Group A, n = 15) were compared to those in whom OMP was added to I&amp;D and ABs (Group B, n = 18).</div></div><div><h3>Results</h3><div>Baseline characteristics were similar between groups, as well as infectious organisms. Two-year survival was significantly improved in Group B (OMP + I&amp;D + ABs) as compared to Group A (I&amp;D + ABs without OMP) [77% vs. 7%; <em>p</em> &lt; 0.001]. Recurrent infection-related readmissions were notably lower in Group B compared to Group A (0.18 vs. 0.24 admissions/patient-year), with a significant reduction within Group B following the application of OMP (0.13 to 0.06 admissions/patient-year). Following OMP, intravenous (IV) antibiotics were successfully replaced with oral long-term ABs in the 78% of patients. No long-term antibiotic-related complications were noted.</div></div><div><h3>Conclusion</h3><div>This report, comprising the most extensive such experience to date, indicates that combining surgical Omentoplasty (OMP) with incision and debridement (I&amp;D) plus antibiotic (AB) treatment is remarkably effective for suppressing deep LVAD infections, improving survival and decreasing infection-related readmissions. Filling the open space around an implanted LVAD with highly vascularized omentum, as a living tissue with anti-infective properties, appears to be effective for improving outcomes with LVAD infections.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"8 ","pages":"Article 100264"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143843164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of lung transplantation for scleroderma versus other indications: Insigts from a single center","authors":"Masashi Furukawa MD PhD ,&nbsp;Ernest G. Chan MD MPH ,&nbsp;John P. Ryan PhD ,&nbsp;Chadi A. Hage MD ,&nbsp;Pablo G. Sanchez MD PhD","doi":"10.1016/j.jhlto.2025.100266","DOIUrl":"10.1016/j.jhlto.2025.100266","url":null,"abstract":"<div><h3>Background</h3><div>Scleroderma is an autoimmune disease affecting the skin and internal organs, with pulmonary disease being the leading cause of mortality. Lung transplantation is a potential therapy, but its indication has been limited by concerns about complications, such as esophageal dysmotility.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed on 959 lung transplant patients from 2011 to 2023, including 77 with scleroderma-related lung disease. Survival rates, post-transplant complications, such as chronic lung allograft dysfunction, and acute cellular rejection rates.</div></div><div><h3>Results</h3><div>Scleroderma patients had higher mean pulmonary arterial pressure (32 vs. 24 mmHg, p &lt; 0.001) and increased esophageal dysmotility (85% vs. 27%, p &lt; 0.001). Double lung transplantation was more common (99% vs. 87%, p = 0.003). Scleroderma patients experienced higher rates of delayed chest closure (44% vs. 25%, p &lt; 0.001), severe primary graft dysfunction at 72 hours (30% vs. 17%, p = 0.006), and longer mechanical ventilation (median 7 vs. 4 days, p = 0.002). They also required more gastrojejunostomy tubes (79% vs. 20%, p &lt; 0.001) and had longer ICU stays (median 12 vs. 8 days, p = 0.007). However, adjusted competing risks regression showed no significant association between scleroderma and chronic lung allograft dysfunction (HR 0.69 [0.33 – 1.46], p = 0.31) or survival (HR 0.90 [0.56 – 1.45], p = 0.68).</div></div><div><h3>Conclusions</h3><div>Our findings suggest that lung transplantation might be an important therapeutic option for patients with scleroderma, showing outcomes similar to those of patients with different underlying conditions.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"8 ","pages":"Article 100266"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transbronchial cryobiopsy alone versus combined with traditional forceps biopsy for acute cellular rejection in lung transplant recipients. A diagnostic randomized trial","authors":"Carolin Steinack MD ,&nbsp;Maurice Roeder MD ,&nbsp;Silvan Vesenbeckh MD ,&nbsp;Martina Haberecker MD ,&nbsp;Jan H. Rüschoff MD ,&nbsp;René Hage MD, PhD ,&nbsp;Silvia Ulrich MD ,&nbsp;Malcolm Kohler MD ,&nbsp;Macé M. Schuurmans MD ,&nbsp;Daniel P. Franzen MD ,&nbsp;Thomas Gaisl MD, PhD","doi":"10.1016/j.jhlto.2025.100262","DOIUrl":"10.1016/j.jhlto.2025.100262","url":null,"abstract":"<div><h3>Background</h3><div>Transbronchial lung biopsy is routinely performed to identify acute cellular rejection (ACR) in lung transplant recipients (LTRs). This trial evaluates the clinical value of forceps and cryobiopsies versus cryobiopsies as a standalone diagnostic tool.</div></div><div><h3>Methods</h3><div>In this randomized trial, LTRs were randomly assigned to receive either 2 cryobiopsies (cryobiopsy group) or a combination of 5 forceps- and 2 cryobiopsies (combined group). The primary outcome was the diagnostic yield to detect ACR; the secondary outcome was the incidence of ACR. We conducted a paired, intraindividual comparison in the combined group alongside interindividual comparisons.</div></div><div><h3>Results</h3><div>A total of 80 LTRs were randomly assigned to the cryobiopsy group (<em>n</em> = 40) or the combined group (<em>n</em> = 40) with 90 and 87 procedures performed, respectively. The diagnostic yield for ACR in the cryobiopsy group was similar to the combined group (95.6% vs 97.7%, <em>p</em> = 0.430). The sole use of cryobiopsies did not lead to a lower ACR incidence compared to the combined group (10% vs 17.2%, risk ratio 2.21 [95% confidence interval (CI) 0.67-7.29]; <em>p</em> = 0.190). Adverse events did not differ between the 2 groups (60.9% vs 57.5%, <em>p</em> = 0.655). The pneumothorax rate was overall 1.7%. There were no deaths or occurrences of severe bleeding.</div></div><div><h3>Conclusions</h3><div>Cryobiopsies did not detect lower ACR than the combined group and can be used as primary and standalone diagnostic tools for histologic assessment of ACR without requiring forceps biopsies.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"8 ","pages":"Article 100262"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redo bilateral lung transplantation in a previous heart-lung transplant recipient for invasive pulmonary scedosporiosis","authors":"Akshay Chauhan MBBS ,&nbsp;Nischal Ranganath MD, PhD ,&nbsp;John P. Scott MD ,&nbsp;Paschalis Vergidis MD ,&nbsp;Anja C. Roden MD ,&nbsp;Philip J. Spencer MD ,&nbsp;Mauricio A. Villavicencio MD ,&nbsp;Richard C. Daly MD ,&nbsp;Sahar A. Saddoughi MD, PhD","doi":"10.1016/j.jhlto.2025.100247","DOIUrl":"10.1016/j.jhlto.2025.100247","url":null,"abstract":"<div><div>Redo-bilateral lung transplant in previous heart-lung transplant is a rare operation. We describe our surgical and medical management experience with a heart-lung transplant recipient who developed chronic lung allograft dysfunction and invasive <em>Scedosporium</em> apiospermum infection. The patient underwent a redo-bilateral lung transplant followed by a combination of inhaled voriconazole, caspofungin, and olorofim for a prolonged period. We observed no issues with bronchial anastomosis healing, and the patient is doing well on 1-year follow-up. This report outlines a successful management approach to this rare complication of heart-lung transplant recipients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"8 ","pages":"Article 100247"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143835156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes following isolated right ventricular assist device as durable support for primary right heart failure: An INTERMACS analysis","authors":"Edo Y. Birati MD ,&nbsp;E. Wilson Grandin MD, MPH ,&nbsp;Robert S. Zhang MD ,&nbsp;Fausto Cabezas MD ,&nbsp;Keshava Rajagopal MD, PhD ,&nbsp;Matthew Seigerman MD ,&nbsp;Allison Padegimas MD ,&nbsp;Jeremy A. Mazurek MD ,&nbsp;Michael S. Kiernan MD ,&nbsp;Navin K. Kapur MD ,&nbsp;Pavan Atluri MD ,&nbsp;Guilherme H. Oliveira MD ,&nbsp;Francis D. Pagani MD ,&nbsp;Susan L. Myers ,&nbsp;Jeffrey Teuteberg MD ,&nbsp;Robert L. Kormos MD ,&nbsp;James K. Kirklin MD ,&nbsp;Michael A. Acker MD ,&nbsp;Jesus Eduardo Rame MD","doi":"10.1016/j.jhlto.2025.100258","DOIUrl":"10.1016/j.jhlto.2025.100258","url":null,"abstract":"<div><div>Outcomes with isolated right ventricular assist devices (iRVAD) using pumps designed for the left ventricle are not well described. This study compares the clinical characteristics and outcomes of iRVAD patients to those patients treated with left ventricular assist device (LVAD) and biventricular assist devices (BiVAD). This study consisted of patients who received iRVAD from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registry (2006-2017). The primary outcome was 2-year survival. Of 20,789 patients, 26 (0.13%) received iRVAD, 17 with pulsatile flow and 9 with continuous-flow devices. Device strategy was bridge to recovery/rescue therapy in 9 (35%), bridge to transplant/decision in 14 (52%), and destination therapy in 3 (12%). Twelve (46%) patients were INTERMACS profile 1, 5 patients (19%) required extracorporeal membrane oxygenation, and 13 (50%) needed mechanical ventilation. Two-year survival for patients with iRVAD (41.3%) was similar to BiVAD (45.2%) and significantly lower than LVAD (69.0%). In patients with isolated right-sided failure, long-term iRVAD support is feasible.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"8 ","pages":"Article 100258"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying the determinants of health–related quality of life in children after heart transplant","authors":"Jonathan B. Edelson ,&nbsp;Jing Huang ,&nbsp;Zi Wang ,&nbsp;Vicky Tam ,&nbsp;Debra Lefktowitz ,&nbsp;Matthew J. O’Connor ,&nbsp;Rachel White ,&nbsp;Lynne Ha ,&nbsp;Carol A. Wittlieb-Weber ,&nbsp;Joseph W. Rossano ,&nbsp;Kimberly Lin ,&nbsp;Melissa K. Cousino ,&nbsp;Meghan Lane-Fall ,&nbsp;Michael L. O’Byrne","doi":"10.1016/j.jhlto.2025.100250","DOIUrl":"10.1016/j.jhlto.2025.100250","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric heart transplant (PHT) recipients have impaired health–related quality of life (HRQOL) that is not fully explained by cardiac limitations. Environment is known to influence HRQOL in other chronic disease populations but is less understood in PHT. Understanding the determinants of HRQOL is a necessary step in identifying high-risk groups and designing actionable interventions.</div></div><div><h3>Methods</h3><div>This cross-sectional study includes 8- to 18-year heart transplant (HT) recipients and their families. Generalized estimating equations were used to evaluate the associations of individual characteristics (diagnosis, pulmonary capillary wedge pressure [PCWP], cardiac index [CI]), microenvironment (parent education level, financial security, parental stress [PSI], assessment of child anxiety) and macroenvironment [Child Opportunity Index (COI)] with HRQOL.</div></div><div><h3>Results</h3><div>Of 31 participants, 32% self-identified as Black, and 40% had congenital heart disease. On cardiac catheterization, 61% had a CI ≥3 liter/min/m² and PCWP ≤10 mm Hg. Most households had ≥1 parent who had completed college (58%); 28% of households expressed difficulty paying bills. The PSI showed elevated parental stress [64.5 (interquartile range [IQR] 52.0, 77.8)], while the COI was low [73.0 (IQR 44.5, 89.0)] as was HRQOL [Pediatric Quality of Life 4.0 Core Scales 71.7 (IQR 64.2-82.5), Pediatric Cardiac Quality of Life Index 61.8 (IQR 55.7-74.8)]. Higher parental stress (<em>p</em> = 0.036), higher parental perception of child anxiety (<em>p</em> = 0.058), lower Max VO₂ (<em>p</em> = 0.059), and higher PCWP (<em>p</em> = 0.006) were independently associated with worse quality of life.</div></div><div><h3>Conclusions</h3><div>HRQOL in children after heart transplant is reduced and determined not only by traditional measures of cardiovascular function, but also by patient psychology and their household environment, highlighting the utility of using an adapted ecological systems framework to understand HRQOL.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"8 ","pages":"Article 100250"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143835158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Graded response of the pulmonary circulation to progressive pulmonary embolism in sheep: From compensation to lethal right heart failure","authors":"Cheng Zhou MD ,&nbsp;Yuman Li MD ,&nbsp;Kyle Polley ,&nbsp;Cherry Ballard-Croft PhD ,&nbsp;Masashi Kawabori MD ,&nbsp;Keshava Rajagopal MD, PhD ,&nbsp;Joseph B. Zwischenberger MD ,&nbsp;Dongfang Wang MD, PhD","doi":"10.1016/j.jhlto.2025.100260","DOIUrl":"10.1016/j.jhlto.2025.100260","url":null,"abstract":"<div><h3>Background</h3><div>Severe pulmonary embolism (PE) with right heart failure (RHF) has high mortality. To more fully understand PE progression, we evaluated the right ventricle (RV) and pulmonary circulation response to graded PE in an acute PE sheep model.</div></div><div><h3>Methods</h3><div>Polydextran beads were intravenously administered every 15 minutes in 250 mg doses to adult female sheep (<em>n</em> = 8) until death. Concurrent pulmonary artery (PA) blood flow/pressure was measured. RV pressure-volume (P-V) loops were generated with a conductance catheter. Pulmonary vascular resistance was used to stage PE severity into mild, moderate, and severe groups.</div></div><div><h3>Results</h3><div>All sheep developed graded RHF. For mild, moderate, and severe PE, 3, 6, and 9 doses were needed, respectively. Only 1 additional dose triggered death. In severe PE, mean PA pressure reached 42 ± 6 mm Hg with significantly decreased cardiac output (CO). Pulmonary impedance spectra showed significantly increased Z₀ (RV static load) and Z₁ (RV pulsatile load). PE shifted the RV P-V loop from lower left triangular to upper right rectangular shape. PA elastance (Ea, RV afterload) and end-systolic elastance (Ees, RV contractility) progressively increased. Ees/Ea (RV-PA coupling) was initially maintained but became uncoupled in severe PE, causing RHF.</div></div><div><h3>Conclusions</h3><div>Compensatory increases in RV contractility initially maintain CO in PE despite RV afterload elevation. Increased RV contractility eventually fails to compensate for elevated RV afterload, causing RV-PA uncoupling in severe PE with RHF. Severe PE rapidly progresses to lethal RHF and will likely require immediate intervention to prevent death.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"8 ","pages":"Article 100260"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}