JHLT Open最新文献

{"title":"Thrombotic Microangiopathy After Lung Transplantation: A Retrospective Observational Multicenter Cohort Study","authors":"Pierre Gazengel MD ,&nbsp;Vincent Bunel MD ,&nbsp;Kinan El-Husseini MD ,&nbsp;Mohamad Zaidan MD ,&nbsp;Edouard Lefevre MD ,&nbsp;Romain Kessler MD ,&nbsp;Xavier Demant MD ,&nbsp;Loïc Falque MD ,&nbsp;Emmanuel Eschapasse MD ,&nbsp;Thomas Villeneuve MD ,&nbsp;Gaelle Dauriat MD ,&nbsp;Pauline Pradère MD ,&nbsp;Olaf Mercier MD ,&nbsp;Elie Fadel MD ,&nbsp;Clément Picard MD ,&nbsp;Jérôme Le Pavec MD","doi":"10.1016/j.jhlto.2025.100335","DOIUrl":"10.1016/j.jhlto.2025.100335","url":null,"abstract":"<div><h3>Background</h3><div>Thrombotic microangiopathy (TMA) is a well-recognized complication of solid-organ transplantation that chiefly affects the kidneys. The objective of this study was to describe TMA features and outcomes after lung transplantation.</div></div><div><h3>Patients and methods</h3><div>This retrospective observational study included patients with TMA following lung or heart-lung transplantation at eight French centers in 2006–2023. Univariate and multivariate analyses were done to identify factors associated with outcomes.</div></div><div><h3>Results</h3><div>Of the 4565 patients, 82 (1.8%) experienced TMA, at a median of 19 [6−34] months after transplantation; among them, 79 were included (51% female; median age 50 [33−61] years). Mortality during the median follow-up of 31 [11−66] months was 38/79 (48%). Etiological factors were above-target calcineurin inhibitor (CNI) trough levels (48%), combined CNI and mTOR inhibitor therapy (23%), and infection (9%). CNI was continued in 70 patients and replaced by belatacept in 9 patients. In the belatacept group, renal function at one year was better but death, bacterial pneumonia, and CMV viremia were more common; none of the differences was significant, perhaps given the small sample size.</div></div><div><h3>Conclusion</h3><div>Mortality was high after TMA in lung or heart-lung transplant recipients. CNI monitoring protocols should be improved to minimize the risk of toxicity. Belatacept instead of CNI therapy was associated with better kidney function but also with higher frequencies of adverse events, suggesting a need for great caution. Studies adequately powered to assess the risk/benefit ratio of belatacept therapy according to the dosing regimen, patient features, and concomitant immunosuppressants are needed.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100335"},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672103","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":"Ex situ heart perfusion: A novel platform to test cardiovascular therapeutics in human hearts","authors":"John Onsy Louca ,&nbsp;Magnus Althage ,&nbsp;Marco Öchsner ,&nbsp;Aravinda Page ,&nbsp;Joao Pedro Nunes ,&nbsp;Catherine Wilson ,&nbsp;Sanjay Sinha ,&nbsp;Simon Messer ,&nbsp;James Matt Bae ,&nbsp;Mostin Hu ,&nbsp;Nicole Asemota ,&nbsp;Sarah Fielding ,&nbsp;Sai Bhagra ,&nbsp;Neil Henderson ,&nbsp;Johnny Lindquist ,&nbsp;Daniela Später ,&nbsp;Anna Collén ,&nbsp;Kaushik Sengupta ,&nbsp;Benjamin Challis ,&nbsp;Justin Perkins ,&nbsp;Stephen Large","doi":"10.1016/j.jhlto.2025.100336","DOIUrl":"10.1016/j.jhlto.2025.100336","url":null,"abstract":"<div><h3>Background</h3><div>Explanted hearts from recipients undergoing cardiac transplantation may be utilized as a human model of cardiomyopathy. Ex-situ perfusion of hearts allows control of the physiological and biochemical conditions of perfusion. <em>AZD8601 is</em> a novel modRNA for VEGF-A that was shown to be safe in a Phase IIa clinical trial – the EPICCURE trial. This proof-of-concept study aimed to demonstrate the potential utility of testing novel therapies on explanted recipient hearts using ex situ machine perfusion.</div></div><div><h3>Methods</h3><div>In order to ascertain the expression of VEGF-A in a human model of cardiomyopathy, <em>AZD8601</em> was injected at high- and low-dose into the mid-myocardium of the left ventricle of human hearts explanted at the time of cardiac transplantation and perfused on the m0rgan, a novel, normothermic organ perfusion machine. Hearts were perfused ex situ for 6 h. After which, injection sites were biopsied and divided into subendocardium, mid-myocardium and sub-epicardial myocardium. Immuno-analysis was performed to assess levels of VEGF-A protein.</div></div><div><h3>Results</h3><div>There were elevated levels of VEGF-A protein in the subendocardium and mid-myocardium of injection sites which received <em>AZD8601</em>. Low-dose and high-dose <em>AZD8601</em> resulted in a significantly higher concentration of VEGF-A protein in the myocardium.</div></div><div><h3>Conclusions</h3><div>This study builds on the EPICCURE study, a phase IIa clinical trial which demonstrated safety of this mRNA in patients undergoing coronary artery bypass grafting. This study provides a novel model of diseased human heart for experimental studies utilizing ex situ heart perfusion.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100336"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696767","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":"Mechanical circulatory support in failing single-ventricle physiology","authors":"Ryan L. Kobayashi MD,&nbsp;Christina J. VanderPluym MD","doi":"10.1016/j.jhlto.2025.100334","DOIUrl":"10.1016/j.jhlto.2025.100334","url":null,"abstract":"<div><div>The use of ventricular assist device (VAD) therapy for advanced heart failure in infants and children with single-ventricle (SV) congenital heart disease (CHD) has expanded rapidly. However, issues pertaining to patient size, developmental hemostasis, device availability, complicated anatomy, and complex modes of hemodynamic/circulatory failure associated with each stage of SV palliation make VAD support particularly challenging in this population. Over the last 20 years, there has been significant improvement in support outcomes for this complex population; however, survival and rates of adverse events still lag behind children with other diagnoses. Herein, we review current mechanical circulatory support approaches, ongoing challenges, and outcomes for patients with SV CHD.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100334"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702263","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":"Pediatric heart failure: Current approach and treatment","authors":"Benjamin A. Olsen ,&nbsp;Shelley D. Miyamoto","doi":"10.1016/j.jhlto.2025.100331","DOIUrl":"10.1016/j.jhlto.2025.100331","url":null,"abstract":"<div><div>Pediatric heart failure (HF) is a heterogenous disease process. While the incidence is low compared to adults, resource utilization and in hospital mortality is higher. We aim to review the current approaches and treatment strategies for pediatric HF and discuss ongoing efforts to improve outcomes for this patient population. Pediatric HF is a diverse disease entity with variable pathophysiologic processes and symptoms. This review will focus on myocardial failure related to intrinsic cardiomyocyte, or cardiac muscle cell, dysfunction. While myocardial failure is a shared pathway in adult and pediatric HF, unique disease mechanisms are observed in pediatric patients, providing potential explanations for why existing HF treatment regimens are more effective in adults than children. Diagnosis and serial assessment of pediatric HF is achieved by employing multimodality imaging techniques, laboratory evaluation, and cardiac catheterization, as well as sleep and exercise studies. Pharmacologic therapies are largely based on adult guideline directed medical therapy, although supportive evidence is lacking in pediatric HF. Novel therapies are being developed that have potential for efficacy based on the current understanding of pediatric specific HF pathophysiology. Medical therapy for HF is often complemented by non-pharmacologic therapies, and in cases of end stage HF, patients may require ventricular assist devices or heart transplantation. The current approaches and treatments of pediatric HF face unique challenges; however, there is reason for an optimistic future. Improved outcomes can be achieved by utilizing emerging therapies and technologies, increasing collaboration, and through a dedication to delivering equitable care.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100331"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634501","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":"Telomere biology disorders in lung transplantation: Clinical challenges and management strategies","authors":"Farah Mesli ,&nbsp;Quentin Philippot ,&nbsp;Kinan El Husseini ,&nbsp;Vincent Bunel ,&nbsp;Caroline Kannengiesser ,&nbsp;Marie Pierre Debray ,&nbsp;Alice Guyard ,&nbsp;Bruno Crestani ,&nbsp;Ibrahima Ba ,&nbsp;Raphaël Borie","doi":"10.1016/j.jhlto.2025.100333","DOIUrl":"10.1016/j.jhlto.2025.100333","url":null,"abstract":"<div><div>Telomeres, repetitive DNA sequences at the ends of chromosomes, play a crucial role in maintaining genomic stability. In recent years, their significance in lung transplantation has gained growing attention. Shortened telomeres—whether due to inherited telomeropathies or acquired attrition—have emerged as a risk factor for various pulmonary diseases, particularly pulmonary fibrosis, which is a leading indication for lung transplantation.</div><div>This review provides a comprehensive overview of current knowledge on the impact of short telomeres in lung transplant recipients, encompassing pre-transplant assessment and post-transplant outcomes. Patients with telomere-biology disorder present unique clinical challenges. Before transplantation, they may exhibit extra-pulmonary manifestations such as bone marrow dysfunction, hepatic abnormalities, precipitation to develop cancer, all of which necessitate a tailored evaluation and multidisciplinary management. After transplantation, these patients appear to be at increased risk of complications, including drug-related hematologic toxicity, bone marrow failure, and heightened susceptibility to infections.</div><div>The review emphasizes the importance of identifying patients with telomere biology disorders early in the transplant process and supports the incorporation of telomere length testing in selected populations. Furthermore, it highlights the need for adjusted immunosuppressive strategies and closer surveillance in this vulnerable population. Ultimately, the authors advocate for prospective, multicenter studies aimed at refining the prognostic value of telomere length and guiding evidence-based, individualized transplant strategies for patients with telomere biology disorders related interstitial lung diseases.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100333"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672102","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":"Days alive and out of the hospital at 1 year following heart transplant: Comparing donation after brain death versus after circulatory death","authors":"Fadi M. Azar MD ,&nbsp;Antoinette S. Birs MD ,&nbsp;Quan M. Bui MD ,&nbsp;Nicholas Wettersten MD ,&nbsp;Hao A. Tran MD ,&nbsp;Mark J. Kearns MD ,&nbsp;Victor Pretorius MBChB ,&nbsp;Marcus A. Urey MD","doi":"10.1016/j.jhlto.2025.100330","DOIUrl":"10.1016/j.jhlto.2025.100330","url":null,"abstract":"<div><h3>Background</h3><div>Heart transplantation (HTx) remains the definitive therapy for select patients with Stage D heart failure. Donation after circulatory death (DCD) has emerged as a promising strategy to expand the donor pool, with studies showing comparable survival to donation after brain death (DBD). However, little is known about how DCD impacts post-transplant quality of life. Days alive and out of the hospital (DAOH) at 1 year is a validated, patient-centered metric reflecting both post-transplant morbidity and survival.</div></div><div><h3>Methods</h3><div>We conducted a single-center, retrospective cohort study of 226 adult patients who underwent HTx between January 2021 and June 2023 (117 DBD and 109 DCD recipients). The primary outcome was DAOH at 1 year. Secondary outcomes included post-transplant graft function, inotrope and intensive care unit (ICU) duration, readmissions, and mortality. Baseline characteristics and outcomes were compared using appropriate statistical methods, and quantile regression was used to adjust for clinical confounders.</div></div><div><h3>Results</h3><div>Baseline characteristics were largely similar, although DBD recipients had higher pre-operative acuity. Median DAOH at 1 year did not differ significantly between DBD and DCD recipients (344 vs 343 days; <em>p</em> = 0.896). Adjusted analyses confirmed no clinically meaningful difference. Secondary outcomes, including 1-year mortality, ICU stay, and readmission rates, were also comparable.</div></div><div><h3>Conclusions</h3><div>In this cohort, DCD recipients achieved similar DAOH at 1 year compared to DBD recipients, supporting the use of DCD as a viable strategy in HTx. This is one of the first studies to compare post-transplant quality of life in DBD and DCD HTx recipients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100330"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589097","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":"Palliative care for the cardiothoracic transplant recipient","authors":"Erika J. Mejia ,&nbsp;Christiane Kugler ,&nbsp;Elizabeth Blume","doi":"10.1016/j.jhlto.2025.100329","DOIUrl":"10.1016/j.jhlto.2025.100329","url":null,"abstract":"<div><div>Palliative care is a multidisciplinary approach to management that is integral to the delivery of high-quality patient centered care for all cardiothoracic transplant recipients. Life as a heart or lung transplant patient is one filled with an array of physical and psychosocial experiences, periods of clinical acuity, as well as episodes of uncertainty. Structured support attending to physical and psychosocial needs as a means to improve the patient experience and support goal concordant care are palliative care practices that are central to the provision of care to the cardiothoracic transplant population.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100329"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589096","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":"Long-term outcomes of light chain amyloidosis patients receiving heart transplant: A single-center experience","authors":"Khush Patel MD ,&nbsp;Zoe H. Tu PharmD ,&nbsp;Carrie Yuen MD ,&nbsp;Siddhartha Ganguly MD ,&nbsp;Allison N. Yun PharmD, BCTXP ,&nbsp;Janardhana R. Gorthi MD, MBBS ,&nbsp;Barry H. Trachtenberg MD ,&nbsp;Ashrith Guha MD, MPH ,&nbsp;Mahwash Kassi MD ,&nbsp;Ju Kim MD ,&nbsp;Rayan Yousefzai MD ,&nbsp;Kelty Baker MD ,&nbsp;Lawrence Rice MD ,&nbsp;Rammurti T. Kamble MD ,&nbsp;Horacio E. Adrogue MD ,&nbsp;Erik E. Suarez MD ,&nbsp;Mark Ghobrial MD PhD ,&nbsp;Ashish Saharia MD ,&nbsp;Constance M. Mobley MD PhD ,&nbsp;David W. Victor MD ,&nbsp;Arvind Bhimaraj MD, MPH, FACC, FHFSA, (Associate Professor)","doi":"10.1016/j.jhlto.2025.100328","DOIUrl":"10.1016/j.jhlto.2025.100328","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac amyloidosis is a less common indication for orthotopic heart transplantation (OHT). Light chain (AL) amyloidosis specifically poses challenges. While previous small studies have established the validity of OHT for AL amyloidosis, we present experience from a large contemporary series at a single center.</div></div><div><h3>Methods</h3><div>This was a retrospective single-center study of patients receiving OHT between 2009 and 2023 at our institution. A data warehouse was curated from our electronic medical records and United Network for Organ Sharing databases. Univariable and multivariable analyses of donor and recipient characteristics were performed. Patients who received OHT after 2016 were active in our electronic medical record and hence AL-OHT patients after 2016 had granular details regarding immunosuppression, chemotherapy regimens, amyloidosis, and post-transplant-related outcomes within their first-year post-OHT.</div></div><div><h3>Results</h3><div>Thirty-one patients received an OHT for cardiac AL while 595 received OHT for non-amyloid indication during the study period. One-, three-, five-, and eight-year survival (87%, 83%, 73%, and 67%, respectively) was not statistically different compared to non-AL OHT patients (92%, 85%, 79%, and 68%, respectively). In a subset of 18 patients with access to electronic medical record data, all patients remained on tacrolimus and prednisone through 1-year post-OHT, but nearly half were off mycophenolate.</div></div><div><h3>Conclusion</h3><div>Select AL patients with advanced cardiac involvement can gain survival advantage with OHT similar to other advanced heart failure patients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100328"},"PeriodicalIF":0.0,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581081","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":"Beyond the consult: Outcomes following pediatric VAD referral","authors":"Shannon Oliver MBBS ,&nbsp;Asseel Alsalmi MD ,&nbsp;Tara Pidborochynski MSc ,&nbsp;Holger Buchholz MD ,&nbsp;Simon Urschel MD ,&nbsp;Paula Holinski MD ,&nbsp;Vijay Anand MD ,&nbsp;Diana Ly RN ,&nbsp;Jennifer Conway MD","doi":"10.1016/j.jhlto.2025.100318","DOIUrl":"10.1016/j.jhlto.2025.100318","url":null,"abstract":"<div><h3>Background</h3><div>Little is known about patients who are referred for ventricular assist device (VAD) therapy but not implanted. The purpose of this study is to describe their outcomes at 1-year post initial consultation.</div></div><div><h3>Methods</h3><div>Retrospective analysis for patients referred to our VAD services between 01/2019 and 12/2023. Outcomes were reported at 30 days and 1-year post-consult. Patients who died, were too unwell for VAD or required extracorporeal membrane oxygenation (ECMO) within 30 days of consultation were considered acute referrals. Multivariate logistic regression analysis was used to determine risk factors for being an acute referral.</div></div><div><h3>Results</h3><div>There were 128 patients included, with median age at referral 2.7 years (IQR 0.3, 0.9), 50.8% being male, and 52.3% of patients having congenital heart disease (CHD). The primary indication for VAD consult was due to the patient undergoing a transplant evaluation. At 30 days 31% (<em>n</em> = 41) were considered acute referrals, with 28.1% (<em>n</em> = 36) receiving ECMO, 3.1% (<em>n</em> = 4) being too unwell for VAD, and 0.8% (<em>n</em> = 1) patients dying. Patients who were acute referrals and had not received VAD therapy or transplant had worse 1-year survival (<em>p</em> &lt; 0.001) then elective referrals, with the highest risk for mortality being early in the course. Diagnosis of biventricular CHD, other (non-CHD, non-cardiomyopathy) or absence of co-morbidities were independent factors associated with being an acute referral.</div></div><div><h3>Conclusion</h3><div>Of patients referred to the VAD service, one-third were considered acute referrals. Patients who were acute referrals had increased 1-year mortality than those who were elective referrals. Factors associated with being an acute referral included diagnosis of biventricular CHD or other and no co-morbidities.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100318"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556900","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":"To build a better VAD: What is needed to make MCS truly competitive with cardiac transplantation for long-term outcomes?","authors":"Jennifer A. Cowger MD, MS ,&nbsp;Evgenij Potapov MD, PhD","doi":"10.1016/j.jhlto.2025.100325","DOIUrl":"10.1016/j.jhlto.2025.100325","url":null,"abstract":"<div><div>While average survival in patients undergoing durable left ventricular assist device (dLVAD) support now approximate 6 years, the application of therapy remains limited across the globe. Herein we highlight important deficiencies common to present technology and propose device innovations and field corrections that will be necessary to improve acceptance of dLVAD support by both patients and medical providers caring for patients with end-stage heart failure. Pragmatic trials will also be needed to help identify the therapeutic strategy (permanent dLVAD support vs heart transplant vs dLVAD as a bridge to transplant) that affords the best outcomes for a patient’s risk profile and total survival goals.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100325"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581068","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}