JHLT Open最新文献

{"title":"Impact of disease location and laterality on hemodynamic response following pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension","authors":"Bryan O. Pérez Martínez MD ,&nbsp;Gabriella V. Rubick MD ,&nbsp;Avi Toiv MD ,&nbsp;Sidney Perkins MD ,&nbsp;Jorge Vinales ,&nbsp;Victor M. Moles MD ,&nbsp;Vallerie V. McLaughlin MD ,&nbsp;Thomas M. Cascino MD MSc ,&nbsp;Bryan Kelly DO ,&nbsp;Gillian Grafton DO ,&nbsp;Rana Awdish MD ,&nbsp;Jonathan W. Haft MD ,&nbsp;Vikas Aggarwal MD MPH","doi":"10.1016/j.jhlto.2025.100314","DOIUrl":"10.1016/j.jhlto.2025.100314","url":null,"abstract":"<div><h3>Background</h3><div>In patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing pulmonary thromboendarterectomy (PTE), obstructive disease burden predicts positive hemodynamic responsiveness. However, the effect of disease location (upper, middle, or lower lobes) and lung laterality (right or left) has not been studied.</div></div><div><h3>Objectives</h3><div>Examine the effect of obstructive disease location and laterality on hemodynamic response following PTE.</div></div><div><h3>Methods</h3><div>This analysis is a retrospective cohort study of 56 consecutive patients diagnosed with CTEPH who underwent PTE at the University of Michigan Hospital between August 2019 and July 2022. Disease burden, location, and laterality were assessed on invasive pulmonary angiography (IPA), and lobar segments were assigned a score based on these features and correlated with an absolute change in pulmonary vascular resistance (PVR) following PTE. The relationship between disease burden and hemodynamic responsiveness was modeled using linear regressions with <em>R</em>² reported as a measure of correlation.</div></div><div><h3>Results</h3><div>Most patients were World Health Organization (WHO) class III or IV (<em>n</em> = 47; 83.9%) and had a history of acute pulmonary embolism (<em>n</em> = 51; 91.1%). A modest correlation between patients’ overall disease burden and absolute change in PVR was noted, with the strongest contributions from the right lower lobe (RLL), right middle lobe (RML), and left lower lobe (LLL) (<em>R</em>² = 0.16, 0.10, and 0.03, respectively).</div></div><div><h3>Conclusion</h3><div>Disease location in the RLL, RML, and LLL may predict hemodynamic improvement in patients with CTEPH undergoing PTE.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100314"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518282","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":"Psychosocial considerations in pediatric heart transplantation: Initial validation of the Pediatric Psychosocial Assessment Tool at a single center","authors":"Michael O. Killian PhD, MSW ,&nbsp;Sonnie E. Mayewski MSW ,&nbsp;Schyler E. Brumm MSW ,&nbsp;Zhe He PhD ,&nbsp;Dipankar Gupta MBBS, DCH, MD","doi":"10.1016/j.jhlto.2025.100319","DOIUrl":"10.1016/j.jhlto.2025.100319","url":null,"abstract":"<div><h3>Background</h3><div>Pre-transplant psychosocial assessment, in conjunction with medical and surgical evaluation, is a critical component of determining pediatric heart transplant candidacy. Psychosocial factors such as family dynamics, health literacy, mental health, financial stability, and adherence potential are often multidimensional and interdependent, making their assessment both vital and complex. However, few standardized tools exist to guide these evaluations in pediatric heart transplant settings, and even fewer have demonstrated empirical validity or predictive value. To address this gap, the Pediatric Psychosocial Assessment Tool (PPAT) was developed to provide a structured, semi-quantitative framework for evaluating psychosocial risk in pediatric transplant candidates.</div></div><div><h3>Methods</h3><div>This study presents initial validation data for the PPAT, based on 189 assessments conducted at a large pediatric heart transplant center. The tool evaluates nine psychosocial domains, assigns risk ratings, and yields a total risk score.</div></div><div><h3>Results</h3><div>Confirmatory factor analysis supported the unidimensional structure of the tool, and internal consistency was strong (α = 0.89). Higher PPAT scores were significantly associated with lower odds of being listed for transplant by the center’s multidisciplinary medical review board (MRB), even after accounting for clinical factors. Domain-level findings revealed financial and health literacy issues as commonly identified risk areas.</div></div><div><h3>Conclusion</h3><div>The PPAT holds promise as a valid, reliable, and clinically useful instrument for guiding MRB discussions and targeting interventions to support high-risk families. Future directions include expanding implementation to other centers and integrating the PPAT into digital platforms using artificial intelligence and natural language processing to enhance efficiency, consistency, and patient-centered care.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100319"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534293","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":"Synchronized biatrial arrhythmias: Anatomic differences in biatrial versus bicaval orthotopic heart transplants drive arrhythmogenic sequelae","authors":"Michael C. Downey MD ,&nbsp;Edwin Zishiri MD","doi":"10.1016/j.jhlto.2025.100321","DOIUrl":"10.1016/j.jhlto.2025.100321","url":null,"abstract":"<div><div>A 37-year-old male with a history of familial Titin (TTN) gene mutation and orthotopic heart transplant (OHT) 20 years prior presented for evaluation of persistent atrial arrhythmias, including atrial fibrillation and atrial flutter. Despite the lower risk for atrial fibrillation in OHT patients due to surgical anastomosis isolating the pulmonary veins, biatrial OHT, which preserves the native atrial connection (unlike bicaval OHT), allows for arrhythmogenesis on both the donor and recipient atrial sides. This patient's case illustrates a unique arrhythmic mechanism where electrical reentry between residual and transplanted atrial myocardium resulted in multiple distinct atrial tachycardias. Intracardiac electrograms revealed sinus rhythm along with atrial tachycardia, particularly in the posterior left atrium and the right atrium. High-density voltage mapping identified significant scarring along the anterior and lateral right atrium, likely due to the prior recipient-to-donor right atrial anastomosis. A narrow gap of viable tissue indicated electrical reconnection across the suture line, facilitating multiple micro-reentrant circuits. Radiofrequency ablation (RFA) was performed to interrupt this excitable gap, isolating the native and donor atrial tissues. The RFA lesion set transected the anastomosis site and extended to the cavo-tricuspid isthmus, reestablishing electrical isolation. This case highlights the importance of understanding the biatrial OHT anatomy for targeted electrophysiologic interventions, selective placement of reference electrodes/catheters for mapping, and the need for careful consideration of electrical reconnection across surgical anastomoses to prevent arrhythmogenesis.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100321"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518278","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":"Chest wall strapping in a porcine model: Dynamic dysanapsis dilates airways for optimized function of the “oversized” lung","authors":"Eric Abston ,&nbsp;Michael Eberlein","doi":"10.1016/j.jhlto.2025.100317","DOIUrl":"10.1016/j.jhlto.2025.100317","url":null,"abstract":"<div><div>Chest-Wall-Strapping (CWS), a technique forcing the lung to operate at low volumes, is a model for an oversized lung allograft. Dynamic-dysanapsis describes airway dilation mediated by increased elastic recoil from CWS. We hypothesized that Dynamic-dysanapsis can be quantified via the Dysanapsis-Ratio, defined as the airway-size to lung-volume ratio.</div><div>Farm-raised pigs (n=3) were mechanically ventilated. Stepwise CT-images throughout the lung deflation limb in control and CWS conditions were analyzed quantifying airway dimensions and lung volume.</div><div>CWS (30%-reduction in lung-volume) was associated with a significant increase in the Dysanapsis-Ratio (p&lt;0.001). CWS increased airway distensibility at the 6th major branch of the right lower airway (27±7% vs. 39±5%, p=0.04).</div><div>The dysanapsis-ratio allows quantification of dynamic-dysanapsis with CWS. Dynamic-dysanapsis appears to be a compensatory mechanism to preserve pulmonary gas exchange by airway dilation when the lung is forced to operate at lower lung volumes. Dynamic-dysanapsis furthers the understanding of oversized allografts in lung transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100317"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490870","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":"Airway complications after lung transplantation: Perioperative risk factors and clinical outcomes","authors":"Siddhartha G. Kapnadak MD ,&nbsp;Kathleen J. Ramos MD, MS ,&nbsp;Rachel Flodin MS ,&nbsp;Sanaa Mansoor MD ,&nbsp;Kyle Bilodeau MD ,&nbsp;Peter Beidler BS ,&nbsp;Erika D. Lease MD ,&nbsp;Ryan Thomas BS ,&nbsp;Richard Dubois MD ,&nbsp;Jay Pal MD, PhD ,&nbsp;Michael S. Mulligan MD","doi":"10.1016/j.jhlto.2025.100315","DOIUrl":"10.1016/j.jhlto.2025.100315","url":null,"abstract":"<div><h3>Background</h3><div>Airway complications after lung transplantation are common and contribute to worse outcomes. There are limited data documenting perioperative risk factors that could be mitigated to reduce risk. Our objectives were to (1) assess the impact of pretransplant disease–modifying medications and post-transplant hypotension, hypovolemia, and mechanical ventilation on the risk of airway complications; (2) evaluate the association of airway complications with post-transplant lung function and survival.</div></div><div><h3>Methods</h3><div>One hundred and forty-five bilateral lung transplant recipients at our center were included. Demographics, pretransplant medications, post-transplant intensive care unit variables, and lung function were compared between recipients who did vs did not develop airway complications. Post-transplant survival was estimated using Kaplan-Meier analysis.</div></div><div><h3>Results</h3><div>Forty-eight (33.1%) recipients (75% male) developed airway complications. There were no significant associations in pretransplant exposure to prednisone (including by dose), other immunosuppressants, or antifibrotics, alone or in any combination, with the development of airway complications. There were no differences in ventilation pressures, but recipients with airway complications had higher peak vasopressor-inotropic scores (18.0 vs 13.0, <em>p</em> = 0.021), lactate levels (9.1 vs 6.8, <em>p</em> = 0.017), need for hemodialysis (22.9% vs 10.3%, <em>p</em> = 0.042), and net fluid balance at 48 hours (10.6 vs 8.9 liters, <em>p</em> = 0.028), respectively, compared to those without. Airway complications were associated with significantly worse survival (HR 2.74 [95% CI 1.35, 5.55], <em>p</em> = 0.004) and lung function (peak forced expiratory value in 1 second 74.8% vs 86.3% predicted, respectively, <em>p</em> = 0.013).</div></div><div><h3>Conclusions</h3><div>Postoperative hypotension and hypoperfusion are associated with increased risk for airway complications after lung transplantation. Airway complications are associated with poor outcomes, and further studies are needed to delineate risk-mitigation strategies.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100315"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366951","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 donation after brain death heart transplantation from older donors: A contemporary analysis of the UNOS database","authors":"Selena S. Li MD ,&nbsp;Adham Makarem MD, MPH ,&nbsp;Masaki Funamoto MD, PhD ,&nbsp;Eriberto Michel MD ,&nbsp;Antonia Kreso MD ,&nbsp;Alireza S. Rabi MD, PhD ,&nbsp;Van-Khue Ton MD, PhD ,&nbsp;Daniel Zlotoff MD, PhD ,&nbsp;Bin Quan Yang MD ,&nbsp;Gregory Lewis MD ,&nbsp;David D’Alessandro MD ,&nbsp;Asishana A. Osho MD, MPH","doi":"10.1016/j.jhlto.2025.100313","DOIUrl":"10.1016/j.jhlto.2025.100313","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The effect of older donor age on heart transplant outcomes remains controversial, with traditional views that older donors lead to worse post-transplant survival. However, in the modern era, the use of extended donor criteria has included older donors in efforts to expand the donor pool. In this study, we examine the effects of older donor age (≥50 years) on post-transplant outcomes in donation after brain death (DBD) heart transplants in the post-allocation change era.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This United Network for Organ Sharing (UNOS) database study included adult heart transplants from October 18, 2018 to June 30, 2023. We excluded circulatory death donors, prior heart and multiorgan transplants, and loss to follow-up. Propensity-matching was performed with 3:1 matching. Primary outcome was overall survival. Secondary outcomes included acute rejection, coronary vasculopathy (CAV), 30-day and 1-year mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 12,802 patients were included, 11,936 who received hearts from standard donors (age &lt;50 years), and 866 from older donors (age ≥50 years). Recipients of older hearts were older (median age 61 vs 56 years, &lt;em&gt;p&lt;/em&gt; &lt; 0.001), more likely to have durable left ventricular assist devices (LVADs) (30.1% vs 24.3%, &lt;em&gt;p&lt;/em&gt; = 0.001) and less likely to be hospitalized (49.1% vs 71.4%, &lt;em&gt;p&lt;/em&gt; &lt; 0.001). Older donors were more likely male (71.6% vs 64.7%, &lt;em&gt;p&lt;/em&gt; &lt; 0.001) with history of smoking (25.0% vs 11.7%, &lt;em&gt;p&lt;/em&gt; &lt; 0.001), diabetes (9.1% vs 3.7%, &lt;em&gt;p&lt;/em&gt; &lt; 0.001), and hypertension (42.9% vs 13.9%, &lt;em&gt;p&lt;/em&gt; &lt; 0.001). The majority of older organs were received by recipients at waitlist status 4 (31.2%), while younger hearts were primarily transplanted into status 2 recipients (51.9%, &lt;em&gt;p&lt;/em&gt; &lt; 0.001).&lt;/div&gt;&lt;div&gt;On unadjusted analysis, recipients of older hearts had worse overall survival (&lt;em&gt;p&lt;/em&gt; = 0.0062, Figure 1A), but after propensity-matching, this difference was no longer significant (&lt;em&gt;p&lt;/em&gt; = 0.32). Multivariable Cox regression demonstrated no difference in graft failure, risk stratifying donor age by decade. Subgroup analysis on donors with preoperative coronary angiograms demonstrated worse survival in older donors with coronary artery disease (CAD), which remained significant after adjusting for donor and recipient characteristics.&lt;/div&gt;&lt;div&gt;Recipients of older hearts were more likely to develop coronary vasculopathy (12.9% vs 9.5%, &lt;em&gt;p&lt;/em&gt; = 0.002) at a median follow-up of 32 months, which persisted after propensity-matching (Table 1). On multivariable regression, donor age was an independent risk factor for coronary vasculopathy with increased risk per decade compared to donor age &lt;30 years (all &lt;em&gt;p&lt;/em&gt; &lt; 0.05).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Older donor hearts (age ≥50 years) may achieve comparable perioperative outcomes and survival with careful selection. CAD in older ","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100313"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366952","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":"Fluid management of cardiopulmonary bypass during pulmonary endarterectomy for CTEPH patients impacts perioperative outcome","authors":"K. Furrer MD ,&nbsp;D. Bettex MD ,&nbsp;T. Horisberger ,&nbsp;I. Inci MD ,&nbsp;N.G. Nagaraj ,&nbsp;H.-T. Morselli ,&nbsp;B. Battilana ,&nbsp;R. Schuepbach MD ,&nbsp;S. Ulrich MD ,&nbsp;M. Hebeisen MSc ,&nbsp;I. Opitz MD","doi":"10.1016/j.jhlto.2025.100253","DOIUrl":"10.1016/j.jhlto.2025.100253","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary endarterectomy (PEA) using deep hypothermic circulatory arrest (DHCA) and cardiopulmonary bypass (CPB) is the preferred treatment for chronic thromboembolic pulmonary hypertension (CTEPH). Crystalloid priming solutions cause hemodilution with disadvantages, and no standard exists for PEA. This study evaluates CTEPH patient outcomes after adding 5% human albumin (HA) to the CPB-prime and hemodilution solution during PEA.</div></div><div><h3>Methods</h3><div>The effect of the CPB-protocol change was evaluated by comparing patients operated under the old and new protocols in a 1:1 propensity score match based on age, sex, and preoperative peripheral vascular resistance (PVR).</div></div><div><h3>Results</h3><div>Matching resulted in 56 patients (28 per group) between July 1, 2010, and May 31, 2020. The new protocol group had a lower intraoperative fluid balance (1.85 vs 6.76 liters, <em>p</em> &lt; 0.001), vasoactive-inotropic score (VIS) (8.7 vs 17.7, <em>p</em> = 0.04), shorter operative- (407 vs 451 min, <em>p</em> = 0.03), and hospitalization time (LOS) (18 vs 27 days, <em>p</em> = 0.008). Morbidity and mortality at 30- and 90-days were similar in both groups. The new protocol was associated with reduced intraoperative fluid balance after adjustment for operative time (−3.7 liters [95% CI −5.2, −2.1], <em>p</em> &lt; 0.0001). Lower intraoperative fluid balance was associated with shorter hospitalization in the intensive care unit, intubation time, LOS, and lower VIS (<em>p</em> = 0.0011, 0.0013, 0.008, &lt;0.0001, respectively). The protocol change shortened LOS, independent of operative time, by 27% [95% CI, 44%, 6%], <em>p</em> = 0.02.</div></div><div><h3>Conclusions</h3><div>Priming and maintenance protocol for CPB with the addition of 5% HA had a beneficial effect on intraoperative fluid balance and improved outcome after PEA for patients with CTEPH.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100253"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490869","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":"Heart Transplantation in post-infarction ventricular septal rupture: Contemporary outcomes from the 2016-2021 National Inpatient Database","authors":"Daniel B. Hanna MD ,&nbsp;Dhiran Verghese MD ,&nbsp;Wael Dakkak MD ,&nbsp;Juan Sierra MD ,&nbsp;Viviana Navas MD ,&nbsp;Luis Paz MD ,&nbsp;Travis Howard MD ,&nbsp;Mazen Albaghdadi MD ,&nbsp;Dee Dee Wang MD ,&nbsp;Carl E. Orringer MD ,&nbsp;Robert J. Cubeddu MD","doi":"10.1016/j.jhlto.2025.100278","DOIUrl":"10.1016/j.jhlto.2025.100278","url":null,"abstract":"<div><h3>Introduction</h3><div>Ventricular septal rupture (VSR) is a devastating complication of myocardial infarction (MI), with high mortality, particularly in cardiogenic shock (CS). Heart transplantation (HT) has emerged as a potential alternative to surgery or transcatheter closure (TCC). This study evaluates contemporary trends and outcomes of HT in post-MI VSR using the National Inpatient Sample (NIS) database.</div></div><div><h3>Objectives</h3><div>To assess in-hospital mortality and resource utilization of HT compared to surgical repair or TCC for post-MI VSR with CS.</div></div><div><h3>Methods</h3><div>We analyzed NIS data (2016–2021) for MI-VSR hospitalizations with CS. Patients undergoing HT were compared to those receiving surgical repair or TCC. Primary and secondary endpoints included in-hospital mortality (IHM), total hospital charges (TOTCHG), and length of stay (LOS). Multivariable logistic regression adjusted for age, sex, race, comorbidities, and hospital characteristics, with surgical repair as the control.</div></div><div><h3>Results</h3><div>Of 2,514,025 acute MI hospitalizations, 4765 (0.20%) had VSR. IHM was 82% with CS vs. 60% without. Among VSR-CS patients, 30 (1.2%) underwent HT, 600 (24.1%) surgical repair, 225 (9.2%) TCC, and 1635 (65%) medical therapy. IHM was 0% for HT vs. 66% (surgery), 75% (TCC), and 97% (medical therapy). All HT patients received mechanical circulatory support [IABP (50%), Impella (27%), ECMO ± Impella (10%), ECMO (13%)].). Patients undergoing HT had an average LOS approximately 20 days longer than those treated surgically (p = 0.004; 95% CI: 13.78–47.29) and 15 days longer with TCC (p = 0.008; 95% CI: 19.32–54.23). Similarly, mean total hospital charges (TOTCHG) were higher for HT patients ($1,456,693) compared to surgical repair ($325,032; p = 0.001; 95% CI: $145,002–$634,293) and TCC ($210,032; p = 0.001; 95% CI: $119,230–$542,200).</div></div><div><h3>Conclusions</h3><div>From 2016 to 2021, among VSR-CS admissions in the United States, patients who underwent HT had no in-hospital mortality, in contrast to the high in-hospital-mortality observed with surgical or transcatheter closure. Despite inherent selection biases, including survival to transplantation, HT was associated with favorable outcomes compared to surgical repair. While promising, these findings are preliminary due to the small sample size and selective nature of the patient cohort. Further studies are required before HT can be broadly recommended as a primary treatment option.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100278"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313632","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":"Unique association of extreme elevation of cell free DNA and histologic patterns of intra-alveolar injury among lung transplant recipients","authors":"Zehra Dhanani ,&nbsp;Omar Al Omari ,&nbsp;Alonso Marquez ,&nbsp;Kartik Shenoy ,&nbsp;Fatima Anjum","doi":"10.1016/j.jhlto.2025.100305","DOIUrl":"10.1016/j.jhlto.2025.100305","url":null,"abstract":"<div><h3>Background</h3><div>Donor-derived cell-free DNA (dd-cfDNA) is a valuable biomarker for allograft injury, but its association with various histopathologic injury patterns as specified in the Lung Allograft Standardized Histological Analysis (LASHA) protocol remains unclear. This study evaluates the relationship between various histopathologic findings as per the LASHA protocol, dd-cfDNA levels including extreme molecular injury (EMI), and allograft outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of lung transplant recipients at a single center (2022-2024). A total of 84 patients with 589 dd-cfDNA samples were analyzed, with 124 samples having corresponding transbronchial biopsy (TBBX) and bronchoalveolar lavage (BAL) data. EMI was defined as dd-cfDNA &gt; 5%. Multivariate regression analyses examined associations between histopathologic findings—including hemosiderin-laden macrophages (HLM) and organizing pneumonia (OP)—clinical comorbidities, EMI, and allograft outcomes.</div></div><div><h3>Results</h3><div>EMI was observed in 29% of the cohort and was significantly associated with CLAD (<em>p</em> = 0.04), diabetes (<em>p</em> = 0.009), and elevated DSAs (<em>p</em> = 0.03). EMI was also more frequently detected in Black patients. On histopathology, OP was present in 11.2% of TBBX samples, while 8.9% had HLM. Patients with OP had significantly higher median dd-cfDNA levels compared to those without OP (<em>p</em> &lt; 0.05) and exhibited lymphocytic-predominant BAL (<em>p</em> &lt; 0.001). HLM was more prevalent in Black patients and in those with clinical or radiographic suspicion of OP, even in the absence of OP on histopathology.</div></div><div><h3>Conclusion</h3><div>Our study highlights novel associations between dd-cfDNA, histopathologic findings, comorbidities, race, and allograft injury, emphasizing the need for personalized monitoring and risk stratification in lung transplantation and to explore mechanisms underlying the observed disparities.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100305"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144291297","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":"Differences in wait-list mortality: Temporary vs durable circulatory support devices","authors":"Mahwash Kassi MD ,&nbsp;Salma Zook MD ,&nbsp;Duc Nguyen MD, PhD ,&nbsp;Katelyn Ingram BS ,&nbsp;Sapna Legha MD ,&nbsp;Rayan Yousefzai MD ,&nbsp;Ju Kim MD ,&nbsp;Imad Hussain MD ,&nbsp;Cindy M. Martin MD ,&nbsp;Janardhana Gorthi MD ,&nbsp;Adeel Ahsan Syed MD ,&nbsp;Nadia Fida MD ,&nbsp;Arvind Bhimaraj MD ,&nbsp;Edward A. Graviss PhD ,&nbsp;Ashrith Guha MD","doi":"10.1016/j.jhlto.2025.100312","DOIUrl":"10.1016/j.jhlto.2025.100312","url":null,"abstract":"<div><h3>Background</h3><div>In 2018, changes in the United Network for Organ Sharing (UNOS) allocation system led to a shift in practices, making durable left ventricular assist devices less desirable as a bridge to transplantation compared to temporary mechanical circulatory support. This study compares the composite outcome of waitlist mortality and delisting incidence at 1 year between these two support types.</div></div><div><h3>Methods</h3><div>All actively listed adult patients on mechanical circulatory support listed for heart transplantation under the current UNOS system from October 2018 to October 2021 were included, excluding those with right ventricular devices, biventricular devices, total artificial hearts, and extracorporeal membrane oxygenators. The primary outcome was the composite of waitlist mortality and delisting due to clinical deterioration at 1 year. Survival analysis was conducted using Kaplan-Meier curves and multivariable Cox regression.</div></div><div><h3>Results</h3><div>A total of 4,569 patients were included, with 1,877 on temporary mechanical circulatory support and 2,692 on left ventricular assist devices. Propensity-score matching was performed on 660 patients divided into two groups. The event rate was lower in the left ventricular assist device group compared to the temporary mechanical circulatory support group (15.9% vs 35.2%, <em>p</em> &lt; 0.001). Temporary mechanical circulatory support had a significantly higher multivariable hazard ratio (HR) for outcome events (HR 3.37, <em>p</em> &lt; 0.001). The HeartMate 3 (HM3) had the best outcomes compared to all other device types.</div></div><div><h3>Conclusion</h3><div>In this propensity-score-matched analysis, durable mechanical circulatory support had better outcomes than temporary mechanical circulatory support. HM3 had the lowest risk of composite outcomes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100312"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144331278","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}