JHLT Open最新文献

{"title":"ECPELLA bridge to heart transplantation for a large ischemic ventricular septal defect and refractory ventricular arrhythmias","authors":"Max Frenkel MD, PhD ,&nbsp;Romulo Fajardo MD ,&nbsp;John Dollerschell MD ,&nbsp;Aurangzeb Baber MD ,&nbsp;Joshua Hermsen MD ,&nbsp;Yu Xia MD, MS","doi":"10.1016/j.jhlto.2025.100288","DOIUrl":"10.1016/j.jhlto.2025.100288","url":null,"abstract":"<div><div>Post-myocardial infarction (MI) ventricular septal defects (VSDs) are rare but life-threatening. Temporary mechanical support options range from intra-aortic balloon pumps (IABPs) to venoarterial extracorporeal membrane oxygenation (VA-ECMO). There are few anecdotes of the Impella as a bridge to repair. We present a case of post-MI VSD and cardiogenic shock requiring combined Impella 5.5 and VA-ECMO (ECPELLA) as a bridge to transplant.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100288"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281171","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":"Improving pediatric heart failure outcomes through collaboration and innovation: The current status of the Advanced Cardiac Therapies Improving Outcomes Network (ACTION)","authors":"Lydia K. Wright MD, MSc, Assistant Professor ,&nbsp;David M. Peng MD ,&nbsp;Joseph A. Spinner MD ,&nbsp;Jenna M. Murray NP ,&nbsp;Matthew J. O’Connor MD ,&nbsp;Christina J. VanderPluym MD ,&nbsp;David N. Rosenthal MD ,&nbsp;Lauren Smyth MHA ,&nbsp;Angela Lorts","doi":"10.1016/j.jhlto.2025.100311","DOIUrl":"10.1016/j.jhlto.2025.100311","url":null,"abstract":"<div><div>The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) was founded in 2017 as a learning health care system to bring together all stakeholders with the aim of improving outcomes for pediatric and congenital heart disease patients with heart failure. From an initial focus on the ventricular assist device (VAD) population, work in the network has expanded to encompass the scope of heart failure in these patients. Through the collection and use of real-world data, the field has gained greater understanding of best practices in care of these patients, as well as improved access to devices with pediatric labeling of devices previously approved only for adults. Recent and current work across the network’s major focus areas (VAD, heart failure, muscular dystrophy, and Fontan) are highlighted.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100311"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313447","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":"Left ventricular longitudinal function is reduced but partially compensated by increased radial function after heart transplantation","authors":"Grunde Gjesdal MD PhD ,&nbsp;Anna Székely MD ,&nbsp;Henrik Engblom MD PhD ,&nbsp;Håkan Arheden MD PhD ,&nbsp;Oscar Ö Braun MD PhD ,&nbsp;Katarina Steding-Ehrenborg RPT PhD","doi":"10.1016/j.jhlto.2025.100308","DOIUrl":"10.1016/j.jhlto.2025.100308","url":null,"abstract":"<div><h3>Background</h3><div>In healthy hearts, left ventricular atrioventricular plane displacement (LVAVPD) measured by cardiac magnetic resonance (CMR) contributes to ∼60% of stroke volume. LVAVPD has been shown to correlate with maximal cardiac output and exercise capacity and is an independent predictor of outcomes in patients with heart failure. We aimed to assess if longitudinal pumping is altered, if LVAVPD is associated with exercise capacity, and if any difference in longitudinal pumping could be explained by the presence of a right bundle branch block (RBBB) in heart-transplanted patients.</div></div><div><h3>Method</h3><div>This single-center study included 34 heart-transplanted patients who had undergone CMR and a cardiopulmonary exercise test as part of a clinical post-transplant surveillance program. Data was compared to 34 healthy sex- and age-matched controls.</div></div><div><h3>Results</h3><div>Heart-transplanted patients had decreased LVAVPD (10.3 vs 13.7 mm, <em>p</em> &lt; 0.01), lower longitudinal contribution (46% vs 53%, <em>p</em> &lt; 0.01), and lower septal contribution (−3% vs 8%, <em>p</em> &lt; 0.01) to stroke volume compared to controls. Furthermore, the lateral contribution was increased (44% vs 28%, <em>p</em> &lt; 0.01) in the heart-transplanted patients. Longitudinal contribution to stroke volume was neither associated with exercise capacity (<em>p</em> = 0.20) nor cardiac output at rest (<em>p</em> = 0.62). There was no difference in LVAVPD in patients with and without RBBB (<em>p</em> = 0.81).</div></div><div><h3>Conclusion</h3><div>Heart-transplanted patients have decreased left ventricular longitudinal function compared to healthy controls, in part compensated by an augmented lateral function. Longitudinal function is not associated with cardiac output at rest or exercise capacity in this patient group. Whether the altered pumping mechanics seen are associated with outcome remains to be investigated.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100308"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144331240","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":"Rehabilitation in children with ventricular assist devices","authors":"Matthew J. O’Connor","doi":"10.1016/j.jhlto.2025.100310","DOIUrl":"10.1016/j.jhlto.2025.100310","url":null,"abstract":"<div><div>Ventricular assist devices play a critical role in the management of end-stage heart failure, with a significant increase in their utilization in children over the past 20 years. While much attention has been given toward the success of ventricular assist devices in reversing the physiologic consequences of chronic heart failure, the ability of ventricular assist devices to facilitate rehabilitation should not be underestimated. For patients with chronic heart failure, rehabilitation can be understood to include exercise rehabilitation, nutritional rehabilitation, and psychosocial rehabilitation. In this review article, the effects of chronic heart failure on these 3 domains of rehabilitation are described, along with the impact of ventricular assist devices on these domains in children. Data demonstrating the effects of ventricular assist device therapy on rehabilitation are reviewed, and areas where opportunities for the improvement in care exist are identified as well.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100310"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313446","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":"Risk factors affecting mortality in pediatric heart transplantation: A comprehensive review of pre- and post-transplant contributors","authors":"Sydney Elizer MD ,&nbsp;Benjamin S. Mantell MD, PhD, Assistant Professor of Pediatrics","doi":"10.1016/j.jhlto.2025.100309","DOIUrl":"10.1016/j.jhlto.2025.100309","url":null,"abstract":"<div><div>Pediatric heart transplantation (HT) has transformed outcomes for children with end-stage heart failure. Despite advances in surgical techniques and immunosuppressive strategies, mortality remains influenced by numerous risk factors. This review consolidates current literature on pre- and post-transplant variables affecting mortality in pediatric HT, focusing on donor, recipient, and environmental contributors. Pertinent adult studies are also incorporated to highlight overlapping considerations. Recognition of these factors is critical to improving graft survival and long-term outcomes. Key pre-transplant elements include repeated sternotomies, high pulmonary vascular resistance, and extremes of body mass index, while post-transplant issues such as infection, rejection, and cardiac allograft vasculopathy (CAV) remain pivotal. Social determinants of health further modulate survival, reflecting the multifaceted nature of pediatric HT outcomes. By synthesizing existing data, this review aims to provide a framework for identifying high-risk profiles in pediatric HT recipients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100309"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366513","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":"Sizing in lung transplantation: principles, practices and ideas for the future","authors":"Michael Eberlein ,&nbsp;Robert M. Reed ,&nbsp;Eric Abston ,&nbsp;Roy Brower ,&nbsp;Matthew G. Hartwig ,&nbsp;Yu Xia ,&nbsp;Daniel P. McCarthy","doi":"10.1016/j.jhlto.2025.100304","DOIUrl":"10.1016/j.jhlto.2025.100304","url":null,"abstract":"<div><div>Lung transplantation (LTx) is an important treatment option for many end-stage lung diseases. The goal of LTx is to restore pulmonary physiology (gas exchange and respiratory system mechanics) towards normal, so that LTx recipients can experience an improved quality of life and live significantly longer. An optimized approach to donor-to-recipient size matching is a strategy to increase opportunities for successful transplants and optimize outcomes. In this review we discuss relevant pulmonary gas exchange and respiratory systems mechanics principles as a framework to optimize donor-to-recipient size matching and LTX-recipient management. The predicted total lung capacity (pTLC) is a refined estimate of organ size utilizing regression equations to calculate lung size based on height, sex and age. In general, irrespective of the underlying lung disease the chest cavity is “reverse remolding” back towards normal size in most recipients. The parameter that can reflect the sizing goal to restore physiology towards normal is the recipient pTLC. A pragmatic size matching metric is the donor-to-recipient pTLC-ratio. Significant undersizing based on the pTLC-ratio is a risk factor for complications and lower LTx survival. If significant changes to the LTx candidate’s chest cavity size occur (as can occur in severe restrictive lung disease or severe emphysema), or if the chest cavity cannot “reverse remodel” towards normal, it is important to consider additional donor-to-recipient sizing metrics. In addition to the recipient’s measured actual total lung capacity imaging-based metrics can be considered. Chest X-ray and computer tomography based volumetric analyses can provide information facilitating a successful LTx.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100304"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144331238","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":"The value of systematic study and biobanking of explanted hearts: Insights from an international ISHLT pathology survey","authors":"Marny Fedrigo MD PhD ,&nbsp;Diego Perazzolo Ing ,&nbsp;Gerald J. Berry MD ,&nbsp;Annalisa Angelini MD","doi":"10.1016/j.jhlto.2025.100306","DOIUrl":"10.1016/j.jhlto.2025.100306","url":null,"abstract":"<div><div>This study evaluates global practices for managing explanted hearts, with a focus on tissue collection and biobanking protocols. A survey conducted through the International Society for Heart and Lung Transplantation (ISHLT) assessed responses from centers across Europe, North America, and Other Countries. Results demonstrated significant variability in tissue sampling, grossing protocols, and storage practices. While 78.8% of centers had grossing protocols, fewer (73.1%) adapted sampling based on pathology. Fresh tissue collection was prevalent in 63.5% of centers, but volumes varied: North America led with higher sampling rates (10-25 samples per heart), while Europe and Other Countries collected fewer samples. Coronary artery sampling also showed regional differences. Fresh tissues enable advanced molecular studies, while fixed tissues remain fundamental for histopathology. Standardized global protocols for sampling, storage, and reporting could enhance the clinical and research value of explanted hearts, optimizing post-transplant care and driving innovation in cardiac medicine.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100306"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313445","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":"It takes two: Aberrant repair and low-grade inflammation characterize bronchiolitis obliterans syndrome after lung transplantation in serum proteomic analysis","authors":"Eline A. van der Ploeg ,&nbsp;Alen Faiz ,&nbsp;Greta J. Teitsma ,&nbsp;Alejandro Sánchez Brotons ,&nbsp;Natalia Govorukhina ,&nbsp;Jannie M.B. Sand ,&nbsp;Diana J. Leeming ,&nbsp;Barbro N. Melgert ,&nbsp;Peter Horvatovich ,&nbsp;Janette K. Burgess ,&nbsp;C. Tji Gan","doi":"10.1016/j.jhlto.2025.100303","DOIUrl":"10.1016/j.jhlto.2025.100303","url":null,"abstract":"<div><h3>Background</h3><div>The obstructive phenotype of chronic lung allograft dysfunction, bronchiolitis obliterans syndrome (BOS), is diagnosed after lung transplantation (LTx) when irreversible airway obstruction is already present. This study aimed to investigate biomarkers indicative of aberrant repair resulting in a fibrotic response and inflammation signals in the serum of patients with BOS.</div></div><div><h3>Methods</h3><div>LTx patients transplanted at the University Medical Center Groningen between 2004 and 2017 were screened. Nineteen patients with BOS were selected and matched with 19 patients with non-BOS. Only patients for whom lung function and longitudinal serum samples post-LTx were available were included. Enzyme-linked immunosorbent assays were performed for neoepitopes of collagen types I, III, and VI and osteoprotegerin (OPG) in serum. Additionally, serum samples were analyzed by label-free liquid chromatography with tandem mass spectrometry proteomics analysis.</div></div><div><h3>Results</h3><div>Collagen neoepitopes did not differ significantly between patients with BOS and non-BOS at any timepoint. OPG was significantly higher in non-BOS compared to BOS 6 months before BOS onset (<em>p</em> &lt; 0.04). In proteomics analysis, proteins indicating cell repair and proliferation, namely human type II keratin-6 and centromere protein F (both FDR &lt; 0.1), were significantly lower 3 months before BOS onset in patients with BOS compared to patients with non-BOS. C-reactive protein (FDR &lt; 0.05) and SERPINA3 (FDR &lt; 0.05), among others, were higher in end-stage patients with BOS compared to patients with non-BOS.</div></div><div><h3>Conclusions</h3><div>Differences in the expression of proteins that reflect the complex interplay between aberrant repair and inflammation in BOS were identified. These proteins should be investigated and validated in larger cohorts and may aid in expanding knowledge about the development of BOS.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100303"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313388","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":"Invasive surgical site infections after lung transplantation: contemporary risk factors and associated clinical outcomes","authors":"Manuela Carugati MD ,&nbsp;Sana Arif MD ,&nbsp;John Michael Reynolds MD ,&nbsp;John Carroll Haney MD ,&nbsp;Michael Edwards Yarrington MD, MM ,&nbsp;Katherine Young MD ,&nbsp;Deepika Kulkarni MD ,&nbsp;Alzora Benjamin ,&nbsp;Katina Walline ,&nbsp;Jonathan Huggins MD, MSCE ,&nbsp;Morgan Rosser PhD ,&nbsp;Samantha Morrison PhD ,&nbsp;Sarah Peskoe PhD ,&nbsp;Brandi Ann Bottiger MD ,&nbsp;Rachel Ann Miller MD ,&nbsp;Barbara Dudley Alexander MD, MHS","doi":"10.1016/j.jhlto.2025.100294","DOIUrl":"10.1016/j.jhlto.2025.100294","url":null,"abstract":"<div><h3>Background</h3><div>Invasive primary surgical site infections (IP-SSI) complicate lung transplant (LT) surgery. Identification of IP-SSI risk factors is critical to IP-SSI prevention.</div></div><div><h3>Methods</h3><div>This single-center retrospective cohort study of adult patients who underwent LT at Duke University over a 5-year period (2017–2021) aimed to identify IP-SSI risk factors and describe outcomes associated with IP-SSI diagnosis. IP-SSI risk factors were identified using a Least Absolute Shrinkage and Selection Operator procedure for logistic regression.</div></div><div><h3>Results</h3><div>IP-SSI occurred in 74/568 (13.0%) LT recipients. Restrictive lung disease, donor positive respiratory or blood cultures, operative time, post-transplant thoracic re-operation within 90 days of transplant, and ECMO by day 3 post-transplant were positively associated with IP-SSI. Obstructive lung disease, primary closure, and enhanced immunosuppression within 90 days of transplant were negatively associated with IP-SSI. Patients with IP-SSI were descriptively characterized by longer index transplant hospitalizations (92 <em>vs.</em> 22 days) and higher in-hospital (26.1% <em>vs.</em> 5.5%) and 1-year (20.3% <em>vs.</em> 12.1%) mortality rates than patients without IP-SSI. IP-SSI was significantly associated with 1-year mortality (HR 2.4, 1.3–4.3, p=0.003); however, the association was no longer significant (HR 1.4, 0.7–2.6, p=0.310) after adjusting for possible confounders.</div></div><div><h3>Conclusions</h3><div>Conservative surgical approaches, targeted antimicrobial prophylaxis, and increased surveillance for patients with IP-SSI risks may play a critical roleto limit IP-SSI in the LT population.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100294"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281175","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":"The state of the art in medical therapies for pediatric heart failure","authors":"Humera Ahmed MD,&nbsp;Joseph W. Rossano MD, MS","doi":"10.1016/j.jhlto.2025.100292","DOIUrl":"10.1016/j.jhlto.2025.100292","url":null,"abstract":"<div><div>Pediatric heart failure is a rare but serious condition affecting children with congenital heart disease and various forms of cardiomyopathy. The treatment paradigm for pediatric heart failure has historically been shaped by expert consensus guidelines, largely informed by the results of adult heart failure trials. Recently, however, there has been an increased focus on pediatric-specific drug development and clinical trials. Medications such as digoxin, beta-blockers, and renin-angiotensin-aldosterone system inhibitors have been explored in children, but responses can vary based on the underlying heart disease. Newer treatments such as sacubitril-valsartan and sodium-glucose cotransporter 2 inhibitors show promise, but more data are needed to determine their safety and efficacy in young children. This article explores the current state of medical therapy for chronic pediatric heart failure, highlighting the evolution of treatment strategies and the novel therapies under exploration.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100292"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518283","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}