Journal of Heart and Lung Transplantation最新文献

{"title":"Listening to the donor heart: A metabolic window into DCD heart transplantation.","authors":"Jens Böhmer","doi":"10.1016/j.healun.2026.09.019","DOIUrl":"10.1016/j.healun.2026.09.019","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial metabolism during DCD heart donation and transplantation assessed by microdialysis.","authors":"Maja Brøgger Thomassen, Klaes Vincent Lenbroch, Johanne Gade Lilleøre, Shan Awzhin Ali, Niels Moeslund, Per Lehnert, Mats Bue, Maiken Stilling, Roni Ranghøj Nielsen, Tor Skibsted Clemmensen, Hans Eiskjær","doi":"10.1016/j.healun.2026.09.016","DOIUrl":"10.1016/j.healun.2026.09.016","url":null,"abstract":"<p><strong>Background: </strong>Myocardial metabolism during donation after circulatory death (DCD) heart transplantation remains poorly characterized. This study investigated the feasibility of intramyocardial microdialysis for real-time metabolic monitoring and characterized changes in ischemic metabolites and mitochondrial function throughout the transplantation sequence.</p><p><strong>Methods: </strong>Danish Female Landrace pigs (76-85 kg) were used for six orthotopic DCD heart transplantations. Donor hearts underwent 10 min of asystolic warm ischemia followed by normothermic regional perfusion (NRP), procurement, and static cold storage (SCS). Microdialysis catheters were placed in both ventricles for continuous measurement of glucose, lactate, pyruvate, and glycerol. Serial myocardial biopsies were analyzed by high-resolution respirometry for assessment of mitochondrial function. After implantation, grafts were reperfused and assessed by invasive hemodynamic measurements.</p><p><strong>Results: </strong>Intramyocardial microdialysis was feasible and identified four distinct metabolic phases. The lactate-to-pyruvate (L/P) ratio increased during the first phase of circulatory arrest, partially normalized during the second phase of NRP, increased again during SCS and implantation in the third phase, and declined following reperfusion in the fourth phase. The highest L/P ratios were observed during implantation. The right ventricle (RV) exhibited a significantly greater L/P ratio than the left ventricle. Peak RV L/P ratio was associated with elevated post-transplant central venous pressure and inversely correlated with mitochondrial oxidative phosphorylation capacity following NRP.</p><p><strong>Conclusion: </strong>Intramyocardial microdialysis is a feasible method for real-time assessment of myocardial metabolism during DCD heart transplantation. DCD transplantation is characterized by dynamic phase-specific metabolic alterations, with the L/P ratio serving as a sensitive marker of ischemic stress and mitochondrial dysfunction.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating proteomic signatures associated with cardiac allograft vasculopathy in adult and pediatric heart transplant recipients: An exploratory study.","authors":"Charles D Nicoli, Praveen Ramaswamy, Sariah Hyacinth, Chase Bolding, Samantha L Nelson, Macee Owen, Dana Arenz, Stephanie J Nakano, Daniel Lin, John C Messenger, David S Raymer, Scott R Auerbach, Anastacia M Garcia, Benjamin J Kopecky","doi":"10.1016/j.healun.2026.09.014","DOIUrl":"10.1016/j.healun.2026.09.014","url":null,"abstract":"<p><strong>Background: </strong>Cardiac Allograft Vasculopathy (CAV) is a common complication following orthotopic heart transplant (OHT). Detection by coronary angiography is invasive and insensitive. Prior biomarker investigations examined a narrow proteomic range, and age-group differences in the CAV proteome remain undefined. We aimed to quantify the CAV proteome and compare across age groups in a hypothesis-generating manner.</p><p><strong>Methods: </strong>We sampled 35 pediatric and 28 adult OHT recipients from the University of Colorado heart biobanks. CAV was defined angiographically, when blood was sampled for assay of 5416 plasma proteins. Pediatric recipients contributed longitudinal data for up to two additional time points. Univariable binary logistic regression and univariable ordinal logistic regression assessed associations between protein abundance and prevalent CAV and CAV severity, respectively. Mixed-effects ordinal logistic regression examined longitudinal associations in the pediatric subcohort.</p><p><strong>Results: </strong>In the overall cohort, 340 and 323 proteins were nominally associated with prevalent CAV and higher CAV grade, respectively; 503 proteins showed nominal effect modification by age group. No cross-sectional associations survived FDR correction. In exploratory pathway analyses, we observed patterns of these nominal protein associations characterized by extracellular matrix remodeling and immune signaling in the overall cohort, innate immunity and vascular inflammation in the pediatric subcohort, and lipid metabolism and vascular biology in the adult subcohort.</p><p><strong>Conclusions: </strong>In this hypothesis-generating study, circulating proteomic associations with CAV differed between pediatric and adult OHT recipients. These exploratory differences were characterized by immune and vascular inflammatory pathways in children and metabolic and vascular pathways in adults; results require external validation.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements toward clinical application of AI-assisted CT analysis in pulmonary hypertension: A systematic literature review.","authors":"Hakim Ghani, Oliver Li, Alessandro Ruggiero, Martin Graves, Joanna Pepke-Zaba","doi":"10.1016/j.healun.2026.09.015","DOIUrl":"10.1016/j.healun.2026.09.015","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography (CT) plays an important role in pulmonary hypertension (PH) evaluation but remains largely restricted to qualitative or semi-quantitative imaging features. Artificial intelligence (AI) has potential to enable automated extraction of quantitative CT data, providing additional PH assessment tools. This systematic review evaluated current evidence on clinically actionable AI-enabled CT analysis in PH.</p><p><strong>Methods: </strong>Systematic literature search of PubMed, EMBASE, Web of Science, and Cochrane Library was performed from database inception to 5th January 2026. Studies were eligible if they applied AI methodologies to CT imaging in adult PH populations for diagnostic detection, aetiological or endophenotype classification, prognostication or risk stratification, or treatment assessment. Risk of bias and applicability were evaluated using the PROBAST tool.</p><p><strong>Results: </strong>17 studies met the inclusion criteria. AI-assisted CT analysis showed potential for PH detection, with area under the curves of 0.66-0.99, derived from quantitative pulmonary vascular morphology, cardiac chamber dimensions, lung perfusion, and/or parenchymal abnormalities. Several studies demonstrated ability to differentiate CTEPH from acute pulmonary embolism using perfusion and parenchymal features, and to identify pulmonary arterial hypertension endophenotypes through fibrosis quantification. Additionally, CT-based vascular and parenchymal metrics showed potential utility for prognostic risk stratification and evaluation of response to CTEPH interventions. However, most studies involved small, retrospective, or highly selected cohorts, with limited external validation, and methodological heterogeneity precluding meaningful comparability.</p><p><strong>Conclusion: </strong>AI-assisted CT analysis shows potential for advancing PH assessment through automated quantitative biomarkers. Robust validation, methodological comparability, and clinically intuitive metrics are required before potential clinical integration.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Functional Warm Ischemic Time on Outcomes after DCD Heart Transplantation: A Paradigm Shift Over a Decade.","authors":"Taimoor Khan, Stephen Pettit, Muhammad Raza Sarfraz, Mahmoud Hashim, Sri Aurovind, Luis Martinez, Clive Lewis, Anna Kydd, Prashant Mohite, Muhammad Umar Rafiq, Pradeep Kaul, Steven Tsui, David Jenkins, Sai Bhagra, Stephen Large, Marius Berman, Hassiba Smail","doi":"10.1016/j.healun.2026.09.012","DOIUrl":"https://doi.org/10.1016/j.healun.2026.09.012","url":null,"abstract":"<p><strong>Background: </strong>Functional warm ischemic time (FWIT) is known to affect outcomes after donation after circulatory death (DCD) heart transplantation (HTx), but its definition lacks worldwide consensus. This study examines the impact of FWIT on outcomes in DCD HTx.</p><p><strong>Methods: </strong>This study included 125 adult DCD HTx recipients retrieved by direct procurement and perfusion (DPP), 2015-2026. FWIT was defined as the interval from donor systolic blood pressure <50 mmHg to reperfusion on ex-situ normothermic machine perfusion. Recipients were stratified by FWIT (≤30 vs >30 minutes). Primary outcomes were severe primary graft dysfunction (PGD) and all-cause mortality, modelled using restricted cubic splines (RCS) and Cox regression.</p><p><strong>Results: </strong>FWIT was ≤30 minutes in 87 recipients (69.6%) and >30 minutes in 38 (30.4%), median FWIT was 27 minutes (IQR 24-32). Over a median follow-up of 5.4 years, 24 deaths occurred. FWIT was not independently associated with mortality (HR 1.11, 95% CI 0.83-1.46), RCS modelling showed no significant association across the observed range (HR 1.10 at 35 min, HR 1.13 at 40 min, vs. reference of 30 min). There was no significant difference between ≤30 and >30 min groups in survival at 1 year (88.8% vs 84.4%, p=0.75), incidence of severe PGD (23% vs 23.7%, p>0.99), post-transplant mechanical circulatory support (23% vs 31.6%, p=0.31), or long-term survival on Kaplan-Meier analysis (p=0.304).</p><p><strong>Conclusions: </strong>Prolonged FWIT does not appear to adversely affect HTx outcomes in this cohort. Larger, multicentre studies are needed to define an optimal FWIT threshold and a unified definition worldwide.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of donor-transmitted coronary artery disease on the progression of coronary vasculopathy after heart transplantation.","authors":"David Couto-Mallón, Luis Almenar-Bonet, Eduardo Barge-Caballero, Francisco José Hernández-Pérez, Juan Delgado-Jiménez, María Jesús Valero-Masa, María Ángeles Castel-Lavilla, Sonia Mirabet-Pérez, Iris Paula Garrido-Bravo, Carles Díez-López, Amador López-Granados, Rebeca Manrique-Antón, Carmen Neri Fernández-Pombo, Javier Muñiz, Maria Generosa Crespo-Leiro","doi":"10.1016/j.healun.2026.09.011","DOIUrl":"10.1016/j.healun.2026.09.011","url":null,"abstract":"<p><strong>Background: </strong>The prognostic significance of angiographically diagnosed donor-transmitted coronary artery disease (dtCAD) for post-heart transplant (HT) coronary artery disease (CAD) progression is poorly defined because of limited and heterogeneous evidence. We aimed to evaluate the role of angiographic dtCAD in the development and progression of CAD in HT recipients.</p><p><strong>Methods: </strong>Retrospective multicenter study including consecutive adult HT recipients (2008-2018) in Spain, with a coronary angiogram within 3 months post-HT. dtCAD was classified as significant (s-dtCAD: ≥50% stenosis), non-significant (ns-dtCAD: <50%), or absent (no-dtCAD). CAD progression, defined as new (≥50% stenoses in previously unaffected territories) was evaluated using protocol-based (performed at 1 and 5 years post-transplant) and clinically indicated angiograms. Progression risk was assessed by means of competing risk analysis using the Fine-Gray method.</p><p><strong>Results: </strong>From a cohort of 1918 recipients, 937 underwent baseline angiogram. dtCAD was identified in 172 patients (65 s-dtCAD). At follow-up, 791 patients had 1-year and 246 had 5-year angiograms. A total of 1960 angiograms were evaluated. Cumulative incidence of CAD progression was 5.39% (95%CI 3.81-7.36) and 16.09% (95%CI 12.30-20.33) at 1 and 5 years, respectively. Progression rates were higher among patients with dtCAD compared with those with no-dtCAD: s-dtCAD: 9.65 per 100 person-years (95%CI 5.35-17.43), ns-dtCAD: 9.24 (95%CI 5.82-14.67), no-dtCAD: 2.72 (95%CI 2.00 - 3.69). Both s-dtCAD (adjusted SHR: 2.38; 95%CI: 1.26-4.52; p = 0.008) and ns-dtCAD (adjusted SHR: 2.92; 95%CI 1.67-5.08; p< 0.001) were independent predictors of CAD progression.</p><p><strong>Conclusions: </strong>dtCAD was independently associated with an approximately threefold higher risk of CAD progression after HT.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung utilization and transplant outcomes after donor management at an in-hospital donor care unit versus the donor hospital.","authors":"Darren E Stewart, Philip M Sommer, Victoria Davis, Stephanie H Chang, Jake G Natalini, Greta L Piper, Sapna A Mehta, Jennifer P McBride, Gabriella C Boulton, Melissa B Lesko, Allan B Massie, Dorry L Segev, Robert A Montgomery, Luis F Angel","doi":"10.1016/j.healun.2026.08.026","DOIUrl":"10.1016/j.healun.2026.08.026","url":null,"abstract":"<p><strong>Background: </strong>Fewer than 20% of donated lungs are transplanted. We examined the impacts of donor management and recovery at an in-hospital donor care unit (DCU) established in 2021 versus the donor hospital (DH).</p><p><strong>Methods: </strong>Using Organ Procurement and Transplantation Network data on donors recovered March 2021 to December 2024, we compared lung utilization and post-transplant outcomes after donor management in the DCU (n = 334) versus the donor hospital (DH, n = 399), adjusting for donor factors with propensity weighting. Secondary outcomes included heart, liver, and kidney utilization. Changes in donor PaO₂/FiO₂ (P/F ratio) were examined as a hypothesized effect modifier. We projected the national impact of improved utilization on lung transplant volume.</p><p><strong>Results: </strong>After adjusting for donor differences, lung utilization was 88% higher (aRR: 1.88; 95% CI: 1.40, 2.53) in the DCU versus DH setting. Median P/F ratio increased from 275 to 348 mm Hg (p < 0.0001) in the DCU and explained approximately 38% of the improvement in lung utilization. Non-lung organ utilization was either improved or non-inferior in the DCU. Lung graft survival and pulmonary function were similar for recipients of DCU versus DH-managed donors. Nationally, an 88% improvement in lung utilization among donors not currently transferred to a DCU could theoretically result in ≥300 more lung transplants per year.</p><p><strong>Conclusions: </strong>Lung transplantation can be nearly doubled through lung-centric donor management in a DCU, without sacrificing recipient outcomes nor the utilization of other organs. Donor management practices to optimize lung utilization should be proliferated by establishing more DCUs and, where feasible, applying lung-centric protocols in donor hospitals.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nearly twice as many lungs: Is the intervention the donor care unit or the care?","authors":"Dathe Benissan-Messan, Kunal J Patel","doi":"10.1016/j.healun.2026.09.013","DOIUrl":"10.1016/j.healun.2026.09.013","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial electrophysiological properties of normothermic ex-situ perfused hearts donated after circulatory death.","authors":"Mark F A Bierhuizen, Hongxian Xiang, Mathijs van Schie, Jorik H Amesz, Sanne J J Langmuur, Paul Knops, Olivier C Manintveld, Jolanda Kluin, Yannick J H J Taverne, Natasja M S de Groot","doi":"10.1016/j.healun.2026.09.009","DOIUrl":"10.1016/j.healun.2026.09.009","url":null,"abstract":"<p><strong>Background: </strong>Donation after circulatory death (DCD) hearts undergo warm and cold ischemia before transplantation. Atrial ischemia is an important contributor to the development of electrophysiological abnormalities and post-transplantation atrial arrhythmias. The purpose of this study was to characterize atrial electrophysiological properties of DCD hearts during normothermic ex-situ heart perfusion (ESHP), and to report post-transplantation incidence of atrial tachyarrhythmias, sinus node dysfunction (SND) and atrioventricular block (AVB).</p><p><strong>Methods: </strong>High-resolution epicardial mapping was performed in 23 human DCD hearts during ESHP and compared to a control group consisting of 15 patients undergoing intra-operative epicardial mapping during coronary artery bypass surgery. Unipolar potential voltages and potential types (single, short double, long double, and complex potentials), conduction velocity (CV), continuous conduction delay, and block (cCDCB) lines were quantified in the right atrium (RA), including the sinoatrial node (SAN) exit site, Bachmann's bundle (BB), and the left atrium (LA). The occurrence of post-transplantation atrial tachyarrhythmias, SND, and AVB was evaluated.</p><p><strong>Results: </strong>The atria of DCD hearts were characterized by lower median potential voltages and a higher proportion of low-voltage areas, fractionation, and areas of slow and heterogeneous conduction. Atrial tachyarrhythmias (57%), SND (9%), and AVB (13%) were prevalent in DCD hearts after transplantation. Patients with post-transplantation AVB had significantly longer functional warm ischemic times (FWIT) (24 vs 18 minutes, p = 0.002) and first cold ischemic times (CIT-1) (43 [35-43] vs 34 [31-35] minutes, p = 0.033), whereas patients with AF had significantly longer second cold ischemic times (CIT-2) (103 vs 80 minutes, p = 0.038).</p><p><strong>Conclusion: </strong>During ESHP, atrial electrophysiological properties of the DCD hearts are characterized by abnormal electrical signal morphologies and conduction abnormalities. Post-transplantation arrhythmias are prevalent and are associated with ischemia duration during the transplantation procedure.</p><p><strong>Translational perspective: </strong>DCD hearts show atrial electrical abnormalities during normothermic ex-situ heart perfusion, reflecting ischemic injury that may predispose recipients to early post-transplant arrhythmias. Electrical abnormalities at the sinoatrial node activation site and in atrioventricular conduction are detectable before transplantation and may be associated with post-transplant sinus node dysfunction and atrioventricular block. After transplantation, atrial fibrillation and atrial flutter occur frequently. These findings support intensified perioperative rhythm surveillance, consideration of early pacing strategies, and efforts to minimize ischemic time to improve rhythm outcomes after DCD heart transplantation.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitral regurgitation after left ventricular assist device weaning for cardiac recovery or left ventricular assist device-related complications: A ventricular assist device wean recovery network report.","authors":"Oliver D Bhadra, Jonas Pausch, Snehal R Patel, Evgenij Potapov, Manreet K Kanwar, Palak Shah, Constanze Volgmann, Benjamin Sun, Lennart Bax, Stephan Schueler, Hermann Reichenspurner, Emil Najjar, Isabell Anna Just, Filip Berisha, Markus J Barten, Sarah Berger Veith, Torsten Budelmann, Hanno Grahn, Ioannis Kyriakoulis, Christina Magnussen, Evaldas Girdauskas, Stavros G Drakos, Alexander M Bernhardt","doi":"10.1016/j.healun.2026.07.033","DOIUrl":"10.1016/j.healun.2026.07.033","url":null,"abstract":"<p><strong>Background: </strong>Durable left ventricular assist device (LVAD) support can reduce mitral regurgitation (MR) through ventricular unloading and reverse remodeling. Although improvement in MR during LVAD support is well described, the trajectory of MR after LVAD weaning due to cardiac improvement or LVAD-related complications has not been systematically studied.</p><p><strong>Methods: </strong>Using the multicenter VAD Wean Registry, we identified 603 patients who underwent LVAD weaning due to either cardiac improvement or LVAD-related complications. The present analysis included 367 patients with less than moderate MR (grade <2) at the time of weaning and at least one echocardiographic follow-up assessment thereafter. The primary endpoint was moderate or greater MR (grade ≥2). MR was assessed at predefined echocardiographic follow-up timepoints: 1, 3, 6, and 12 months after weaning, then annually up to 10 years. The primary endpoint was defined as the first documentation of ≥2 MR at any of these timepoints. Kaplan-Meier analysis was used to estimate cumulative incidence, and Cox proportional hazards regression to identify independent predictors.</p><p><strong>Results: </strong>Over a mean follow-up of 33.3 months, 75 of 367 patients (20.2%) developed ≥2 MR. The cumulative incidence was 13.2% at 1 year, 19.6% at 3 years, 26.0% at 5 years, and 36.0% at 7 years. Independent predictors of developing worsening MR included older age at weaning (HR 1.04 per year, 95% CI 1.02-1.06, p < 0.001), higher MR grade at original implantation (HR 1.58 per grade, 95% CI 1.17-2.12, p = 0.003), male sex as a protective factor (HR 0.56, 95% CI 0.32-0.98, p = 0.042), and complete device explantation (HR 1.69, 95% CI 1.00-2.86, p = 0.049). The indication for weaning (responder vs. partial responder) was not an independent predictor. Development of ≥2 MR was associated with higher mortality (40.5% vs. 19.5%, p = 0.013), more heart failure readmissions (68.9% vs. 25.6%, p < 0.001), and lower event-free survival (p < 0.001).</p><p><strong>Conclusions: </strong>Moderate or greater MR after LVAD weaning is associated with progressive cardiac remodeling and adverse clinical outcomes. Future research is warranted to investigate whether interventions targeting the modifiable factors we identified being associated with the development of MR can further improve outcomes.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}