The Journal of Heart and Lung Transplantation最新文献

{"title":"Superior cardiac protection in combined ex-situ perfusion of heart and liver.","authors":"Sanaz Hatami,Joshua Hefler,Guilherme da Silva,Mitchell Wagner,Mobashir Khan,Sayed Himmat,Shubham Shan,Xiuhua Wang,Benjamin Adam,James Shapiro,Jayan Nagendran,Darren H Freed","doi":"10.1016/j.healun.2025.09.012","DOIUrl":"https://doi.org/10.1016/j.healun.2025.09.012","url":null,"abstract":"BACKGROUNDNormothermic ex-situ heart perfusion has helped expand the heart donor pool however, it is not optimized yet. Experimental ex-situ organ perfusion incorporating cross-circulation with a live animal has achieved significantly longer safe ex-situ preservation times; however, the underlying mechanisms are not clear.METHODSIn this study, combined ex-situ heart-liver perfusion of porcine hearts was compared to ex-situ isolated heart perfusion. Discarded human donor hearts were also perfused ex-situ and cardiac function and metabolism was studied.RESULTSThe hearts perfused together with liver were preserved significantly better, with lower edema, preserved key nutrients, and lower oxidative stress, (comparable to in vivo samples). Human donor hearts subjected to ex-situ perfusion had similar function and oxidative patterns compared to isolated porcine hearts, suggesting these hearts are vulnerable to the same phenomena as porcine hearts.CONCLUSIONSOur findings suggest that efficient antioxidant and energy metabolite support is necessary for improving the functional preservation of the donor heart during ex-situ perfusion.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153365","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":"Modernization of the U.S. Transplant System: Protecting donors and saving lives one donation at a time.","authors":"","doi":"10.1016/j.healun.2025.09.004","DOIUrl":"https://doi.org/10.1016/j.healun.2025.09.004","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153384","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":"An evolving landscape: the many complexities of pediatric mechanical circulatory support.","authors":"Jondavid Menteer","doi":"10.1016/j.healun.2025.09.008","DOIUrl":"https://doi.org/10.1016/j.healun.2025.09.008","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140371","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":"Fluoroless bedside implantation of the ProtekDuo cannula: clinical experience at a tertiary care center.","authors":"Pasquale Nardelli,Savino Altizio,Evgeny Fominskiy,Alessandro Ortalda,Luca Baldetti,Claudia Francescon,Silvia Ajello,Anna Mara Scandroglio","doi":"10.1016/j.healun.2025.09.005","DOIUrl":"https://doi.org/10.1016/j.healun.2025.09.005","url":null,"abstract":"The ProtekDuo dual-lumen cannula allows percutaneous support in right ventricular failure with or without gas exchange impairments. However, positioning of the device is resource demanding. Usual approach requires a fluoroscopy-equipped operating room, possibly limiting its wider and timely adoption. We report our initial experience with bedside, fluoroless ProtekDuo implantation under transesophageal echocardiography (TEE) guidance in a tertiary care national referral center. Eight critically ill patients underwent bedside ProtekDuo placement for right ventricular dysfunction or acute respiratory distress syndrome with right ventricular failure. All procedures were completed successfully without procedural complications. Our findings demonstrate that bedside, TEE-guided, fluoroless ProtekDuo cannulation is feasible and safe, potentially expanding access to advanced mechanical circulatory support.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140369","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":"Early Experience in Heart Transplantation Utilizing Donors with HIV.","authors":"Omar Saeed,Vagish Hemmige,Lorenzo D' Angelo,Christiana Gjelaj,Yoram A Puius,Shivank Madan,Yogita Rochlani,Julia Shin,Daniel B Sims,Daniel J Goldstein,Ulrich P Jorde,Snehal R Patel","doi":"10.1016/j.healun.2025.09.011","DOIUrl":"https://doi.org/10.1016/j.healun.2025.09.011","url":null,"abstract":"The use of organs between donors and recipients with HIV in solid organ transplantation is an area of growing interest. We conducted a single center observational study to compare early outcomes after heart transplantation (HTx) in HIV-positive recipients using HIV-positive or HIV-negative donors. Overall, 10 HIV-positive recipients underwent HTx, with 4 receiving HIV-positive and 6 receiving HIV-negative organs. At 3 months, both groups had similar survival (100% vs 100%, p=1.00), episodes of rejection (0, 0-0.5 vs 0, 0-1, p=0.39) and infection (0, 0-2.5 vs 1, 1-1, p=0.31) per patient, HIV suppression with antiretroviral therapy (VL <20 copies/ml or undetectable: 100% vs 100%, p=1.00) and donor derived cell free DNA (0.14, 0.06-0.22% vs 0.36, 0.12-0.59%, p=0.35). These data provide early evidence supporting the feasibility of utilizing organs from donors with HIV for HTx in recipients with HIV.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140260","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":"DOAC or don't? - Direct oral anticoagulants in LVADs.","authors":"Roxana Moayedifar","doi":"10.1016/j.healun.2025.09.014","DOIUrl":"https://doi.org/10.1016/j.healun.2025.09.014","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140370","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":"Reanimation-less Rapid Recovery of a Donor Heart After Circulatory Death With Prolonged 8-Hour Ischemic Time.","authors":"Aaron M Williams,Awab Ahmad,Kevin McGann,Chen Chia Wang,Swaroop Bommareddi,Brian Lima,Mark Petrovic,Eric Quintana,Tarek Absi,Stephen A DeVries,Joshua Lowman,Matthew Bacchetta,Kelly Schlendorf,Ashish S Shah,John M Trahanas","doi":"10.1016/j.healun.2025.09.009","DOIUrl":"https://doi.org/10.1016/j.healun.2025.09.009","url":null,"abstract":"Cardiac allografts from donation after circulatory death (DCD) donors have helped increase the donor pool for heart transplantation. Techniques that reanimate the heart, such as ex situ perfusion or thoracoabdominal normothermic regional perfusion (TA-NRP), are typically employed. We recently described a novel method for the \"reanimation-less\" rapid recovery of DCD hearts for transplantation. Here, we highlight using our rapid recovery with extended ultra-oxygenation preservation (REUP) technique combined with 10C static cold storage to recover an older donor allograft (45 years of age) with a prolonged 8-hour ischemic time (477 minutes). The recipient underwent successful heart transplantation with subsequent normal biventricular function and excellent postoperative outcomes out to 8 months following surgery.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"156 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116627","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":"Direct oral anticoagulants in left ventricular assist devices: Where are we now?","authors":"Leticia Blazquez-Arroyo,Guglielmo Gallone,Luca Baldetti,Mario Gramegna,Thomas Castelein,Riet Dierckx,Francesca Fiorelli,Diana Gorog,Eftychia Galiatsou,Haifa Lyster,Sascha Ott,Brijesh Patel,Alex Rosenberg,Dan Schelfaut,Lorenz Van der Linden,Jeroen Dauw,Ward Heggermont,Marc Vanderheyden,Stijn Wouters,Maria Monteagudo-Vela,Christopher T Bowles,Fernando Riesgo Gil,Bart Meyns,Donna Hall,Vasileios Panoulas,Hoong Sern Lim,Nir Uriel,Clément Delmas,Christophe Vandenbriele","doi":"10.1016/j.healun.2025.08.025","DOIUrl":"https://doi.org/10.1016/j.healun.2025.08.025","url":null,"abstract":"Despite significant advances in left ventricular assist device (LVAD) technology, particularly with the HeartMate 3, hemocompatibility-related adverse events (HRAEs), especially bleeding, remain common due to complex patient-device interactions and the need for anticoagulation. This has prompted interest in exploring new and less aggressive antithrombotic strategies. Direct oral anticoagulants (DOACs) have gained attention for their predictable pharmacokinetics, fixed dosing, and lower bleeding risk in other populations. Among them, apixaban has emerged as the most extensively studied DOAC in the HeartMate 3 setting, standing out as a promising alternative to VKAs in carefully selected patients, with the potential to lower bleeding risk without compromising thrombotic protection. However, available evidence remains limited by small sample sizes, short follow-up, and selected patient populations. Important gaps persist regarding optimal dosing, timing of initiation, level monitoring, and safety in vulnerable subgroups, particularly patients awaiting heart transplantation. This review synthesizes the current evidence on DOAC use in HeartMate 3-supported patients, provides practical guidance for real-world decision-making, and highlights areas where further research is needed. Although more data are required to define its role, apixaban is increasingly positioned as a promising VKA alternative in LVAD-patients and could ultimately reshape anticoagulation practice in this population.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059121","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":"Method for generating right ventricular pressure-volume loops in routine practice.","authors":"Nils Kremer,Felix Glocker,Simon Schaefer,Patrick Janetzko,Athiththan Yogeswaran,Zvonimir Rako,Bruno Thal,Hans-Bernd Hopf,Werner Seeger,Hossein-Ardeschir Ghofrani,Paul M Heerdt,Khodr Tello","doi":"10.1016/j.healun.2025.09.002","DOIUrl":"https://doi.org/10.1016/j.healun.2025.09.002","url":null,"abstract":"BACKGROUNDAnalysis of pressure-volume (PV) loops from conductance catheterization is the gold standard for evaluating right ventricular (RV) function, but the complexity of conductance catheterization limits clinical implementation. This study validates a novel method for reconstructing RV PV loops from pressure waveforms acquired during routine right heart catheterization (RHC).METHODSAn algorithm was developed to estimate RV volume from pressure using the hydromotive source pressure model with external calibration. The method was validated against conductance catheterization in swine (preclinical cohort) and in patients with pulmonary hypertension (clinical cohort), and against 3-dimensional echocardiography in patients with routine RHC (feasibility cohort). Agreement was assessed using Bland-Altman analysis and correlation.RESULTSIn the preclinical cohort (n = 10, 22 recordings), pressure-derived stroke work (SW) demonstrated very good agreement with conductance values (bias -0.4%; percentage error 7.0%). End-diastolic volume (EDV) showed moderate agreement (bias 3.7%; percentage error 29.0%). In the clinical cohort (n = 44, 44 recordings), agreement was good for SW (bias -2.8%; percentage error 14.6%), and borderline for EDV (bias -5.5%; percentage error 35.3%). In the feasibility cohort (n = 29, 29 recordings), agreement was good for ejection fraction (bias 2.2%, percentage error 30.3%) and moderate for stroke volume, EDV, end-systolic elastance, and arterial elastance. All parameters correlated strongly with reference values (Pearson r ≥ 0.79, p < 0.001).CONCLUSIONThis pressure-based method reconstructs RV PV loops from standard RHC data and reliably estimates SW, contractility, and afterload, supporting its integration into routine clinical workflows (tool freely available at https://pv-loop-generator.onrender.com).","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059115","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":"Cardiac Function Recovery After 20-Minute Hands-Off Using Thoracoabdominal-Normothermic Regional Perfusion.","authors":"Sofia Martin-Suarez,Luca Botta,Giuseppe Barberio,Valeria Santamaria,Silvia Snaidero,Sara Tassi,Filippo Londi,Maria Francesca Scuppa,Agnese Manigrasso,Valentina Ovi,Erika Cordella,Nicola Alvaro,Valentina Roncarati,Maria Benedetto,Elisa Cerchierini,Massimo Baiocchi,Marta Velia Antonini,Marco Masetti,Luciano Potena,Mario Sabatino,Alessandra De Palma,Massimo Cardillo,Emmanouela Chourda,Davide Pacini","doi":"10.1016/j.healun.2025.09.003","DOIUrl":"https://doi.org/10.1016/j.healun.2025.09.003","url":null,"abstract":"BACKGROUNDThe increasing prevalence of end-stage heart failure coupled with limited donor organs creates a critical need for novel strategies in heart transplantation. Donation after circulatory death offers a promising approach to expand the donor pool. Italian legislation mandates a prolonged \"no-touch\" period for death declaration, raising concerns about organ preservation. This study presents the initial experience of a single Italian center performing heart transplantation from donation after circulatory death donors.METHODSWe conducted a retrospective observational study of donation after circulatory death heart transplants performed from August 2023 to March 2025. Donor hearts underwent reconditioning via thoracoabdominal normothermic regional perfusion before procurement and were preserved in cold storage. Primary endpoints included 30-day mortality and severe primary graft dysfunction. Secondary endpoints encompassed intensive care unit and hospital length of stay, postoperative complications, echocardiographic assessment of graft function and rejection rates.RESULTSA total of eleven donation after circulatory death heart transplants were performed. The mean donor age was 56.8±4.8 years, with an average functional warm ischemic time of 49.5±11.3 minutes. All hearts demonstrated preserved function preprocurement and post-transplantation. No recipients required mechanical circulatory support postoperatively, and the 30-day survival rate was 100%.CONCLUSIONSHeart transplantation with donation after circulatory death is a feasible and effective strategy to expand the donor pool, yielding short-term outcomes comparable to donation after brain death. Despite Italy's prolonged mandatory warm ischemic time, graft viability was maintained. Larger studies with extended follow-up are needed to confirm long-term efficacy and optimize patient selection criteria.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059128","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}