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. The 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.
{"title":"Fluoroless bedside implantation of the ProtekDuo cannula: Clinical experience at a tertiary care center","authors":"Pasquale Nardelli MD , Savino Altizio MD , Evgeny Fominskiy MD , Alessandro Ortalda MD , Luca Baldetti MD , Claudia Francescon PT , Silvia Ajello MD , Anna Mara Scandroglio MD","doi":"10.1016/j.healun.2025.09.005","DOIUrl":"10.1016/j.healun.2025.09.005","url":null,"abstract":"<div><div>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. The 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.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 1","pages":"Pages 85-88"},"PeriodicalIF":6.0,"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":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-23DOI: 10.1016/j.healun.2025.09.014
Roxana Moayedifar MD PhD
{"title":"DOAC or don’t? – Direct oral anticoagulants in LVADs","authors":"Roxana Moayedifar MD PhD","doi":"10.1016/j.healun.2025.09.014","DOIUrl":"10.1016/j.healun.2025.09.014","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 1","pages":"Pages 83-84"},"PeriodicalIF":6.0,"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":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-23DOI: 10.1016/j.healun.2025.09.010
Aaron M. Williams MD, Ashish S. Shah MD
{"title":"The occasional heart transplant program","authors":"Aaron M. Williams MD, Ashish S. Shah MD","doi":"10.1016/j.healun.2025.09.010","DOIUrl":"10.1016/j.healun.2025.09.010","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 1","pages":"Pages 57-58"},"PeriodicalIF":6.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149379","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}
Pub Date : 2025-09-12DOI: 10.1016/S1053-2498(25)02242-9
{"title":"Information for Readers","authors":"","doi":"10.1016/S1053-2498(25)02242-9","DOIUrl":"10.1016/S1053-2498(25)02242-9","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 10","pages":"Page A10"},"PeriodicalIF":6.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145047808","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}
Pub Date : 2025-09-12DOI: 10.1016/j.healun.2025.06.004
Shelley D. Miyamoto , Claire Irving , Estela Azeka , Rachele Adorisio , Elizabeth D. Blume , Carmel Bogle , Henry Chubb , Jennifer Conway , Melissa K. Cousino , Jonathan Edelson , Katrina Ford , Paula Holinski , Jan Janousek , Ashwin Lal , Teresa Lee , Angela Lorts , Stephanie Nakano , David N. Rosenthal , Joseph Rossano
Pediatric heart failure (HF) secondary to cardiomyopathies, acquired heart disease, and congenital heart disease is associated with significant morbidity and mortality. These guidelines represent an update from the International Society for Heart and Lung Transplantation guidelines for the management of pediatric HF that were published in 2014 and incorporate interval advancements in medical therapies and new approaches in the evaluation and management of children with HF.
{"title":"Authors Insights on the Updated International Society for Heart and Lung Transplantation Guidelines for the Management of Pediatric Heart Failure (Update From 2014)","authors":"Shelley D. Miyamoto , Claire Irving , Estela Azeka , Rachele Adorisio , Elizabeth D. Blume , Carmel Bogle , Henry Chubb , Jennifer Conway , Melissa K. Cousino , Jonathan Edelson , Katrina Ford , Paula Holinski , Jan Janousek , Ashwin Lal , Teresa Lee , Angela Lorts , Stephanie Nakano , David N. Rosenthal , Joseph Rossano","doi":"10.1016/j.healun.2025.06.004","DOIUrl":"10.1016/j.healun.2025.06.004","url":null,"abstract":"<div><div>Pediatric heart failure (HF) secondary to cardiomyopathies, acquired heart disease, and congenital heart disease is associated with significant morbidity and mortality. These guidelines represent an update from the International Society for Heart and Lung Transplantation guidelines for the management of pediatric HF that were published in 2014 and incorporate interval advancements in medical therapies and new approaches in the evaluation and management of children with HF.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 10","pages":"Pages 1529-1534"},"PeriodicalIF":6.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145047810","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}
Pub Date : 2025-09-12DOI: 10.1016/j.healun.2025.08.025
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 , Christophe Vandenbriele MD, PhD
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.
{"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 , Christophe Vandenbriele MD, PhD","doi":"10.1016/j.healun.2025.08.025","DOIUrl":"10.1016/j.healun.2025.08.025","url":null,"abstract":"<div><div>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.</div><div>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.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 1","pages":"Pages 71-82"},"PeriodicalIF":6.0,"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":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-12DOI: 10.1016/j.healun.2025.05.004
Erik Fung MD, PhD
{"title":"Passive leg raise during cardiac catheterization work-up for HFpEF: is it worth the trouble?","authors":"Erik Fung MD, PhD","doi":"10.1016/j.healun.2025.05.004","DOIUrl":"10.1016/j.healun.2025.05.004","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 10","pages":"Pages 1555-1556"},"PeriodicalIF":6.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046045","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}
Pub Date : 2025-09-12DOI: 10.1016/j.healun.2025.06.028
Christopher R. Broda MD , Katherine Kearney MBBS, PhD , S. Lucy Roche MB ChB, MD (research)
Many adults with moderate or complex congenital heart disease (CHD) develop chronic heart or circulatory failure syndromes, often becoming clinically apparent in their 30 s, 40 s, or 50 s and carrying a high risk of mortality. Although the pathophysiology of adult congenital heart disease-related heart failure (ACHD-HF) is highly heterogeneous, it is typically characterized by a prolonged pre-symptomatic phase. During this time, chronic compensatory mechanisms mask disease progression, making the severity of the condition difficult to recognize in a timely manner. This clinical challenge is compounded by fragmented care models, limited specialist resources, and persistent knowledge gaps. Consequently, patients are referred late for advanced therapies, contributing to the excess mortality, particularly in the context of transplant.
While it is recognized that excellent outcomes from transplant and mechanical circulatory support options are achievable in adult CHD patients, contemporary selection practices leave the population undertreated. To advance this cause, we convened a meeting at the 2025 International Society for Heart and Lung Transplantation 45th Annual Meeting & Scientific Sessions in Boston, Massachusetts. The meeting brought together more than 35 participants, including adult and pediatric cardiologists, surgeons, advanced practice providers, researchers, and trainees from North America, Europe and Australia. This diverse group shared opinions regarding priorities for research, education and patient advocacy.
A widely supported outcome was the development of an ACHD-HF specific professional community under the umbrella of ISHLT. This entity would serve as a collaborative home for those dedicated to addressing the knowledge gaps in ACHD-HF, advancing care, and improving outcomes for this growing and vulnerable population.
{"title":"Enabling effective care, empowering discovery: Tackling the tough questions about advanced heart failure in adult congenital heart disease","authors":"Christopher R. Broda MD , Katherine Kearney MBBS, PhD , S. Lucy Roche MB ChB, MD (research)","doi":"10.1016/j.healun.2025.06.028","DOIUrl":"10.1016/j.healun.2025.06.028","url":null,"abstract":"<div><div>Many adults with moderate or complex congenital heart disease (CHD) develop chronic heart or circulatory failure syndromes, often becoming clinically apparent in their 30 s, 40 s, or 50 s and carrying a high risk of mortality. Although the pathophysiology of adult congenital heart disease-related heart failure (ACHD-HF) is highly heterogeneous, it is typically characterized by a prolonged pre-symptomatic phase. During this time, chronic compensatory mechanisms mask disease progression, making the severity of the condition difficult to recognize in a timely manner. This clinical challenge is compounded by fragmented care models, limited specialist resources, and persistent knowledge gaps. Consequently, patients are referred late for advanced therapies, contributing to the excess mortality, particularly in the context of transplant.</div><div>While it is recognized that excellent outcomes from transplant and mechanical circulatory support options are achievable in adult CHD patients, contemporary selection practices leave the population undertreated. To advance this cause, we convened a meeting at the 2025 International Society for Heart and Lung Transplantation 45th Annual Meeting & Scientific Sessions in Boston, Massachusetts. The meeting brought together more than 35 participants, including adult and pediatric cardiologists, surgeons, advanced practice providers, researchers, and trainees from North America, Europe and Australia. This diverse group shared opinions regarding priorities for research, education and patient advocacy.</div><div>A widely supported outcome was the development of an ACHD-HF specific professional community under the umbrella of ISHLT. This entity would serve as a collaborative home for those dedicated to addressing the knowledge gaps in ACHD-HF, advancing care, and improving outcomes for this growing and vulnerable population.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 10","pages":"Pages 1679-1682"},"PeriodicalIF":6.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145047806","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}
Pub Date : 2025-09-12DOI: 10.1016/j.healun.2025.06.017
Brent K. Winemiller , Joshua A. Daily , Paolla G. Anderson , Taufiek Konrad Rajab
{"title":"First-in-human operations require more than technical excellence","authors":"Brent K. Winemiller , Joshua A. Daily , Paolla G. Anderson , Taufiek Konrad Rajab","doi":"10.1016/j.healun.2025.06.017","DOIUrl":"10.1016/j.healun.2025.06.017","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 10","pages":"Pages 1672-1673"},"PeriodicalIF":6.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048228","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}
Pub Date : 2025-09-11DOI: 10.1016/j.healun.2025.08.023
Jennifer K.L. Chow MD, MS , Amanda R. Vest MBBS, MPH , David DeNofrio MD , David R. Snydman MD
Background
Letermovir (LET) is a newer antiviral that has successfully been used for primary cytomegalovirus (CMV) prophylaxis in kidney transplant recipients. Valganciclovir (VGC), the current first-line CMV antiviral, is effective at prophylaxis but carries a significant risk of myelotoxicity with related downstream consequences. We studied the tolerability and clinical effectiveness of LET for primary CMV prophylaxis after heart transplant (HT) and compared rates of neutropenia and CMV disease to a historical HT cohort.
Methods
All single-organ, first-time HTs at our center who gave informed consent and were eligible to receive primary CMV prophylaxis (not CMV donor/recipient seronegative) were included. Subjects were subsequently excluded if they needed renal replacement therapy or did not survive >72 hours post-HT. Outcomes were compared to a historical control group (N = 204) treated with VGC for CMV prophylaxis.
Results
Thirty-two patients completed 3 or 6 months of LET prophylaxis. There were no episodes of neutropenia while on LET compared to 15% (30/204) in the historical VGC group (p = 0.02). There were no breakthrough CMV deoxyribonucleic acid (DNA) infections compared to 3% (5/204) in the VGC group (p = 0.37). No patients stopped LET early due to adverse effects.
Conclusions
LET is well tolerated and shows comparable clinical effectiveness for primary CMV prophylaxis post-HT compared to a historical, predominantly VGC prophylaxis cohort. LET prophylaxis was associated with no cases of neutropenia nor breakthrough CMV DNAemia in this prospective cohort. Study of the cost-effectiveness of LET for primary CMV prophylaxis post-HT is warranted.
{"title":"Tolerability and clinical efficacy of letermovir for primary cytomegalovirus prophylaxis after heart transplantation","authors":"Jennifer K.L. Chow MD, MS , Amanda R. Vest MBBS, MPH , David DeNofrio MD , David R. Snydman MD","doi":"10.1016/j.healun.2025.08.023","DOIUrl":"10.1016/j.healun.2025.08.023","url":null,"abstract":"<div><h3>Background</h3><div>Letermovir (LET) is a newer antiviral that has successfully been used for primary cytomegalovirus (CMV) prophylaxis in kidney transplant recipients. Valganciclovir (VGC), the current first-line CMV antiviral, is effective at prophylaxis but carries a significant risk of myelotoxicity with related downstream consequences. We studied the tolerability and clinical effectiveness of LET for primary CMV prophylaxis after heart transplant (HT) and compared rates of neutropenia and CMV disease to a historical HT cohort.</div></div><div><h3>Methods</h3><div>All single-organ, first-time HTs at our center who gave informed consent and were eligible to receive primary CMV prophylaxis (not CMV donor/recipient seronegative) were included. Subjects were subsequently excluded if they needed renal replacement therapy or did not survive >72 hours post-HT. Outcomes were compared to a historical control group (N = 204) treated with VGC for CMV prophylaxis.</div></div><div><h3>Results</h3><div>Thirty-two patients completed 3 or 6 months of LET prophylaxis. There were no episodes of neutropenia while on LET compared to 15% (30/204) in the historical VGC group (<em>p</em> = 0.02). There were no breakthrough CMV deoxyribonucleic acid (DNA) infections compared to 3% (5/204) in the VGC group (<em>p</em> = 0.37). No patients stopped LET early due to adverse effects.</div></div><div><h3>Conclusions</h3><div>LET is well tolerated and shows comparable clinical effectiveness for primary CMV prophylaxis post-HT compared to a historical, predominantly VGC prophylaxis cohort. LET prophylaxis was associated with no cases of neutropenia nor breakthrough CMV DNAemia in this prospective cohort. Study of the cost-effectiveness of LET for primary CMV prophylaxis post-HT is warranted.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 1","pages":"Pages 148-156"},"PeriodicalIF":6.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056672","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}
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