Pub Date : 2025-09-24DOI: 10.1016/j.healun.2025.09.004
Matthew Galen Hartwig MD , Dennis Mark Lyu MD
{"title":"Modernization of the U.S. transplant system: Protecting donors and saving lives 1 donation at a time","authors":"Matthew Galen Hartwig MD , Dennis Mark Lyu MD","doi":"10.1016/j.healun.2025.09.004","DOIUrl":"10.1016/j.healun.2025.09.004","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 1","pages":"Pages 159-160"},"PeriodicalIF":6.0,"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":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.2025.09.008
Jondavid Menteer MD (Professor of Pediatrics (Clinician/Educator))
{"title":"An evolving landscape: The many complexities of pediatric mechanical circulatory support","authors":"Jondavid Menteer MD (Professor of Pediatrics (Clinician/Educator))","doi":"10.1016/j.healun.2025.09.008","DOIUrl":"10.1016/j.healun.2025.09.008","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 1","pages":"Pages 101-102"},"PeriodicalIF":6.0,"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":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.2025.09.002
Nils Kremer MD , Felix Glocker MSc , Simon Schaefer , Patrick Janetzko , Athiththan Yogeswaran MD , Zvonimir Rako MD , Bruno Thal , Hans-Bernd Hopf MD , Werner Seeger MD , Hossein-Ardeschir Ghofrani MD , Paul M. Heerdt MD, PhD , Khodr Tello MD
Background
Analysis 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).
Methods
An 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.
Results
In 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 (EF) (bias 2.2%, percentage error 30.3%) and moderate for stroke volume (SV), EDV, end-systolic elastance (Ees), and arterial elastance. All parameters correlated strongly with reference values (Pearson r ≥ 0.79, p < 0.001).
Conclusion
This 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).
{"title":"Method for generating right ventricular pressure-volume loops in routine practice","authors":"Nils Kremer MD , Felix Glocker MSc , Simon Schaefer , Patrick Janetzko , Athiththan Yogeswaran MD , Zvonimir Rako MD , Bruno Thal , Hans-Bernd Hopf MD , Werner Seeger MD , Hossein-Ardeschir Ghofrani MD , Paul M. Heerdt MD, PhD , Khodr Tello MD","doi":"10.1016/j.healun.2025.09.002","DOIUrl":"10.1016/j.healun.2025.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Analysis 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).</div></div><div><h3>Methods</h3><div>An 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.</div></div><div><h3>Results</h3><div>In the preclinical cohort (<em>n</em> = 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 (<em>n</em> = 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 (<em>n</em> = 29, 29 recordings), agreement was good for ejection fraction (EF) (bias 2.2%, percentage error 30.3%) and moderate for stroke volume (SV), EDV, end-systolic elastance (Ees), and arterial elastance. All parameters correlated strongly with reference values (Pearson <em>r</em> ≥ 0.79, <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>This 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 <span><span>https://pv-loop-generator.onrender.com</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 273-281"},"PeriodicalIF":6.0,"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":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}
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