Long-term outcomes after percutaneous withdrawal of HeartWare left ventricular assist device (HVAD) support: A 10-year update.

Ten years have passed since we reported percutaneous decommissioning of an implantable left ventricular assist device (LVAD) using 2 Amplatzer vascular plugs in a 17-year-old male who was bridged to recovery after 22 months of LVAD support. While his left ventricular (LV) dimensions never completely normalized and there has been persistent mild impairment of LV systolic function, the patient remains free of heart failure symptoms and his natriuretic peptide level has been well suppressed on guideline-directed medical therapy. He is anticoagulated with Warfarin.

Future Hospital Commission, 10 years on - Lessons learned and next steps: The Chief Registrar Programme - what has been achieved?

The Royal College of Physicians (RCP) Chief Registrar Programme (CRP) emerged from the RCP Future Hospital Commission Report (2013) and aimed to address development of clinical leadership and quality improvement to maintain high standards of patient safety and experience. The 2016 pilot created a new senior leadership role recruiting doctors in training committed to quality improvement and leadership development to champion delivering change in trusts, supported by a year-long bespoke development programme designed and delivered by the RCP. Following validation of the pilot's impact, the CRP has evolved to become a 'flagship' programme for the RCP with increasing penetrance across the UK to maximise impact for chief registrars to lead and deliver quality improvement in trusts.

Mechanical circulatory support in patients with congenital heart disease: a European Registry for Patients with Mechanical Circulatory Support (EUROMACS) study.

Objectives: This study aims to explore characteristics and clinical outcomes of patients with congenital heart disease (CHD) in the European Registry for Patients with Mechanical Circulatory Support (EUROMACS).

Methods: This is a retrospective study of EUROMACS participants receiving MCS as bridge-to-transplant, possible bridge-to-transplant, or rescue therapy/bridge-to-recovery from 2011 to 2023 (n = 5340). Adult and paediatric cohorts were analysed separately.

The impact of interprofessional incivility on medical performance, service and patient care: a systematic review.

The stressful nature of the medical profession is a known trigger for aggression or abuse among healthcare staff. Interprofessional incivility, defined as low-intensity negative interactions with ambiguous or unclear intent to harm, has recently become an occupational concern in healthcare. While incivility in nursing has been widely investigated, its prevalence among physicians and its impact on patient care are poorly understood.

Prognostic value of three iron deficiency definitions in patients with advanced heart failure.

Aims: There is uncertainty about the definition of iron deficiency (ID) and the association between ID and prognosis in patients with advanced heart failure. We evaluated three definitions of ID in patients referred for heart transplantation.

Methods And Results: Consecutive patients assessed for heart transplantation at a single UK centre between January 2010 and May 2022 were included.

COVID-19 in congenital heart disease (COaCHeD) study.

Background: COVID-19 has caused significant worldwide morbidity and mortality. Congenital heart disease (CHD) is likely to increase vulnerability and understanding the predictors of adverse outcomes is key to optimising care.

Objective: Ascertain the impact of COVID-19 on people with CHD and define risk factors for adverse outcomes.

Graft function and incidence of cardiac allograft vasculopathy in donation after circulatory-determined death heart transplant recipients.

Experience in donation after circulatory-determined death (DCD) heart transplantation (HTx) is expanding. There is limited information on the functional outcomes of DCD HTx recipients. We sought to evaluate functional outcomes in our cohort of DCD recipients.

Successful transition for adolescent survivors of CHD: the Cambridge cardiac transition pathway.

Purpose: National standards to ensure effective transition and smooth transfer of adolescents from paediatric to adult services are available but data on successful transition in CHD are limited. The aim of this study is to assess the effectiveness of our transition pathway.

Methods: Adolescents with CHD, aged 15-19 years, who attended the joint cardiac transition clinic between 2009 and 2018 were identified from the Patient Administration Systems.

Comparing Cardiac Mechanics and Myocardial Fibrosis in DBD and DCD Heart Transplant Recipients.

Background: Heart transplantation (HTx) after donation after circulatory death (DCD) is an expanding practice but is associated with increased warm ischemic time. The impact of DCD HTx on cardiac mechanics and myocardial fibrosis has not been reported. We aimed to compare cardiac mechanics and myocardial fibrosis using cardiovascular magnetic resonance (CMR) imaging in donation after brain death (DBD) and DCD HTx recipients and healthy controls.

Coronary imaging of cardiac allograft vasculopathy predicts current and future deterioration of left ventricular function in patients with orthotopic heart transplantation.

Background: Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) improve sensitivity of cardiac allograft vasculopathy (CAV) detection compared to invasive coronary angiography (ICA), but their ability to predict clinical events is unknown. We determined whether severe CAV detected with ICA, IVUS, or OCT correlates with graft function.

Methods: Comparison of specific vessel parameters between IVUS and OCT on 20 patients attending for angiography 12-24 months post-orthotopic heart transplant.

A 5-year single-center early experience of heart transplantation from donation after circulatory-determined death donors.

Background: In an effort to address the increasing demand for heart transplantation within the United Kingdom (UK), we established a clinical program of heart transplantation from donation after circulatory-determined death (DCD) donors in 2015. After 5 years, we report the clinical early outcomes and impact of the program.

Methods: This is a single-center, retrospective, matched, observational cohort study comparing outcomes of hearts transplanted from DCD donors from March 1, 2015 to February 29, 2020 with those from matched donation after brain death (DBD) donors at Royal Papworth Hospital (RPH) (Cambridge, UK).

Vasoplegia following heart transplantation and left ventricular assist device explant is not associated with inferior outcomes.

Background: Vasoplegia has been associated with inferior outcomes following heart transplantation (HTx). This observational study was designed to investigate outcomes in recipients with vasoplegia following left ventricular assist device (LVAD) explant HTx.

Methods: Patients undergoing LVAD explant followed by HTx from 01/2013-12/2018 at our centre were included.

Prioritising transplantation for adult congenital heart disease, UK national data.

Objective: There are no multi-centre data on the outcomes of transplant for adult congenital heart disease (ACHD) outside of North America. The literature has identified a number of concerns for this population such as increased wait-list and early post-operative mortality. We investigated outcomes in a national cohort to see if these problems are replicated outside of America.

Transfer of Patients With Cardiogenic Shock Using Veno-Arterial Extracorporeal Membrane Oxygenation.

Objectives: The authors describe the experience of patient transfer on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) used as a salvage therapy for refractory cardiogenic shock, examining feasibility and long-term outcomes.

Design: A retrospective case series.

Setting: A tertiary referral cardiothoracic transplantation center.

Intravascular ultrasound of the proximal left anterior descending artery is sufficient to detect early cardiac allograft vasculopathy.

Objective: Cardiac allograft vasculopathy (CAV) can be detected early with intravascular ultrasound (IVUS), but there is limited information on the most efficient imaging protocol.

Methods: Coronary angiography and IVUS of the three coronary arteries were performed. Volumetric IVUS analysis was performed, and a Stanford grade determined for each vessel.

Outcome after heart transplantation from donation after circulatory-determined death donors.

Background: The requirement for heart transplantation is increasing, vastly outgrowing the supply of hearts available from donation after brain death (DBD) donors. Transplanting hearts after donation after circulatory-determined death (DCD) may be a viable additive alternative to DBD donors. This study compared outcomes from the largest single-center experience of DCD heart transplantation against matched DBD heart transplants.

Retained pacemaker and implantable cardioverter-defibrillator components after heart transplantation are common and may lead to adverse events.

Aims: Many patients have a cardiac implantable electronic device (CIED) extracted at the time of heart transplantation. CIED components may be retained after heart transplantation, but their frequency, nature, and clinical significance is uncertain.

Methods And Results: Consecutive patients that underwent heart transplantation over 10 years from 1 January 2007 until 1 January 2017 were identified from the unit database.

Socioeconomic Deprivation and Survival After Heart Transplantation in England: An Analysis of the United Kingdom Transplant Registry.

Background: Socioeconomic deprivation (SED) is associated with shorter survival across a range of cardiovascular and noncardiovascular diseases. The association of SED with survival after heart transplantation in England, where there is universal healthcare provision, is unknown.

Methods And Results: Long-term follow-up data were obtained for all patients in England who underwent heart transplantation between 1995 and 2014.

Right ventricular failure due to late embolic RV infarction during continuous flow LVAD support.

This report describes a 63-year-old man with a dilated cardiomyopathy, who was supported with a continuous flow left ventricular assist device (LVAD), and on the waiting list for heart transplantation. After a long period of stability, he presented with recurrent ventricular tachycardia and rapidly developed progressive right ventricular (RV) failure. He required implantation of a temporary RV assist device to regain stability and subsequently underwent urgent heart transplantation.

Heart transplantation for advanced heart failure due to cardiac sarcoidosis.

Background: Selected patients with cardiac sarcoidosis undergo heart transplantation, but outcomes may be adversely affected by recurrent cardiac sarcoidosis or progressive extra-cardiac sarcoidosis.

Objectives: We present our single-center experience of patients with cardiac sarcoidosis who underwent heart transplantation.

Methods: Consecutive patients that underwent heart transplantation between 1990 and 2012 were assessed.

Biventricular assist device use in non-dilated hypertrophic cardiomyopathy.

Advanced heart failure is a rare but important complication of hypertrophic cardiomyopathy (HCM). The only definitive treatment is heart transplantation and the role of ventricular assist devices remains uncertain. We describe the use of implantable biventricular assist devices in the treatment of a patient with 'end-stage' non-dilated HCM.