Surgical outcomes following telehealth preoperative evaluation in elective cardiac surgery.

Objective: Telehealth preoperative evaluations have been shown to improve access to care, reduce appointment cancellations, and support efficient procedural planning across multiple surgical subspecialties. However, few studies have assessed the safety and efficacy in patients undergoing elective cardiac surgery.

Methods: We conducted a retrospective multi-institutional cohort study comparing procedural and postoperative outcomes for patients who had telehealth versus in-person preoperative evaluations for elective cardiac surgery between March 1, 2020, and March 1, 2021.

Randomized Controlled Trial of New Oral Anticoagulants Versus Warfarin for Post Cardiac Surgery Atrial Fibrillation: The NEWAF Trial.

Objective: To determine whether anticoagulation for new onset atrial fibrillation (AF) with rivaroxaban decreases length of stay compared to warfarin.

Summary Of Background Data: Direct Oral Anticoagulants (DOACs) have been shown to be noninferior to warfarin for stroke prevention in nonsurgical patients with atrial fibrillation. There are no published randomized trials comparing DOACs to warfarin in cardiac surgery patients, and DOACs are yet to be widely adopted in this population.

A Multi-Institutional Study on the Prevalence and Clinical Impact of Patient-Prosthesis Mismatch in Surgical Aortic Valve Replacement.

Background: Prosthesis-patient mismatch (PPM) impacts surgical aortic valve replacement outcomes, with known associations with adverse clinical consequences. However, contemporary understanding of PPM's clinical implications, trends, and predictive factors remains limited.

Methods: This multi-institutional study included all patients undergoing surgical aortic valve replacement between 2002 and 2023.

Clinical Outcomes With Normothermic Pulsatile Organ Perfusion in Heart Transplantation: A Report From the OCS Heart Perfusion Registry.

Background: A preservation system, the Organ Care System (OCS; TransMedics) uses normothermic pulsatile perfusion during organ transport for heart transplantation. This system has demonstrated favorable outcomes in hearts recovered from extended-criteria donors after brain death (DBD) and donors after circulatory death (DCD).

Methods: The OCS Heart Perfusion Registry collects data on US heart transplantations using the OCS, static cold storage (SCS), or thoracoabdominal normothermic regional perfusion (NRP) and donor hearts recovered from DBD or DCD donors.

Evaluating cardiac function in ex vivo heart perfusion using lumped parameter models.

Background: Heart transplant outcomes and survival depend on the ability to implant well-functioning organs, but there remain no reliable, objective measures of cardiac function prior to implantation. The lack of standardized protocols and advanced technologies results in inconsistencies and subjective assessments, increasing the risk for postoperative graft dysfunction, the leading cause of short-term morbidity and mortality after transplant. Ex-vivo heart perfusion (EVHP) provides a platform to evaluate donor hearts prior to implantation, using machine perfusion to reanimate the heart to a beating, physiologic state.

Moderate controlled hypothermia standard ice-cold storage of cardiac allografts to expand the donor pool: insights from the GUARDIAN registry.

For most of the last almost 60 years of heart transplantation, static ice storage has been the dominant means of organ preservation. This method has allowed about 4 hours of relatively safe cold ischemic time, after which the risk of graft dysfunction increases exponentially. This limitation governed our allocation system and limited our ability to explore remote and extended criteria donors.

Early Renal Outcomes Following Heart Transplantation Using Organs Procured After Circulatory Death.

Background: Transplantation using hearts obtained through donation after circulatory death (DCD) is increasing, but data on recipient renal outcomes are limited.

Methods And Results: Patients at a single institution who underwent heart transplantation using organs procured through DCD or donation after brain death (DBD) from April 2016 to August 2022 were included in this retrospective cohort study. Hemodynamic measures were collected via right heart catheterization performed 1 week after transplantation.

Metabolic Choreography of Energy Substrates During DCD Heart Perfusion.

Background: The number of patients waiting for heart transplant far exceeds the number of hearts available. Donation after circulatory death (DCD) combined with machine perfusion can increase the number of transplantable hearts by as much as 48%. Emerging studies also suggest machine perfusion could enable allograft "reconditioning" to optimize outcomes.

Presentation and outcomes of women and men undergoing surgery for degenerative mitral regurgitation.

Objectives: Degenerative mitral regurgitation is associated with heart failure, arrhythmia and mortality. The impact of sex on timing of surgical referral and outcomes has not been reported comprehensively. We examined preoperative status and surgical outcomes of male versus female degenerative mitral valve regurgitation patients undergoing surgery.

The Public Health Service "Increased Risk" 2020 Policy Change Has not Improved Organ Utilization in the United States: A Nationwide Cohort Study.

Objective: To assess the effects of the 2020 United States Public Health Service (PHS) "Increased Risk" Guidelines update.

Background: Donors labeled as "Increased Risk" for transmission of infectious diseases have been found to have decreased organ utilization rates despite no significant impact on recipient survival. Recently, the PHS provided an updated guideline focused on "Increased Risk" organ donors, which included the removal of the "Increased Risk" label and the elimination of the separate informed consent form, although the actual increased risk status of donors is still ultimately transmitted to transplant physicians.

Early Outcomes in Patients With LVAD Undergoing Heart Transplant via Use of the SherpaPak Cardiac Transport System.

Background: Heart transplant (HT) in recipients with left ventricular assist devices (LVADs) is associated with poor early post-HT outcomes, including primary graft dysfunction (PGD). As complicated heart explants in recipients with LVADs may produce longer ischemic times, innovations in donor heart preservation may yield improved post-HT outcomes. The SherpaPak Cardiac Transport System is an organ preservation technology that maintains donor heart temperatures between 4 °C and 8 °C, which may minimize ischemic and cold-induced graft injuries.

Donation after circulatory death significantly reduces waitlist times while not changing post-heart transplant outcomes: A United Network for Organ Sharing Analysis.

Background: Recently, several centers in the United States have begun performing donation after circulatory death (DCD) heart transplants (HTs) in adults. We sought to characterize the recent use of DCD HT, waitlist time, and outcomes compared to donation after brain death (DBD).

Methods: Using the United Network for Organ Sharing database, 10,402 adult (aged >18 years) HT recipients from January 2019 to June 2022 were identified: 425 (4%) were DCD and 9,977 (96%) were DBD recipients.

Acute rejection in donation after circulatory death (DCD) heart transplants.

Background: Donation after circulatory death (DCD) heart transplantation has promising early survival, but the effects on rejection remain unclear.

Methods: The United Network for Organ Sharing database was queried for adult heart transplants from December 1, 2019, to December 31, 2021. Multiorgan transplants and loss to follow-up were excluded.

A Paradigm Shift in Heart Preservation: Improved Post-transplant Outcomes in Recipients of Donor Hearts Preserved With the SherpaPak System.

Traditional ice storage has been the historic standard for preserving donor's hearts. However, this approach provides variability in cooling, increasing risks of freezing injury. To date, no preservation technology has been reported to improve survival after transplantation.

The effect of warm ischemia and donor ejection fraction on 30-day mortality after donation after circulatory death heart transplantation: A national database analysis.

Donation after circulatory death (DCD) donor hearts recovered using the direct procurement and perfusion method experience variable durations of warm ischemia at the time of procurement (WIP). We used the Organ Procurement and Transplantation Network database to assess the effect of WIP on 30-day mortality after DCD heart transplantation. The analysis evaluated outcomes in 237 recipients of DCD heart transplantation, demonstrating an optimal WIP cut point of <36 minutes.

Transplantation Outcomes with Donor Hearts after Circulatory Death.

Background: Data showing the efficacy and safety of the transplantation of hearts obtained from donors after circulatory death as compared with hearts obtained from donors after brain death are limited.

Methods: We conducted a randomized, noninferiority trial in which adult candidates for heart transplantation were assigned in a 3:1 ratio to receive a heart after the circulatory death of the donor or a heart from a donor after brain death if that heart was available first (circulatory-death group) or to receive only a heart that had been preserved with the use of traditional cold storage after the brain death of the donor (brain-death group). The primary end point was the risk-adjusted survival at 6 months in the as-treated circulatory-death group as compared with the brain-death group.

Improved clinical outcomes associated with the Impella 5.5 compared to the Impella 5.0 in contemporary cardiogenic shock and heart failure patients.

A redesigned surgically implanted heart pump incorporates several design changes from the prior device generation, but no published comparative data demonstrate if these changes translate to improved outcomes. We retrospectively compared clinical characteristics and outcomes, drawn from an FDA-mandated QA database, for contemporary patients treated with the Impella 5.5 or Impella 5.

Nighttime dexmedetomidine for delirium prevention in non-mechanically ventilated patients after cardiac surgery (MINDDS): A single-centre, parallel-arm, randomised, placebo-controlled superiority trial.

Background: The delirium-sparing effect of nighttime dexmedetomidine has not been studied after surgery. We hypothesised that a nighttime dose of dexmedetomidine would reduce the incidence of postoperative delirium as compared to placebo.

Methods: This single-centre, parallel-arm, randomised, placebo-controlled superiority trial evaluated whether a short nighttime dose of intravenous dexmedetomidine (1 μg/kg over 40 min) would reduce the incidence of postoperative delirium in patients 60 years of age or older undergoing elective cardiac surgery with cardiopulmonary bypass.

The Society of Thoracic Surgeons Intermacs 2022 Annual Report: Focus on the 2018 Heart Transplant Allocation System.

The 13th annual report from The Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) highlights outcomes for 27,314 patients receiving continuous-flow durable left ventricular assist devices (LVAD) during the last decade (2012-2021). In 2021, 2464 primary LVADs were implanted, representing a 23.5% reduction in the annual volume compared with peak implantation in 2019 and an ongoing trend from the prior year.

Hemodynamic and Clinical Performance of Hearts Donated After Circulatory Death.

Background: Donor organ demand continues to outpace supply in heart transplantation. Utilization of donation after circulatory death (DCD) hearts could significantly increase heart donor availability for patients with advanced heart failure.

Objectives: The purpose of this study was to describe hemodynamic and clinical profiles of DCD hearts in comparison to standard of care (SOC) hearts donated after brain death (DBD).