Angiotensin-Neprilysin Inhibition and Left Ventricular Assist Device Therapy -Primary results of the multicENter, randomized, open-label, parallel group, study to evaluate the use of sacubitril/valsartan in HeartMate 3 LVAD recipients (ENVAD-HF).

Background: The role of heart failure specific therapies in LVAD recipients is unclear and observational data suggest improved outcomes with neurohormonal blockers. ENVAD-HF evaluated safety and tolerability of the Angiotensin-Neprilysin Inhibitor sacubitril/valsartan, for managing blood pressure (BP) in HeartMate 3 (HM3) LVAD recipients versus standard of care (SOC).

Methods: ENVAD-HF was a prospective multicenter, randomized, open-label study of sacubitril/valsartan or SOC for managing BP (MAP goal 75-90 mmHg) in stable LVAD recipients with 12-month follow-up.

Evolving Paradigms and Future Frontiers In Heart Transplantation in the Modern Era: A State-of-Art Focus Review.

Heart transplantation stands at the threshold of a new era shaped by transformative advances across the clinical and scientific continuum. This contemporary review highlights developments with the greatest potential to shift practice and improve patient outcomes. First, evolving strategies in organ preservation and transport- such as ex vivo perfusion and normothermic techniques- are expanding geographic boundaries and optimizing donor heart utilization.

Impact of Delayed Kidney Graft Function on Long-term Outcomes in Simultaneous Heart-Kidney Transplantation Delayed Kidney Function in Heart-Kidney Transplant Outcomes.

Background: The incidence of simultaneous heart-kidney transplantation is increasing in the current era of transplantation. Whether delayed graft function of the kidney (requiring use of dialysis within the first week post-transplant) influences long-term patient survival remains underexplored.

Methods: This retrospective cohort study analyzed 1,737 recipients of simultaneous heart-kidney transplants from the United Network for Organ Sharing database between October 2018 and October 2024.

"No Hearts Left Behind": A global proposal to rescue discarded donor hearts.

Despite technological and logistical progress in heart transplantation, thousands of viable donor hearts are still discarded annually-particularly in the United States-while patients elsewhere continue to die waiting. This viewpoint proposes a global paradigm shift: enabling transatlantic exchange of unused donor hearts through advanced preservation technologies and reciprocal allocation frameworks. Using registry data from Eurotransplant and the United States, we highlight striking disparities in donor acceptance criteria, especially regarding older or donors previously considered less suitable.

Vasoplegia Syndrome After Cardiac Surgery: Insights Into Mechanisms and Treatment.

Vasoplegia syndrome is a specific form of vasodilatory shock encountered in patients who undergo cardiac surgery, most commonly with cardiopulmonary bypass, which is characterized by severe hypotension in the presence of normal or increased cardiac output with abnormal tissue perfusion. Although numerous risk factors have been identified, the pathophysiology remains incompletely understood, and the therapeutic strategies are limited with a consequent poor prognosis. Current research on mechanisms and treatment has focused on targeting disequilibrium in the biological mediators of vasodilation and vasoconstriction that leads to profound hypotension and end-organ malperfusion.

Relationship Between Remote, Ambulatory Pulmonary Artery Pressures, and All-Cause Mortality in Patients With Chronic Heart Failure.

Background: Hemodynamically guided management of patients with chronic heart failure (HF), using a remote, ambulatory pulmonary artery (PA) pressure monitor, has been shown to reduce mortality and morbidity. These improved outcomes were associated with a reduction in PA pressure. However, several pivotal questions remain unanswered: do systolic, diastolic, or mean PA pressures each predict all-cause mortality? Do PA pressures predict mortality across the ejection fraction (EF) spectrum? Do increases or decreases in PA pressure over time predict increases or decreases in mortality?

Methods: Retrospective analyses of data from CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients; n=550), GUIDE-HF (Hemodynamic-GUIDEed management of Heart Failure; n=2358), US PAS (CardioMEMS HF System Post Approval Study; n=1200), and MEMS-HF (CardioMEMS Monitoring Study for Heart Failure; n=234) were performed, including all enrolled patients regardless of treatment assignments (Total N=4342).

First-in-Human Implantable Inferior Vena Cava Sensor for Remote Care in Heart Failure: FUTURE-HF.

Background: Variations of inferior vena cava (IVC) area and collapsibility serve as early markers of congestion and predict risk for heart failure (HF) events.

Objectives: The aim of this first-in-human study (FUTURE-HF [First in Human Clinical Investigation of the FIRE1 System in Heart Failure Patients]) was to evaluate the safety and feasibility of a novel implantable IVC sensor for remote management in patients with HF. This paper is the final report on primary (3-month) and exploratory (6-month) endpoints.

Concomitant Surgical Procedures and Aspirin Avoidance With Left Ventricular Assist Device Therapy.

Background: ARIES-HM3 (Antiplatelet Removal and Hemocompatibility Events With the HeartMate 3 Pump) demonstrated that aspirin avoidance with a fully magnetically levitated HeartMate 3 (HM3) left ventricular assist device (LVAD) reduces bleeding complications and does not increase thromboembolism. Whether a concomitant surgical procedure modifies the observed safety and benefits remains uncertain.

Objectives: This prespecified analysis of ARIES-HM3 studied clinical outcomes when concomitant surgical procedures are performed during LVAD implantation with excluding aspirin but maintaining a vitamin K antagonist.

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.

"First-in-human" totally robotic orthotopic heart transplant.

Importance: Traditionally, heart transplantation surgery requires a median sternotomy due to the perceived complexity of a large organ replacement. Whether an alternative minimally invasive approach to perform a successful heart transplant can be accomplished remains uncertain.

Objective: To develop a safe and effective technique for totally robotic heart transplantation.

Implantable Cardioverter-Defibrillators and Cardiovascular Resynchronization Therapy with Left Ventricular Assist DevicesA MOMENTUM 3 Trial Analysis.

Background: The benefit of implantable cardioverter-defibrillators (ICDs) and cardiovascular resynchronization therapy defibrillators (CRT-Ds) in patients supported with a HeartMate 3 left ventricular assist device (LVAD) remains uncertain.

Methods: An analysis was done of the Multicenter Study of MAGLEV Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 (MOMENTUM 3) randomized clinical trial and the first 1000 patients in the Continued Access Protocol (CAP) trial. Patients were divided into 3 groups based on the presence of an ICD and/or CRT-D: No device (n = 153, 11%), ICD only (n = 699, 50.

Aspirin and Hemocompatibility After LVAD Implantation in Patients With Atherosclerotic Vascular Disease: A Secondary Analysis From the ARIES-HM3 Randomized Clinical Trial.

Importance: The Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure (ARIES-HM3) study demonstrated that aspirin may be safely eliminated from the antithrombotic regimen after HeartMate 3 (HM3 [Abbott Cardiovascular]) left ventricular assist device (LVAD) implantation. This prespecified analysis explored whether conditions requiring aspirin (prior percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], stroke, or peripheral vascular disease [PVD]) would influence outcomes differentially with aspirin avoidance.

Objective: To analyze aspirin avoidance on hemocompatibility-related adverse events (HRAEs) at 1 year after implant in patients with a history of CABG, PCI, stroke, or PVD.

Left Ventricular Dimensions and Clinical Outcomes With a Fully Magnetically Levitated Left Ventricular Assist Device.

Background: Prior analyses have suggested that a smaller left ventricular end-diastolic diameter (LVEDD) is associated with reduced survival following HeartMate 3 left ventricular assist device implantation.

Objectives: In this trial-based comprehensive analysis, the authors sought to examine clinical characteristics and association with the outcome of this specific relationship.

Methods: The authors analyzed the presence of LVEDD <55 mm among 1,921 analyzable HeartMate 3 patients within the MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3) trial portfolio, on endpoints of overall survival and adverse events at 2 years.