Heart Transplantation
|
|
|
- Beverly Liliana Phelps
- 5 years ago
- Views:
Transcription
1 Heart Transplantation Age and Outcome Mayo Clinic Richard Daly, MD Professor of Surgery Surgical Director Heart & Lung Transplantation 2014 MFMER
2 Rochester, Minnesota 2014 MFMER
3 The frontier practice of William Worrall Mayo and his two sons, William J. and Charles H. Mayo 2014 MFMER
4 The frontier practice of William Worrall Mayo and his two sons, William J. and Charles H. Mayo 2014 MFMER
5 History of Mayo Clinic William J. Mayo Charles H. Mayo 2014 MFMER
6 The Mayo s Clinics Dr. Charlie Mayo conducts a training clinic 2014 MFMER
7 History of Mayo Clinic 1889 St. Marys opens (27 beds, 1 OR) Medical staff: WW, WJ and CH Mayo 2014 MFMER
8 Saint Marys Hospital Beds 1157 ORs MFMER
9 Mayo Clinic 2014 MFMER
10 2014 MFMER
11 Frank Mann 2014 MFMER
12 2014 MFMER
13 General Behavior of the Transplanted Heart After from one to eight days, irregularities became apparent (and) determination of the pulse rate impossible. The surface of the heart was covered with mottled areas of ecchymosis. Histologically the heart was completely infiltrated with lymphocytes, large mononuclears and polymorphonuclears. Mann et al, MFMER
14 2014 MFMER
15 Mayo ClinicCenter for Transplantation and Clinical Regeneration Heart Transplantation 573 Transplants (06/01/88-12/31/14) Indications 071/018/ MFMER
16 2014 MFMER
17 Mayo Clinic Center for Transplantation and Clinical Regeneration Pediatric Heart Transplantation 55 Patients (07/10/91 12/31/14) Indications 01/09/ MFMER
18 Mayo Clinic Center for Transplantation and Clinical Regeneration Pediatric CardiacTransplant 55 Patients Transplanted 07/10/91-12/26/ Survival (%) yr survival = 90.1 ± 4.2 (n=40) 5-yr survival = 81.8 ± 6.0 (n=24) Years after transplant 12/31/2014 CP MFMER
19 Mayo Clinic Center for Transplantation and Clinical Regeneration Cardiac Transplantation - Kaplan-Meier Survival 479 Patients Transplanted 06/01/88-12/26/ Survival (%) yr survival = 93.0 ± 1.2 (n=420) 5-yr survival = 83.1 ± 1.8 (n=280) 10-yr survival = 67.9 ± 2.6 (n=162) Years after transplant 12/31/2014 CP MFMER
20 Survival (%) Mayo Clinic Transplant Center Cardiac Transplantation Mayo vs. ISHLT Database ISHLT Database (n=18,236) (n=34,422) /2008 (n=18,661) Mayo 1-yr survival = 92.6±1.3 (n=345) 5-yr survival = 81.2±2.1 (n=230) 10-yr survival = 64.8±3.0 (n=119) P< Years after transplant J Heart Lung Transplant 29 (10):1083, MFMER
21 CARDIAC TRANSPLANTATION U.S. Transplants per Year Patients Year UNOS Data, MFMER
22 If outcome after heart transplant is reduced with increased age, is it acceptable to use donor hearts in older patients? 2014 MFMER
23 What do we know about age of the recipient and outcome after heart transplant? 2014 MFMER
24 Adult Heart Transplants Diagnosis by Age Group (Transplants: January 2006 June 2013) years 10% 5% 7% 1% 2% Myopathy Congenital Retx CAD Other Valvular years 2% 2% 37% 1% 3% 74% years 53% 0% 3% 70+ years 58% 1% 2% 56% 2% 1% 41% 3% 0% 37% 2014 For some retransplants diagnosis other than retransplant is reported, so the total percentage of retransplants may JHLT Oct; 33(10): be greater MFMER
25 Survival (%) Adult Heart Transplants Kaplan-Meier Survival by Age Group (Transplants: January 1982 June 2012) Median survival (years): 18-39=12.6; 40-59=10.7; 60-69=9.1; 70+= All pair-wise comparisons were significant at p < 0.05 except vs (N=16,581) (N=58,156) (N=21,679) 70+ (N=733) Years 2014 JHLT Oct; 33(10): MFMER
26 Age is a risk factor for reduced Survival after heart transplantation MFMER
27 ADULT HEART TRANSPLANTS (2003-6/2008) Risk Factors For 5 Year Mortality Continuous Factors (see figures) Recipient age Recipient height Recipient BMI Ischemia time Recipient pre-transplant bilirubin Recipient pre-transplant creatinine Donor age Recipient most recent Class I PRA (%) Donor BMI Recipient transpulmonary gradient Transplant center volume 2014 JHLT Oct; 33(10): MFMER
28 ADULT HEART TRANSPLANTS (1998-6/2003) Risk Factors For 10 Year Mortality Continuous Factors (see figures) Recipient age Recipient weight Donor age Donor weight Ischemia time Recipient pre-transplant bilirubin Recipient pre-transplant creatinine Transplant center volume 2014 JHLT Oct; 33(10): MFMER
29 ADULT HEART TRANSPLANTS (1993-6/1998) Risk Factors For 15 Year Mortality Continuous Factors (see figures) Recipient age Difference in recipient and donor age Recipient BMI Ischemia time Recipient pre-transplant creatinine Transplant center volume 2014 JHLT Oct; 33(10): MFMER
30 Hazard Ratio of 5 Year Mortality ADULT HEART TRANSPLANTS (2003-6/2008) Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Age p < Recipient Age (years) 2014 JHLT Oct; 33(10): (N = 10,306) 2014 MFMER
31 Hazard Ratio of 10 Year Mortality ADULT HEART TRANSPLANTS (1998-6/2003) Risk Factors For 10 Year Mortality with 95% Confidence Limits Recipient Age p < Recipient Age (years) 2014 JHLT Oct; 33(10): (N = 11,641) 2014 MFMER
32 Hazard Ratio of 15 Year Mortality ADULT HEART TRANSPLANTS (1993-6/1998) Risk Factors For 15 Year Mortality with 95% Confidence Limits Recipient Age 2.0 p < Recipient Age (years) 2014 JHLT Oct; 33(10): (N = 11,423) 2014 MFMER
33 Hazard Ratio of 20 Year Mortality ADULT HEART TRANSPLANTS (1988-6/1993) Risk Factors For 20 Year Mortality with 95% Confidence Limits Recipient Age 2.0 p < Recipient Age (years) 2014 JHLT Oct; 33(10): (N = 19,208) 2014 MFMER
34 Incidence of Cause-Specific Deaths Adult Heart Transplants Cumulative Incidence of Leading Causes of Death (Transplants: January 1994 June 2012) 16% 14% 12% 10% 8% 6% 4% 2% CAV Malignancy (non-lymph/ptld) Graft Failure Renal Failure Acute Rejection Infection (non-cmv) Multiple Organ Failure 0% Years 2014 JHLT Oct; 33(10): MFMER
35 Incidence of Cause-Specific Deaths Adult Heart Transplants Cumulative Incidence of Leading Causes of Death (Transplants: January 1994 June 2012) 16% 14% 12% 10% CAV Malignancy (non-lymph/ptld) Graft Failure Renal Failure Acute Rejection Infection (non-cmv) Multiple Organ Failure Graft Failure 8% 6% Malignanc 4% CAV 2% 0% Years 2014 JHLT Oct; 33(10): MFMER
36 ADULT HEART TRANSPLANTS (2000-6/2005) Risk Factors for Developing Non-Skin Malignancy within 8 Years Limited to Recipients without Malignancy Pre-Transplant Conditional on Survival to Transplant Discharge Recipient age Continuous Factors (see figures) Donor weight Ischemia time Transplant center volume Donor height Donor/recipient height ratio 2014 JHLT Oct; 33(10): MFMER
37 Hazard Ratio of Non-Skin Malignancy within 8 Years ADULT HEART TRANSPLANTS (2000-6/2005) Risk Factors for Developing Non-Skin Malignancy within 8 Years Limited to Recipients without Malignancy Pre-Transplant Conditional on Survival to Transplant Discharge Recipient Age p < Recipient Age (years) 2014 JHLT Oct; 33(10): (N = 6,214) 2014 MFMER
38 Age is a risk factor for reduced Survival after heart transplantation MFMER
39 Survival % Mayo Clinic Transplant Center Cardiac Transplantation Survival by Age Group Age > 55 Age > 60 Age > 65 Age > 70 Overall Survival Years 2014 MFMER
40 Survival (%) Adult Heart Transplants Kaplan-Meier Survival by Age Group (Transplants: January 1982 June 2012) Median survival (years): 18-39=12.6; 40-59=10.7; 60-69=9.1; 70+= All pair-wise comparisons were significant at p < 0.05 except vs (N=16,581) (N=58,156) (N=21,679) 70+ (N=733) Years 2014 JHLT Oct; 33(10): MFMER
41 Heart Transplantation Recipient Selection Contra-indications Age Nutritional status Infection Malignancy Pulmonary hypertension Renal failure Liver failure Psycho-social issues 2014 MFMER
42 Heart Transplantation Recipient Selection for Older Patients Frailty Weight loss Grip strength Gait speed Low physical activity Fatigue / exhaustion Fried, et al. Gerontal A Sci Med Sci 2010 Rockwood, et al. CMAJ 2005 JAMA Surg 149 (11): MFMER
43 Heart Transplantation Recipient Selection for Older Patients Frail or Heart Failure? Weight loss Grip strength Gait speed Low physical activity Fatigue / exhaustion Sarcopenia / Cachexia Fried, et al. Gerontal A Sci Med Sci 2010 Rockwood, et al. CMAJ 2005 JAMA Surg 149 (11): MFMER
44 Heart Transplantation Recipient Selection for Older Patients Frail Reversible? Weight loss Grip strength Gait speed 6 min. walk Low physical activity Fatigue / exhaustion Sarcopenia / Cachexia Fried, et al. Gerontal A Sci Med Sci 2010 Rockwood, et al. CMAJ 2005 JAMA Surg 149 (11): MFMER
45 Heart Transplantation Recipient Selection Contra-indications Age Nutritional status Infection Malignancy Pulmonary hypertension Renal failure Liver failure Psycho-social issues 2014 MFMER
46 Multi-Organ Transplantation 2014 MFMER
47 Mayo Clinic Transplant Center Heart and Multi-Organ Transplantation 550 Transplants (06/01/88 12/01/14) Transplants (no.) heart-liver heart kidney heart-liver heart-liver Multi Organ Heart alone heart-liver-kidney / 2 heart-kidney heart-liver / 1 heart-kidney heart-kidney / 1 retx heart-liver / 1 heart-kidney heart-kidney / 1 heart-liver-kidney / 1 heart-liver heart-kidney / 1 heart-liver heart-kidney / 2 heart-liver heart-kidney / 1 heart-liver-kidney / 1 peds retx heart-liver / 1 heart-kidney heart-liver / 2 heart-kidney heart-liver / 2 heart-kidney / 1 heart-liver-kidney heart-liver / 3 heart-kidney / 1 peds retx heart-liver / 6 heart-kidney heart-liver / 5 heart-kidney Combined heart-liver n = 35 12/01/ MFMER
48 Multi-Organ Transplantation: Mayo Clinic 72 pts 50% heart-liver > 55 years 50% heart-kidney > 55 years 25% > heart-liver > 60 years 25% > heart-kidney > 60 years 2014 MFMER
49 Combined Heart Liver Transplant Is it an ethically acceptable use of 2 organs?? 2014 MFMER
50 Heart-Liver Transplantation vs Heart Transplant Alone 35 Patients Transplanted 07/07/ /07/ Survival (%) Heart-Liver Transplantation 1-yr survival = 92.7 ± 4.9 (n = 21) 3-yr survival = 86.8 ± 7.1 (n = 15) 5-yr survival = 82.5 ± 8.2 (n = 11) Years after transplant 01/01/ MFMER
51 Heart-Liver Transplantation vs Heart Transplant Alone 31 Patients Transplanted 07/07/ /07/ Survival (%) Heart-Liver Transplantation 1-yr survival = 92.7 ± 4.9 (n = 21) 3-yr survival = 86.8 ± 7.1 (n = 15) 5-yr survival = 82.5 ± 8.2 (n = 11) Heart Transplantation 1-yr survival = 93.2 ± 1.2 (n = 375) 3-yr survival = 87.4 ± 1.7 (n = 309) 5-yr survival = 82.2 ± 2.0 (n = 250) Years after transplant 01/01/ MFMER
52 Heart-Liver Transplantation vs Heart Transplant Alone 31 Patients Transplanted 07/07/ /07/ Survival (%) Heart-Liver Transplantation 1-yr survival = 92.7 ± 4.9 (n = 21) 3-yr survival = 86.8 ± 7.1 (n = 15) 5-yr survival = 82.5 ± 8.2 (n = 11) Heart Transplantation 1-yr survival = 93.2 ± 1.2 (n = 375) 3-yr survival = 87.4 ± 1.7 (n = 309) 5-yr survival = 82.2 ± 2.0 (n = 250) Liver Transplantation 1-yr survival = 94 ± yr survival = 83 ± yr survival = 70 ± Years after transplant 01/01/ MFMER
53 Combined Heart Liver Transplant Is it an ethically acceptable use of 2 organs?? Yes! 2014 MFMER
54 Freedom from Cardiac Allograft Rejections CHLTx vs. HTx Rejection % % 42% P = % IHTx CHLTx Years post Tx 2014 MFMER
55 Combined Heart-Liver Transplant Surgical Strategy Liver Transplant before Heart Transplant Will the liver absorb the Antibodies specific to that donor? 2014 MFMER
56 pre-tx 5/7 post-pp 5/7 post-liver 5/7 8-May 9-May 10-May Donor specific Ab s A34 B45 DR11 DR15 Daly, et al. Transplantation MFMER
57 CARDIAC TRANSPLANTATION U.S. Transplants per Year Patients Year UNOS Data, MFMER
58 Continuous Flow LVAD HeartMate II HeartWare HeartMate III 2014 MFMER
59 VAD Implants (DT/BTT) 2014 MFMER
60 How does LVAD as DT compare to heart transplant in patients > 65 years? 2014 MFMER
61 Ann Thorac Surg 2015;99: by The Society of Thoracic Surgeons 2014 MFMER
62 Comparison of Outcomes After Heart Replacement Therapy in Patients Over 65 Years Old Survival HTx BTT DT Fig 1 Kaplan-Meier analysis of 2-year survival stratified by treatment group. Robert A. Sorabella, Halit Yerebakan, Ryan Walters, Koji Takeda, Paolo Colombo, Melana Yuzefpolskaya, Ulrich... The Annals of Thoracic Surgery, Volume 99, Issue 2, 2015, MFMER
63 Continuous Flow LVAD s GI Bleed and Pump thrombosis 2014 MFMER
64 Non-Pulsatile LVAD GI Bleed: Mayo Experience Crow, et al. JTCVS 137:208-15, MFMER
65 Von Willebrand Factor Catabolism by ADAMTS-13 Shear ADAMTS-13 Cleavage Globular vwf Multimer Fragments 2014 MFMER
66 Continuous Flow LVAD s GI Bleed and Pump thrombosis 2014 MFMER
67 2014 MFMER
68 December 1, MFMER
69 Increase in HM-II Pump Thrombosis? Starling, et al, NEJM MFMER
70 Pump Thrombosis Intravascular Hemolysis 145 patients with Heartmate-II 14 with hemolysis and suspected pump thrombosis Fine, et al Mayo data in press MFMER
71 LVAD Observations Outcome has improved Survival still not = HTx DT is option for non-candidates for HTx BTD is useful in some situations 2014 MFMER
72 What is the Future? W.W. Mayo 2014 MFMER
73 2014 MFMER
74 Xenotransplantation Preformed Ab -Gal 1,3 galactose 2014 MFMER
75 Xenotransplantation Mayo Components Cloning Site Breeding Site Molecular Biology Site Preclinical Research Site Barrier GMP Site 2014 MFMER
76 2014 MFMER
77 Conclusions Age is a recognized risk factor for reduced survival after HTx HTx can be performed in select patients > 60 years with acceptable outcomes Multi-organ transplantation can have acceptable outcome for select patients > 60 years LVAD as DT is an alternative for non-htx candidates LVAD is BTD in some patients 2014 MFMER
78 2014 MFMER
Heart Transplant: State of the Art. Dr Nick Banner
Heart Transplant: State of the Art Dr Nick Banner Heart Transplantation What is achieved Current challenges Donor scarcity More complex recipients Long-term limitations Non-specific Pharmacological Immunosuppression
Heart Transplantation ACC Middle East Conference Dubai UAE October 21, 2017
Heart Transplantation ACC Middle East Conference Dubai UAE October 21, 2017 Randall C Starling MD MPH FACC FAHA FESC FHFSA Professor of Medicine Kaufman Center for Heart Failure Department of Cardiovascular
Mechanical Circulatory Support in the Management of Heart Failure
Mechanical Circulatory Support in the Management of Heart Failure Feras Bader, MD, MS, FACC Associate Professor of Medicine Director, Heart Failure and Transplant Cleveland Clinic Abu Dhabi Chairman, Heart
Risk Factors for Adverse Outcome after HeartMate II Jennifer Cowger, MD, MS St. Vincent Heart Center of Indiana
Risk Factors for Adverse Outcome after HeartMate II Jennifer Cowger, MD, MS St. Vincent Heart Center of Indiana Advanced Heart Failure, Transplant, & Mechanical Circulatory Support Relevant Financial Relationship
Complications of Left Ventricular Assist Device Chronic Support. Dr. Tal Hasin RMC, Beilinson, Petach-Tiqva, Israel
Complications of Left Ventricular Assist Device Chronic Support. Dr. Tal Hasin RMC, Beilinson, Petach-Tiqva, Israel No disclosures Probability of survival Survival (%) Survival with LVAD Destination Bridge
Bridge to Heart Transplantation
Bridge to Heart Transplantation Ulf Kjellman MD, PhD Senior Consultant Surgeon Heart Centre KFSH&RC 1 Disclosure Appointed for Proctorship by Thoratec/St.Jude/Abbott 2 To run a full overall covering transplant
The multidisciplinary approach to AMR in lung transplantation: Reaching a consensus. Deborah Jo Levine Professor of Medicine University of Texas
The multidisciplinary approach to AMR in lung transplantation: Reaching a consensus Deborah Jo Levine Professor of Medicine University of Texas Disclosures I have no financial relations with any relevant
Mechanical assist patient selection, device selection, and outcomes
Mechanical assist patient selection, device selection, and outcomes Josef Stehlik, MD, MPH Associate Professor of Medicine Medical Director, Heart Transplant Program University of Utah School of Medicine
Translating Device and Mechanical Support Guidelines to ACHD Research. Timothy M. Maul, CCP, PhD Perfusionist Sr. Research Scientist
Translating Device and Mechanical Support Guidelines to ACHD Research Timothy M. Maul, CCP, PhD Perfusionist Sr. Research Scientist Disclosures No financial disclosures May discuss off-label or investigational
LVAD Complications, Recovery
LVAD Complications, Recovery Abbas Ardehali, M.D., F.A.C.S. Professor of Surgery and Medicine, Division of Cardiac Surgery William E. Connor Chair in Cardiothoracic Transplantation Director, UCLA Heart,
Lung Transplantation: Overview and the MUSC Program
Lung Transplantation: Overview and the MUSC Program Timothy P.M. Whelan MD Associate Professor of Medicine Medical Director of Lung Transplantation History of Lung Transplant James Hardy Univ of Mississippi
Heart Transplantation & MCS in 2017 Advances & Challenges
Heart Transplantation & MCS in 2017 Advances & Challenges Steven Tsui Papworth Hospital, Cambridge, UK Papworth Hospital Heart Transplantation ADVANCES AND CHALLENGES Heart Transplants 100 75 Adult Heart
How to mend a broken heart: transplantation or LVAD?
SCDU DI CARDIOCHIRURGIA Università degli Studi di Torino Ospedale S. Giovanni Battista Direttore: Prof. Mauro Rinaldi How to mend a broken heart: transplantation or LVAD? Massimo Boffini Mauro Rinaldi
Heart Transplantation for Patients with a Fontan Procedure
Heart Transplantation for Patients with a Fontan Procedure Kirk R. Kanter MD Professor of Surgery Pediatric Cardiac Surgery Emory University School of Medicine Children s Healthcare of Atlanta Atlanta,
Update on Mechanical Circulatory Support. AATS May 5, 2010 Toronto, ON Canada
Update on Mechanical Circulatory Support AATS May 5, 2010 Toronto, ON Canada Disclosures NONE Emergency Circulatory Support ECMO Tandem Heart Impella Assessment Cardiac Function Pulmonary function Valvular
Effect of Pre-LVAD PVR on Heart Transplant Outcome
AATS 2015, VAD/ECMO Session Effect of Pre-LVAD PVR on Heart Transplant Outcome Masaki Tsukashita, MD, PhD, Hiroo Takayama, MD, PhD, Koji Takeda, MD, PhD, Jiho Han, BS, Sowmyashree Sreekanth, BS, Lauren
Heart Failure Medical and Surgical Treatment
Heart Failure Medical and Surgical Treatment Daniel S. Yip, M.D. Medical Director, Heart Failure and Transplantation Mayo Clinic Second Annual Lakeland Regional Health Cardiovascular Symposium February
Heart Transplantation is Dead
Heart Transplantation is Dead Alternatives to Transplantation in Heart Failure Sagar Damle, MD University of Colorado Health Sciences Center Grand Rounds September 8, 2008 Outline Why is there a debate?
2/28/2017. Adult Heart Transplants Donor and Recipient Characteristics UNOS, Retransplant VCM. Other /2015 (N = 24,474)
1 46% 2% 3% 4% 0% 2% 2% CHD HCM ICM NICM RCM 49% 3% 3% 3% 1% 3% 3% Retransplant VCM 42% Other 35% 1/1982 6/2015 1/2009 6/2015 2016 JHLT. 2016 Oct; 35(10): 1149-1205 UNOS, 2017 Adult Heart Transplants Donor
Predictors of cardiac allograft vasculopathy in pediatric heart transplant recipients
Pediatr Transplantation 2013: 17: 436 440 2013 John Wiley & Sons A/S. Pediatric Transplantation DOI: 10.1111/petr.12095 Predictors of cardiac allograft vasculopathy in pediatric heart transplant recipients
Lessons learned from ENDURANCE, ROADMAP, MedaMACS, and how to go forward?
Lessons learned from ENDURANCE, ROADMAP, MedaMACS, and how to go forward? Mark S. Slaughter, MD Professor and Chair Department of Cardiovascular and Thoracic Surgery University of Louisville What could
Heart Transplantation
Heart Transplantation Abbas Ardehali, M.D., F.A.C.S. Professor of Surgery and Medicine, Division of Cardiac Surgery William E. Connor Chair in Cardiothoracic Transplantation Director, UCLA Heart, Lung,
Concomitant Aortic Valve Procedures in Patients Undergoing Implantation of Continuous-Flow LVADs: An INTERMACS Database Analysis
Concomitant Aortic Valve Procedures in Patients Undergoing Implantation of Continuous-Flow LVADs: An INTERMACS Database Analysis April 11, 2014 Jason O. Robertson, M.D., M.S.; David C. Naftel, Ph.D., Sunil
Lung Transplantation A look Inside A Surgeon s Perspective
Lung Transplantation A look Inside A Surgeon s Perspective Hassan Nemeh, MD Henry Ford Hospital Michigan Society of Respiratory Care Spring Conference 2016 Historical background Alexis Carrel 1905 Reported
Novel Devices for End-Stage Heart Failure
Novel Devices for End-Stage Heart Failure Lynne Warner Stevenson No conflicts of interest Off-label assist devices and expanded indications will be discussed Devices for End-Stage Heart Failure New definitions
Kidney Transplant in the Elderly. Robert Santella, M.D., F.A.C.P.
Kidney Transplant in the Elderly! Robert Santella, M.D., F.A.C.P. Incident Rate of ESRD by Age Age 75+ 65-74 From US Renal Data System, 2012 Should there be an age limit? Various guidelines: Canadian,
Status of Implantable VADs
Status of Implantable VADs John V. Conte, MD, Professor of Surgery Johns Hopkins University School of Medicine Division of Cardiac Surgery The Johns Hopkins Medical Institutions Conflict of Interest Statement
SCOMPENSO CARDIACO AVANZATO Controversia: che fine sta facendo il trapianto cardiaco, è sempre la prima opzione?
University of Pavia School of Medicine San Matteo Hospital, Division of Cardiac Surgery Pavia, Italy Prof. Andrea M. D Armini, M.D. SCOMPENSO CARDIACO AVANZATO Controversia: che fine sta facendo il trapianto
When to implant VAD in patients with heart transplantation indication. Aldo Cannata Dept of Cardiac Surgery Niguarda Ca Granda Hospital Milano
When to implant VAD in patients with heart transplantation indication Aldo Cannata Dept of Cardiac Surgery Niguarda Ca Granda Hospital Milano LVAD strategies In waiting list? Goal Bridge to transplant
Solid Organ Transplant
Solid Organ Transplant Lee R. Goldberg, MD, MPH, FACC Associate Professor of Medicine Medical Director, Heart Failure and CardiacTransplant Program University of Pennsylvania Disclosures Thoratec Consulting
Aortic Insufficiency: How Often Does It Occur and When To Treat
Aortic Insufficiency: How Often Does It Occur and When To Treat Simon Maltais, MD PhD Vice-Chair of Clinical Practice Director of MCS Program Department of Cardiovascular Surgery Mayo Clinic, Rochester,
Pediatric Mechanical Circulatory Support (MCS)
Pediatric Mechanical Circulatory Support (MCS) Ivan Wilmot, MD Heart Failure, Transplant, MCS Assistant Professor The Heart Institute Cincinnati Children s Hospital Medical Center The University of Cincinnati
2017 BANFF-SCT Joint Scientific Meeting. BARCELONA March 2017
2017 BANFF-SCT Joint Scientific Meeting BARCELONA 27-31 March 2017 Adriana Zeevi PhD (D) ABHI Professor of Pathology, Surgery and Immunology Director of Histocompatibility Laboratory University of Pittsburgh
Indications for prolongation of ECMO into the early postoperative period in lung transplantation How we do it
Indications for prolongation of ECMO into the early postoperative period in lung transplantation How we do it W Klepetko, MD Professor of Thoracic Surgery HEAD: DIVISION OF THORACIC SURGERY MEDICAL UNIVERSITY
AND My presentation does include discussion of off-label or investigational use (empiric therapy)
Managing Sensitized Patients Pre-Heart Transplantation Patricia P. Chang, MD MHS Associate Professor of Medicine Director, UNC Heart Failure & Transplant Program Patricia P. Chang, MD MHS Associate Professor
Transplant in Pediatric Heart Failure
Transplant in Pediatric Heart Failure Francis Fynn-Thompson, MD Co-Director, Center for Airway Disorders Surgical Director, Pediatric Mechanical Support Program Surgical Director, Heart and Lung Transplantation
Case (Coding Nightmare) Current Dilemmas in Heart Failure : Closing the Gap between Clinical Care and Coding. Current Dilemmas in Heart Failure :
Current Dilemmas in Heart Failure : Closing the Gap between Clinical Care and Coding Interim Vice Chair for Clinical Affairs Department of Medicine, University of Florida 1 2 Case (Coding Nightmare) 69
Heart Transplantation in Seniors European View
Heart Transplantation in Seniors European View Hynek RIHA Department of Anesthesiology and Intensive Care Institute for Clinical and Experimental Medicine Prague, Czech Republic 3 rd Int l Symposium: Perioperative
Donor/Recipient Risk Scores: Review of Published Approaches from Europe and the US
Donor/Recipient Risk Scores: Review of Published Approaches from Europe and the US Michael M. Givertz, MD Medical Director, Heart Transplant and MCS Brigham and Women s Hospital Professor of Medicine,
What has INTERMACS Taught Us about Patient Outcomes with Durable MCS? James K. Kirklin, MD
What has INTERMACS Taught Us about Patient Outcomes with Durable MCS? James K. Kirklin, MD Disclosure: I am Director of the Data Coordinating Center for the INTERMACS project and receive support through
2018 Update on Heart Failure Management. Where we are today.
2018 Update on Heart Failure Management Where we are today. Mitchell Saltzberg, MD Medical Director Comprehensive Heart Failure and Transplant Program HEART FAILURE 1 Current State of Heart Failure 5.7M
Analysis of Pump Thrombosis in the Intermacs Database
Analysis of Pump Thrombosis in the Intermacs Database Michael Acker William Measey Professor of Surgery Chief of Division of Cardiovascular Surgery Director of Heart and Vascular Center University of Pennsylvania
New Trends and Indications for LVADs
New Trends and Indications for LVADs Mark S. Slaughter, MD Professor and Chief Division of Thoracic and Cardiovascular Surgery University of Louisville Natural History of Heart Failure 100 10 Class III
Frailty Assessment: Simplifying the Complex
Frailty Assessment: Simplifying the Complex Natalie Sanders, DO Internal Medicine, Geriatrics Rocky Mountain Geriatrics Conference 2017 U N I V E R S I T Y O F U T A H H E A L T H, 2 0 1 7 OBJECTIVES Define
เอกราช อร ยะช ยพาณ ชย
30 July 2016 เอกราช อร ยะช ยพาณ ชย Heart Failure and Transplant Cardiology aekarach.a@chula.ac.th Disclosure Speaker, CME service: Merck, Otsuka, Servier Consultant, non-cme service: Novartis, Menarini
Records. Adult Kidney Pancreas Transplant Recipient Registration Worksheet. Recipient Information. Provider Information.
Records Adult Kidney Pancreas Transplant Recipient Registration Worksheet FORM APPROVED: O.M.B. NO. 0915 0157 Expiration Date: 07/31/2020 Note: These worksheets are provided to function as a guide to what
3/23/2018. Complications of VAD Therapy: Arrhythmias. Disclosures. Agenda. I have no relevant disclosures
March 23, 2018 Complications of VAD Therapy: Arrhythmias Sandeep M. Jani, MD, MPH Associate Directory of Advanced Heart Failure and Population Health MedStar Heart and Vascular Institute - Baltimore Sandeep
Why Children Are Not Small Adults? Treatment of Pediatric Patients Needing Mechanical Circulatory Support
Why Children Are Not Small Adults? Treatment of Pediatric Patients Needing Mechanical Circulatory Support Utpal S Bhalala, MD, FAAP Assistant Professor and Director of Research Pediatric Critical Care
How to Develop a Comprehensive Ventricular Assist Device Program
How to Develop a Comprehensive Ventricular Assist Device Program Rodrigo V. González, MD, MS Sección de Cirugía Cardiovascular División de Cirugía Facultad de Medicina Pontificia Universidad Católica de
Antibody Mediated Rejection (AMR) in LUNG TRANSPLANT Recipients
Antibody Mediated Rejection (AMR) in LUNG TRANSPLANT Recipients Lorriana Leard, MD UCSF Transplant Pulmonologist Associate Professor of Clinical Medicine Vice Chief of Clinical Activities Pulmonary, Critical
Strengthening Your VAD Program
Disclosure: I have no financial conflicts of interest. Strengthening Your VAD Program Octavio E. Pajaro MD, PhD Chair, Cardiothoracic Surgery Mayo Clinic Arizona Surgical Director, Heart Transplantation
Disclosures. No disclosures to report
Disclosures No disclosures to report Update on MOMENTUM 3 Trial: The Final Word? Francis D. Pagani MD PhD Otto Gago MD Professor of Cardiac Surgery University of Michigan Ann Arbor, Michigan, USA LVAD
Artificial Heart Program
Artificial Heart Program Provider Review: General VAD Overview Indications for VAD Bridge to transplant (BTT) historically most common (~80%) allow rehab from severe CHF while awaiting donor Bridge to
Surgical Options for Advanced Heart Failure
Surgical Options for Advanced Heart Failure Benjamin Medalion, MD Director, Transplantation and Heart Failure Surgery Department of Cardiothoracic Surgery Rabin Medical Center, Beilinson Hospital Heart
EMS and Nursing Considerations in VAD Patient Care
EMS and Nursing Considerations in VAD Patient Care B R I T T A N Y B U T Z L E R B S N R N V A D C O O R D I N A T O R F R O E D T E R T A N D T H E M E D I C A L C O L L E G E O F W I 1 0 / 2 5 / 1 8
Predicting Major Outcomes after MCSD Implant. Risk Factors for Death, Transplant, and Recovery. James Kirklin, MD David Naftel, PhD
Predicting Major Outcomes after MCSD Implant Risk Factors for Death, Transplant, and Recovery James Kirklin, MD David Naftel, PhD 1 I have no financial disclosures (I am the Principle Investigator for
Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices: the EUROMACS-RHF Risk Score Osama I.I. Soliman, MD, PhD, FACC,
ECMO as a Bridge to Heart Transplant in the Era of LVAD s.
Christian Bermudez MD. Associate Professor Director Thoracic Transplantation Division Cardiac Surgery Department of Surgery University of Pennsylvania ECMO as a Bridge to Heart Transplant in the Era of
End-Stage Heart Failure Care: Advances in Technology and Patient Survival
End-Stage Heart Failure Care: Advances in Technology and Patient Survival Colleen Ciampa, RN, MN, CNS, NP-C St. Vincent Hospital Advanced Heart Failure, Transplant, & Mechanical Circulatory Support Program
Are two better than one?
Are two better than one? Disclosures Ryutaro Hirose, MD Professor in Clinical Surgery University of California, San Francisco I have no relevant disclosures related to this presentation The PROBLEM There
Diagnosis of Device Thrombosis
Diagnosis of Device Thrombosis Andrew Civitello MD, FACC Medical Director, Heart Transplant Program Director, Fellowship Co-Director, Baylor St. Luke's Medical Center / Texas Heart Institute Trends in
Prospective Evaluation of the Eyeball Test for Assessing Frailty in Elderly Patients with Valvular Heart Disease
Prospective Evaluation of the Eyeball Test for Assessing Frailty in Elderly Patients with Valvular Heart Disease Background Frailty is a common occurrence in elderly patients Approximately half of the
Recent Trials With Durable LVADs: Is There a Superior Device?
Recent Trials With Durable LVADs: Is There a Superior Device? Francis D. Pagani MD PhD Otto Gago MD Endowed Professor of Cardiac Surgery Michigan Medicine Current Device Landscape 2018 HeartMate 3 HeartMate
Ramani GV et al. Mayo Clin Proc 2010;85:180-95
THERAPIES FOR ADVANCED HEART FAILURE: WHEN TO REFER Navin Rajagopalan, MD Assistant Professor of Medicine University of Kentucky Director, Congestive Heart Failure Medical Director of Cardiac Transplantation
Christopher M. O Connor, MD, FACC CEO and Executive Director, Inova Heart and Vascular Institute Professor of Medicine (adj.) Duke University Editor
New Strategies in the Management of Acute and Advanced Heart Failure Christopher M. O Connor, MD, FACC CEO and Executive Director, Inova Heart and Vascular Institute Professor of Medicine (adj.) Duke University
Who and When to Refer for a Heart Transplant
Who and When to Refer for a Heart Transplant Dr Jayan Parameshwar Consultant Cardiologist Papworth Hospital BSH 24 th November 2017 BSH Annual Autumn Meeting 2017 Presentation title: Who and when to refer
Ventricular Assist Device: Are Early Interventions Superior? Hamang Patel, MD Section of Cardiomyopathy & Heart Transplantation
Ventricular Assist Device: Are Early Interventions Superior? Hamang Patel, MD Section of Cardiomyopathy & Heart Transplantation Objectives Current rationale behind use of MCS Patient Selection Earlier?
Index. Note: Page numbers of article titles are in boldface type. Heart Transplantation
Heart Transplantation Index Note: Page numbers of article titles are in boldface type. Accelerated graft atherosclerosis (AGA), post heart transplantation, 73-74 Acute rejection, of heart, in adults, 70
The Kidney Allocation System Changed in a Substantive Way on December 5, Your Patients Have Been, and Will Be, Affected by These Changes
The Kidney Allocation System Changed in a Substantive Way on December 5, 2014 Your Patients Have Been, and Will Be, Affected by These Changes 1 The New Kidney Allocation System Terms of Importance Pediatric
Outline. Congenital Heart Disease. Special Considerations for Special Populations: Congenital Heart Disease
Special Considerations for Special Populations: Congenital Heart Disease Valerie Bosco, FNP, EdD Alison Knauth Meadows, MD, PhD University of California San Francisco Adult Congenital Heart Program Outline
Pediatric Kidney Transplantation
Pediatric Kidney Transplantation Vikas Dharnidharka, MD, MPH Associate Professor Division of Pediatric Nephrology Conflict of Interest Disclosure Vikas Dharnidharka, MD, MPH Employer: University of Florida
HEARTMATE 3 LEFT VENTRICULAR ASSIST SYSTEM
HEARTMATE 3 LEFT VENTRICULAR ASSIST SYSTEM A New Milestone in LVAD Therapy HeartMate 3 Left Ventricular Assist Device Introducing the new HEARTMATE 3 LVAD WITH FULL MAGLEV FLOW TECHNOLOGY HeartMate 3 LVAD
Ventricular Assist Devices for Permanent Therapy: Current Status and Future
Ventricular Assist Devices for Permanent Therapy: Current Status and Future Prospects Francis D. Pagani MD PhD Professor of Cardiac Surgery University of Michigan April 28 th, 2012 Disclosures NHLBI and
Regional Differences in Utilization and Outcomes of Left Ventricular Assist Devices: Insights from the INTERMACS Registry
Regional Differences in Utilization and Outcomes of Left Ventricular Assist Devices: Insights from the INTERMACS Registry Selim Krim, MD 1 ; Rey Vivo, MD 2 ; Patrick Campbell, MD 1 ; Jerry Estep, MD 3
EMS: Care of the VAD Patient. Brittany Butzler BSN RN VAD Coordinator Froedtert and the Medical College of WI
EMS: Care of the VAD Patient Brittany Butzler BSN RN VAD Coordinator Froedtert and the Medical College of WI Disclosure No relevant financial relationships by planners or presenters Left Ventricular Assist
Is it safe to transplant against HLA DSA in cardiothoracic patients? development and implementation of national Guidelines
Is it safe to transplant against HLA DSA in cardiothoracic patients? development and implementation of national Guidelines Dr Martin Howell. Laboratory Director. Department of H&I, NHS Blood and Transplant,
Three Sides to Allocation. ECD Extended Criteria Donor
Kidney Allocation- Optimal Use of Deceased Donors The New US System..and impact on wait list management Three Sides to Allocation Justice Peter G Stock MD, PhD Utility Efficiency Standard Criteria Donor
GI Bleeding in the Era of Continuous- Flow Left Ventricular Assist Devices
GI Bleeding in the Era of Continuous- Flow Left Ventricular Assist Devices Patrick Wieruszewski, PharmD PGY1 Pharmacy Resident Pharmacy Grand Rounds March 7, 2017 2017 MFMER slide-1 Objectives Discuss
VAD come Destination therapy nell adulto con Scompenso Cardiaco
VAD come Destination therapy nell adulto con Scompenso Cardiaco Francesco Santini Division of Cardiac Surgery, IRCCS San Martino IST University of Genova Medical School, Italy Heart Transplantation is
3/6/2017. Objectives. Prehabilitation Training the Frail. I have no financial relationships with commercial interests to disclose.
Prehabilitation Training the Frail Christopher J. Sonnenday, MD, MHS Surgical Director of Liver Transplantation University of Michigan Health System Christopher J. Sonnenday, MD, MHS Surgical Director
Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 (MOMENTUM 3) Long Term Outcomes
Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with (MOMENTUM 3) Long Term Outcomes Mandeep R. Mehra, MD, Daniel J. Goldstein, MD, Nir Uriel, MD, Joseph
Renal Transplantation: Allocation challenges and changes. Renal Transplantation. The Numbers 1/13/2014
Renal Transplantation: Allocation challenges and changes Mark R. Wakefield, M.D., F.A.C.S. Associate Professor of Surgery/Urology Director Renal Transplantation Renal Transplantation Objectives: Understand
Minimally Invasive Insertion of HVAD
Minimally Invasive Insertion of HVAD Simon Maltais, MD PhD Vice-Chair of Clinical Practice Director of MCS Program Department of Cardiovascular Surgery Mayo Clinic, Rochester, MN AATS MCS 2018, Houston
Challenges to MCS Use in the Middle East
Challenges to MCS Use in the Middle East Feras Khaliel, MD, Ph.D Consultant Cardiac Surgeon Associate Professor of Surgery, Alfaisal Univerisity King Faisal Specialist Hospital & Research Center Dr. Michael
LIVING A MORE ACTIVE LIFE. with the HeartMate 3 LVAD for the treatment of advanced heart failure RON. Recipient
LIVING A MORE ACTIVE LIFE with the HeartMate 3 LVAD for the treatment of advanced heart failure RON HeartMate 3 LVAD Recipient What is HEART FAILURE? Heart failure sometimes called a weak heart occurs
None. Declaration of conflict of interest
None Declaration of conflict of interest New Long Term Circulatory Support Technology and Treatment Strategies Stephen Westaby Oxford, UK Cardiac Transplantation: Facts from the UNOS Database Median survival
No evidence of C4d association with AMR However, C3d and AMR correlated well
C4d positivity Poor prognostic factor Reversal to C4d negativity did not change prognosis, with current therapy Prognostic factor for CAV Variable time line for CAV/death No correlation with cellular rejection
A Fully Magnetically Levitated Left Ventricular Assist Device. Final Report of the MOMENTUM 3 Trial
A Fully Magnetically Levitated Left Ventricular Assist Device Final Report of the MOMENTUM 3 Trial Mandeep R. Mehra, MD, Nir Uriel, MD, Joseph C. Cleveland, Jr., MD, Daniel J. Goldstein, MD, National Principal
Liver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995
Liver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995 Steven H. Belle, Kimberly C. Beringer, and Katherine M. Detre T he Scientific Liver Transplant Registry (LTR) was established
WHAT S NEW IN HEART FAILURE
WHAT S NEW IN HEART FAILURE Drugs, Devices and Diagnostics John M. Herre, MD, FACC, FACP Director, Advanced Heart Failure Program Sentara Helathcare Professor of Medicine Eastern Virginia Medical School
Do Posttransplant Outcomes Differ in Heart Transplant Recipients Bridged With Continuous and Pulsatile Flow Left Ventricular Assist Devices?
Do Posttransplant Outcomes Differ in Heart Transplant Recipients Bridged With Continuous and Pulsatile Flow Left Ventricular Assist Devices? Kimberly N. Hong, MHSA, Alexander Iribarne, MD, MS, Jonathan
RISK PREDICTION IN TAVR. Beyond STS PROM and the Eyeball Assessment
RISK PREDICTION IN TAVR Beyond STS PROM and the Eyeball Assessment SAVR VS TAVR BIOPROSHETIC OPEN SURGICAL VALVE (SAVR) BIOPROSTHETIC TRANSCATHETER VALVE (TAVR) This Photo by Unknown Author is licensed
Simultaneous Pancreas Kidney Transplantation:
Simultaneous Pancreas Kidney Transplantation: What is the added advantage, and for whom? Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney
5/15/2018. Background. Disclosure Statement
5/15/218 Efficacy of Bronchoscopically-Administered in the Setting of Primary Graft Dysfunction after Lung Transplantation Primary Investigator: Sana Ahmed, PharmD Research Associates: Matthew Soto-Arenall,
Fifth INTERMACS annual report: Risk factor analysis from more than 6,000 mechanical circulatory support patients
http://www.jhltonline.org SPECIAL FEATURE Fifth INTERMACS annual report: Risk factor analysis from more than 6, mechanical circulatory support patients James K. Kirklin, MD, a David C. Naftel, PhD, a Robert
The Balancing Act Bleeding and Thrombosis in MCS. Muhammad Adil Soofi
The Balancing Act Bleeding and Thrombosis in MCS Muhammad Adil Soofi Road Map Survival and complications with LVAD What is the Burden of thrombosis and bleeding Why Bleeding and Thrombosis happen When
Outcome of heart transplantation after bridge-to-transplant strategy using various mechanical circulatory support devices
Interactive CardioVascular and Thoracic Surgery 25 (2017) 918 924 doi:10.1093/icvts/ivx201 Advance Access publication 4 July 2017 ORIGINAL ARTICLE Cite this article as: Yoshioka D, Li B, Takayama H, Garan
The Who, How and When of Advanced Heart Failure Therapies. Disclosures. What is Advanced Heart Failure?
The Who, How and When of Advanced Heart Failure Therapies 9 th Annual Dartmouth Conference on Advances in Heart Failure Therapies Dartmouth-Hitchcock Medical Center Lebanon, NH May 20, 2013 Joseph G. Rogers,
Left Ventricular Assist Devices (LVADs): Overview and Future Directions
Left Ventricular Assist Devices (LVADs): Overview and Future Directions FATIMA KARAKI, M.D. PGY-3, DEPARTMENT OF MEDICINE WASHINGTON UNIVERSITY IN ST. LOUIS ST. LOUIS, MISSOURI, USA St. Louis, Missouri,
Pre- Cardiac intervention. Dr. Victor Sim 26 th Sept 2014
Pre- Cardiac intervention Frailty assessment Dr. Victor Sim 26 th Sept 2014 Defining frailty Lacks consensus (Rockwood CMAJ 2005;173(5):489-95 Introduction) Some consider symptoms, signs, diseases and