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Introduction: Heart transplant (HTx) recipients require continuous monitoring and care in order to prevent and treat possible complications related to the graft function or to the immunosuppressive treatment promptly. Since heart transplantation centers (HTC) are more experienced in managing HTx recipients than other healthcare facilities, the distance between patient residency and HTC could negatively affect the outcomes., Methods: Data of patients discharged after receiving HTx between 2000 and 2021, collected into our institutional database, were retrospectively analyzed. The population was divided into three groups: A (n = 180), B (n = 157), and C (n = 134), according to the distance tertiles between patient residency and HTC. The primary end-point was survival, secondary end-points were incidences of complications., Results: Recipient and donor characteristics did not differ between the three groups. Survival at 10 years was 66 ± 4%, 66 ± 4%, and 65 ± 5%, respectively, for groups A, B, and C (p = .34). Immunosuppressive regimen and rate of complications did not differ between groups. However, the rates of outpatient visits and of hospitalization performed at HTC were higher in group A than others., Conclusion: Distance from the HTC does not represent a barrier to a successful outcome for HTx recipients, as long as regular and continuous follow-up is provided., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aims: We aimed to describe how treatment of patients in cardiogenic shock bridged to heart transplantation with mechanical circulatory support, using either biventricular assist devices (BVADs) or extracorporeal life support (ECLS), has evolved in the last 20 years in our centre., Methods: Since 1998, 72 patients with refractory heart failure and indication for heart transplantation have received mechanical circulatory support: 40 had an ECLS system and 32 a BVAD., Results: Early mortality was similar (17.5 vs. 9.4%, P = 0.25) regardless of the type of support. After a median support time of 8 (1-27) vs. 34 (0-385) days (P < 0.01), 70 vs. 65.6% (P = 0.69) of patients underwent transplantation in the two groups. Prior to transplantation, BVAD patients were more stable with lower need for mechanical ventilation (9 vs. 57%, P < 0.01) and dialysis (0 vs. 38%, P < 0.01). Thirty-day mortality after transplantation was similar (18 vs. 14%, P = 0.53). Patients with extracorporeal support had higher rates of renal (P = 0.02) and respiratory failure (P = 0.03), infections (P = 0.02), atrial fibrillation (P = 0.03) and longer ICU stay (P = 0.01). Late survival was similar, while 5-year freedom from coronary vasculopathy was higher in those with BVAD (P = 0.03)., Conclusion: Although ECLS provides faster and simpler assistance compared with BVADs, no differences in early and medium-term outcomes in the last 20 years were observed in patients with cardiogenic shock. However, BVADs provided longer duration of support, better multiorgan recovery allowing more adequate graft selection, resulting in a lower rate of posttransplant complications., (Copyright © 2020 Italian Federation of Cardiology - I.F.C. All rights reserved.)

Objectives: Patients with mechanical circulatory support bridged to a heart transplant (HTx) are at higher risk of postoperative graft dysfunction. In this subset, a mode of graft preservation that shortens graft ischaemia should be beneficial., Methods: The outcomes of 38 patients on mechanical circulatory support (extracorporeal life support, left ventricular assist device and biventricular assist device) who received a HTx between 2015 and 2020 were analysed according to the method of graft preservation: cold storage (CS) group, 24 (63%) or ex vivo perfusion (EVP) group, 14 (37%)., Results: The median age was 57 (range 30-73) vs 64 (35-75) years (P = 0.10); 88% were men (P = 0.28); extracorporeal life support was more frequent in the CS group (54% vs 36%; P = 0.27) versus left ventricular and biventricular assist devices in the EVP group (46% vs 64%; P = 0.27). Clamping time was shorter in the EVP group (P < 0.001) and ischaemic time >4 h was higher in the CS group (P = 0.01). Thirty-day mortality was 13% (0-27%) in the CS group and 0% (P = 0.28) in the EVP group. A significantly lower primary graft failure [7% (0-23%) vs 42% (20-63%); P = 0.03] was observed in the EVP group. Survival at 1 year was 79 ± 8% (63-95%) in the CS group and 84 ± 10% (64-104%) in the EVP group (P = 0.95)., Conclusions: Our results support the use of ex vivo graft perfusion in patients on mechanical circulatory support as a bridge to a HTx. This technique, by shortening graft ischaemic time, seems to improve post-HTx outcomes., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Bridge to heart transplantation (HTx) with ECMO is associated with poor outcome, but patient status, according to different levels of multiorgan compromise, is generally not considered. The aim of this study was to analyze the prognostic value of acute physiology, age, and chronic health evaluation IV (APACHE IV) score in this setting. Thirty-two patients underwent HTx bridged with ECMO at our institution between 2005 and 2017; they were divided into two groups, according to a cutoff value of APACHE IV score obtained by Receiver operating characteristic curve analysis for 30-day mortality. Kaplan-Meyer survival curves were plotted, and compared through the log-Rank test. Cox regression model was used to estimate which factors were associated with overall survival. The 30-day mortality prediction of the APACHE IV score showed an AUC of 0.98 [95% C.I. 0.84-0.99], with a cutoff value corresponding to a score value of 47 (specificity of 84.6% and sensitivity of 100%) in order to discriminate between a group with low probability (Group A, patients with an APACHE IV score <47), and a group with high probability (Group B, patients with an APACHE IV score ≥47) of 30-day mortality. Median follow up was 26.9 months (range: 0.03-143.8). On overall, patients bridged with ECMO showed a high early mortality (18.7% <30 days, n = 6). All deaths occurred in Group B, where 30-day mortality was 60%. Survival probability among Group B patients was 26.6% at both 1 and 5 years. Conversely, in Group A no early mortality was reported, and the estimated survival was 89.7% at 1 year and 81.5% at 5 years, respectively. Mortality correlated at univariate analysis with recipient age, APACHE IV score and female sex, while the multivariate Cox regression analysis showed that only an APACHE IV score (HR 1.23 [1.08-1.39, 95% C.I.]) and female sex (HR 6.68 [1.42-31.43, 95% C.I.]) had an adverse impact on survival. This study shows that the APACHE IV score could be considered a powerful predictor of survival in patients bridged by ECMO to HTx, and can account for a better selection of patients on ECMO support at time of listing., (© 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Background: Ceftolozane/tazobactam (C/T) is a novel antibiotic with enhanced microbiological activity against multidrug-resistant (MDR) gram-negative bacteria, including MDR Pseudomonas aeruginosa., Case Report: Five months after left ventricular assist device (LVAD) implantation, a 49-year old man developed fever and blood culture was positive for MDR P. aeruginosa, susceptible only to aminoglycosides, ciprofloxacin and colistin. A diagnosis of LVAD-related infection was made based on persistent bacteremia associated with moderate 18 F-fluorodeoxyglucose positron emission tomography/CT uptake in the left ventricular apex. Disk diffusion testing for C/T was performed (MIC 2 μg/mL) and intravenous antibiotic therapy with C/T and amikacin was started, with clinical and microbiological response. Initial conservative management with 6 weeks of systemic antibiotic therapy was attempted, but the patient relapsed one month after antibiotic discontinuation. Priority for transplantation was given and after 4 weeks of antibiotic therapy (C/T + amikacin), LVAD removal and heart transplant were performed, with no infection relapse., Conclusions: We reported the first off-label use of C/T in the management of MDR P. aeruginosa LVAD infection as a bridge to heart transplant. C/T has shown potent anti-pseudomonal activity and good safety profile making this drug as a good candidate for suppressive strategy in intravascular device-associated bloodstream infections caused by MDR P. aeruginosa.

At the moment, there is no score to evaluate clinical risk in heart transplantation. There is a need for such an instrument due to the extended criteria for donations and for recipient evaluation for transplantation. We divided the 203 consecutive patients who underwent heart transplantation (HTx). Between January 1999 and December 2007 into two groups: high and low risk based on several common well-defined variables. Donors were also divided into high- and low-risk groups. We matched the four groups to obtain risk cohorts: GA (high risk), GB and GC (intermediate risk) versus GD (low risk). We analyzed the 30 day-mortality showing a significant difference between GD and the other groups (P = .05) in contrast to no significant difference in 1- and 3-year survival rates among GA, GB, GC, and GD. Although the development of a specific score for heart transplantation is desirable and would be useful, a careful, case-by-case evaluation is indispensable., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Implanting Centers (IC) provide higher standard of care for LVAD patients compared to other facilities. The study aimed to analyze the impact of the distance between the LVAD patient residency and IC on outcomes. All patients discharged from 5 Italian Centers after LVAD implantation from 2010 to 2020 were divided into 2 groups by the distance from IC: A<100 Miles (n=175) and B>100 Miles (n=141). Patients were followed-up regularly by VAD Teams. Primary end-point was freedom from Adverse Events (AEs), a composite outcome including death and device-related complications. Secondary end-points included event rates for mortality and complications. Baseline clinical characteristics and indications for LVAD did not differ between the two groups (Table). Group A patients received more centrifugal flow pump (p=0.02). During a mean time of 23±18 months, Group B was more likely to receive Heart Transplantation compared to Group A (27% vs 14%, p=0.01). Freedom from AEs at 3 years was 51% and 43% for Group A and B, respectively (p=0.32), Fig A. Event-rates complications for patients on pump were similar between the two groups, as shown in Fig B. A distance >100 Miles from IC does not represent a risk factor for worse outcomes at mid-term follow-up. Different factors (strict follow-up protocols and/or telemedicine) could justify satisfactory results independently from patient residency. The higher rate of heart transplantation in group B could be related to different allocation policies among IC. [ABSTRACT FROM AUTHOR]

The Multicenter Italian study on RAdial Mechanically Assisted Circulatory Support (MIRAMACS) represent the first national observational registry, gathering continuous-flow (CF) left ventricular (LVAD) and biventricular assist device (BiVAD) implantation performed in adult patients by high-volume, mechanical circulatory support (MCS) dedicated, Italian centres. Seven participating hospitals contributed pre-, peri- and long-term postoperative data on LVAD implants to the registry. Data for all implants in adult patients (>18 years of age) performed between January 2000 to September 2020 were analysed. BiVADs were excluded in this preliminary analysis. This initial report focuses on patient demographics, survival, device types, adverse events and competing outcomes. A total of 515 patients received a CF LVAD. The mean age of LVAD recipients was 60±10 years. The majority of patients were male (89.3%). The adopted systems were: HeartWare HVAD (n=213), HeartMate III (n=140), HeartMate II (n=89), Jarvik 2000 (n=50), Berlin Heart Incor (n=19) and other brands (n=4). In 6.6% of patients the LVAD implantation was performed by usage of less invasive surgical approaches. Mortality at 30- and 90-days was 6.1% and 11.1%, respectively. A temporary right ventricular assist device (RVAD) support was necessary in 3.1% of patients. Mean follow-up time was 57±15 months. Heart transplantation was performed in 99 patients (19.2%). Survival at 1-year, 3-years, and 5-years of BTT cohort was 82.1%, 60.4% and 41.8%, respectively. Survival at 1-year, 3-years, and 5-years of DT cohort was 69.8%, 45.6% and 30.1%, respectively. Major bleeding, major infection, neurological events and device malfunction were reported in 40 (7.7%), 143 (27.7%), 97 (18.8%) and 36 (6.9%) patients, respectively. This first MIRAMACS report reveals frequencies and results comparable with other registries. Overall success rate of CF LVAD patients seems to be satisfactory. Detailed prospective data collection, additional participating centres and further analyses may provide additional robust scientific contributions. [ABSTRACT FROM AUTHOR]

The Multicenter Italian study on Radial Mechanically Assisted Circulatory Support (MIRAMACS) represents the first national observational registry, gathering continuous-flow (CF) left ventricular (LVAD) and biventricular assist device (BiVAD) implantation performed in adult patients. Eight participating Italian hospitals contributed pre-, peri- and long-term postoperative data on LVAD implants to the registry. Data for all implants in adult patients (>18 years of age) performed between January 2000 to December 2020 were analysed. BiVADs were excluded in this preliminary analysis. This initial report focuses on patient demographics, survival, device types, adverse events and competing outcomes. A total of 515 patients received a CF LVAD. The mean age of LVAD recipients was 60.2 +/- 10.5 years. The majority of patients were male (89.3%). The adopted systems were: HeartWare HVAD (n=213), HeartMate III (n=140), HeartMate II (n=89), Jarvik 2000 (n=50), Berlin Heart Incor (n=19) and other brands (n=4). In 6.6% of patients the LVAD implantation was performed by usage of less invasive surgical approaches. Mortality at 30- and 90-days was 6.1% and 11.1%, respectively. A temporary right ventricular assist device (RVAD) support was necessary in 5.1% of patients. Mean follow-up time was 54.2 +/- 17.1 months. Heart transplantation was performed in 99 patients (19.2%). Survival at 1-year, 3-years, and 5-years of bridge to transplantation (BTT) cohort was 82.1%, 60.4% and 41.8%, respectively. Survival at 1-year, 3-years, and 5-years of destination therapy (DT) cohort was 69.8%, 45.6% and 30.1%, respectively. Major infection, neurological events, major bleeding and device malfunction were reported in 143 (27.7%), 97 (18.8%), 40 (7.7%) and 36 (6.9%) patients, respectively. Full Maglev technology showed competitive results. This first MIRAMACS report reveals frequencies and results comparable with other registries. Overall success rate of CF LVAD patients is satisfactory. Detailed prospective data collection, additional participating centres and further analyses may provide robust scientific contributions. [ABSTRACT FROM AUTHOR]

Cardiac allograft vasculopathy (CAV) represents a relevant issue after Heart Transplantation (HTx), affecting mid and long-term outcomes. Coronary artery disease (CAD) of the donor graft has been implicated in the pathogenesis and progression of CAV. Although definitive data are still lacking, CAD of the donor graft represents an exclusion criteria in many transplant Units. We analyzed the outcomes of patients who underwent HTx from donor hearts affected by no-severe CAD. Patients who received a graft, evaluated with coronary angiogram before the retrieval, were divided into two groups according to the presence or not of no-severe CAD (with lesions ≤50%) of the donor graft (groups CAD and NCAD, respectively). The outcomes analyzed were survival and freedom from grade ≥2 CAV. The study period was between 1990 and 2018. Median follow up was 86 months (range 0.3-317). There were differences between CAD and NCAD groups according to the baseline characteristics, as reported in Table 1. Survival and Freedom from grade ≥2 CAV were similar between the two groups at mid term (p=0.47 and p=0.66, Figure 1). At adjusted multivariate analysis for both survival and freedom from grade ≥2 CAV, donor CAD was not considered a significant risk factor. Coronary angiogram plays a reliable role in identifying suitable organs, even those affected by CAD. In fact, no-severe donor CAD does not seem to affect survival and development of high grade CAV, more likely due to immunological factors. If confirmed by larger studies, these finding could encourage the employment of donor hearts affected by CAD. [ABSTRACT FROM AUTHOR]