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Background Women undergoing heart transplantation (HT) for peripartum cardiomyopathy (PPCM) have been reported to have inferior post-transplant survival. Specific data on the impact of pre-transplant diagnosis on survival in female HT recipients of childbearing age are lacking, but important for pre-conception counseling of women considering a pregnancy. Methods Retrospective data analysis was conducted using the ISHLT Registry. The primary aim was to study the impact of pre-transplant diagnosis and alloimmunisation on post-transplant survival in women aged 15–45 yrs at time of HT. Secondary outcomes included the impact of primary diagnosis on conditional survival at 5, 10 and 15-yrs post HT. Results Of 121,501 HT recipients (Jan 1992–June 2018), 30,179 (24.8%) were women. 9,229 (7.6%) were 15–45 yrs at time of HT. Peripartum cardiomyopathy (PPCM) and congenital heart diseases (CHD) was the primary diagnosis in 8.9% and 9.3%, respectively. Overall median post-transplant survival was 15.2 yrs. Female with PPCM were associated with higher alloimmunisation (Figure 1). PPCM was associated with lower survival (median survival in PPCM vs CHD vs other: 9.1 years vs 15.2 years vs 15.5 years respectively, p Conclusion PPCM as the primary indication for HT is associated with a worse post HT survival. Our data suggest that this is not entirely explained by alloimmunisation. The impact of previous PPCM appears to be greatest in the first 5 yrs post HT. Further research is needed to fully elucidate the mechanisms associated with worse survival in this group and help inform pre-conception counseling in those HT recipients considering a subsequent pregnancy. Funding Acknowledgement Type of funding sources: None.

Purpose The INTERHEART study previously used microarray assessment of 889 heart transplant biopsies to develop the Molecular Microscope Diagnostic System (MMDx) based on expression of rejection-associated transcripts (RATs). The present study reclassified the rejection-related states in an expanded set of 1320 prospectively collected biopsies from 645 patients from 13 centers. Methods Biopsies were classified by ensembles of classifiers and analyzed for left ventricular ejection fraction (LVEF) and survival. Results New algorithms identified 853 No rejection (NR), 179 ABMR, 76 TCMR, 13 Mixed, 161 possible ABMR (pABMR), and 38 possible TCMR (pTCMR). No rejection was subclassified as NR-Normal 462, NR-Minor 359, and NR-Early-injury 32 (Figure 1A). Compared to NR-Normal, NR-Minor biopsies had mild elevation of many inflammation transcripts (e.g. IFNG-inducible genes) and to a lesser extent parenchymal injury transcripts. NR-minor biopsies were often designated as TCMR1R by histology. In all NR biopsies, NR-Minor scores and histologic TCMR1R increased through the first year, peaking about one year, suggesting that Minor inflammation is a late response to injury, unrelated to rejection. LVEF was similar in NR-Normal and NR-Minor but depressed in TCMR and Early injury. In a 3-year post-biopsy survival analysis, NR-Minor and NR-Normal had similar survival. TCMR and Early-injury were associated with increased graft loss, but many losses were not related to rejection. Surprisingly, 76 hearts with ABMR (149 biopsies) and follow-up data had only 3 losses within 3 years post-biopsy (Figure 1B). Conclusion Many biopsies with molecular no rejection develop minor increases in rejection-related transcripts in the first year, often called TCMR1R by histology, with no apparent effects on function or survival. An unexpected finding was that molecular ABMR was associated with very few graft losses over three years. (ClinicalTrials.gov #NCT02670408).

Implementation of high-fidelity 2-qubit operations is a key ingredient for scalable quantum error correction. In superconducting qubit architectures, tunable buses have been explored as a means to higher-fidelity gates. However, these buses introduce new pathways for leakage. Here we present a modified tunable bus architecture appropriate for fixed-frequency qubits in which the adiabaticity restrictions on gate speed are reduced. We characterize this coupler on a range of 2-qubit devices, achieving a maximum gate fidelity of 99.85%. We further show the calibration is stable over one day.

Purpose The complex anatomy and different contraction patterns of the different right ventricular (RV) wall segments has made it challenging to predict acute RV failure (ARVF) in patients receiving a left ventricular assist device (LVAD). We sought to improve the prediction of ARVF after LVAD by performing a comprehensive 18-segment strain (e) analysis of the RV. Methods Prospectively enrolled LVAD recipients had a right heart catheterization and echocardiogram prior to implant. From RV-focused views (Figure 1A), 18-segment e was performed and indexed to pulmonary arterial elastance (Ea [PV]). ARVF was defined as need for RVAD, inotropes for >14 days or pulmonary vasodilator for >48 hours post-LVAD. Logistic regression was used to identify associations between specific parameters and ARVF. Results ARVF occurred in 15 of 30 patients enrolled. Lower pulmonary artery pulsatility index (PAPi), TAPSE and basal free wall (FW) (basal anterior, lateral and posterior FW) segmental e/Ea (PV) were significantly associated with ARVF. Indexed basal FW segmental strain provided incremental predictive value over PAPi and TAPSE (Figure 1B). Conclusion Prediction of ARVF in LVAD candidates can be improved by adding comprehensive RV segmental strain analysis to traditional echocardiographic and hemodynamics parameters.

Purpose Cardiopulmonary exercise testing provides an integrative assessment of multiorgan physiological response to exercise involving the pulmonary, cardiovascular, hematopoietic, neuropsychological, and skeletal muscle systems. The predictive value of peak ventilatory oxygen consumption (maxVo2) in optimizing the timing of heart transplantation (HT) is well established, but its prognostic value for HT outcomes is not known. We aimed to study the predictive role of pre-HT maxVo2 for 1-month and 1-year mortality after HT. Methods We performed an analysis of adult HT recipients in the ISHLT Registry transplanted between 1996 and 2017. Recipients were stratified into quartiles by pre-HT maxVo2. Using multivariable regression modelling we assessed the associations of maxVo2 with 1-month post-transplant mortality and 1-year post-transplant mortality conditional on survival to 1 month. Results Among 12,606 recipients, 26% were women. Median maxVo2 was lower in women (11.5 mL/kg/min [IQR 9,13]) vs men (12.0 mL/kg/min [IQR 10,14], p Conclusion Beyond its key application for prognosis in heart failure and determination of candidacy for HT, maxVo2 has a predictive value for post-HT survival. Patients in the highest maxVo2 quartile are at the lowest risk of 1-month mortality, suggesting perioperative advantage for patients with less functional limitation. More importantly, pre-transplant maxVo2 impairment across the 4 quartiles is associated with risk of mortality between 1-month and 1-year. Whether this risk can be modified by cardiac rehabilitation and physical therapy programs individualized by pre-transplant maxVo2 should be investigated.

Purpose To evaluate the validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) generic measures of social and physical function in patients with a left ventricular assist device (LVAD). Methods Adult heart failure (HF) patients at 12 U.S. sites in 2016-2020 enrolled in The Mechanical Circulatory Support: Measures of Adjustment and Quality Of Life Study (n=361). Post-LVAD implant, they completed PROMIS Ability to Participate in Social Roles and Activities, Satisfaction with Social Roles and Activities, and Physical Function; and Kansas City Cardiomyopathy Questionnaire (KCCQ-12) Social and Physical Limitation measures. PROMIS is standardized to a general population (mean=50; SD=10). KCCQ-12 range is 0-100. Higher scores represent better outcomes. Construct validity was evaluated by Pearson correlations between PROMIS and KCCQ-12 scores. Known-groups validity was evaluated by analysis of variance to distinguish PROMIS means across NYHA and self-reported financial difficulties. Results Mean age was 58 years; 80% were male, 70% were Non-Hispanic White, 79% had financial difficulties due to condition/treatment, and 61% were NYHA I-II. Similar numbers enrolled at 3, 6, 12-26, and > 26 months post-implant. Mean scores for PROMIS and KCCQ-12 measures decreased (worsened) as NYHA worsened (p Conclusion PROMIS measures of social and physical function were associated with well-accepted measures commonly assessed in HF and post-LVAD. Unlike condition-specific measures, PROMIS scores can be compared to the general population or other clinical conditions, thus providing a useful way to interpret social and physical function after LVAD implant.

Purpose Hepatitis C Virus is no longer a contraindication to heart transplant (HT) thanks to curative antiviral therapy. Despite the advent of anti-Hepatitis B Virus (HBV) agents, a cure is less likely. While routine antiviral prophylaxis for resolved/inactive HBV infection is not recommended, the risk of reactivation in immunosuppressed HT recipients is unknown. We studied whether new antivirals have resulted in a higher number of recipients with history of HBV infection and examined their outcomes. Methods We performed a retrospective analysis of adult HT recipients transplanted in 1996-2018 who had HBV data reported in the ISHLT Registry. Chronic HBV (c-HBV) infection at HT was defined by a positive HBV surface antigen (HBsAg), resolved/inactive infection (r-HBV) by negative HBsAg and positive HBV core antibody, and HBV negative patients by negative serology. We examined 5-year freedom from chronic liver disease (CLD) and survival. Results Among 40,774 recipients, there were 580 with c-HBV and 1,509 with r-HBV. The proportion of patients with history of HBV has doubled from ∼3% to ∼6% (p Conclusion Approximately 6% of recent HT recipients have history of HBV infection and these patients have a higher risk of developing CLD after transplant. While survival in these patients is favorable, we identified a small excess in mortality in r-HBV patients. Whether the adverse events seen are a result of the sequelae of HBV infection or are due to HBV reactivation that could be mitigated by antiviral prophylaxis should be further studied.

Purpose Limited data integrating waitlist and post-heart transplant (HT) mortality have evaluated outcomes of LVAD-bridged strategy vs no LVAD based on patient characteristics. We aimed to evaluate waitlist and post-HT mortality in bridged in comparison to non-bridged patients based on body mass index (BMI). Methods We included adults listed for HT in UNOS and patients receiving durable LVAD as bridge to HT or candidacy in STS/INTERMACS databases (2010-2019). Using patient identifiers, we linked both databases. We categorized patients as underweight (BMI Endpoints We included 12,761 LVAD-bridged and 17,518 non-bridged candidates. Bridged vs non-bridged patients were more frequently obese (37.2 vs 28.7%) or underweight (3.6 vs 2.6%) (p LVAD-bridged patients had higher waitlist mortality and lower HT probability in comparison to non-bridged in overweight and obese patients. We will next integrate these results with post-HT survival in the linked STS-INTERMACS/UNOS cohort to provide further insights into the strategy most likely to lead to survival benefit based on BMI and determine whether the current guideline recommendation of using LVAD as a bridge to weight loss should be re-examined.

Purpose Machine learning (ML) techniques can improve predictive modeling over more traditional methods by identifying higher dimensionality and non-linear relationships between variables. We hypothesized that an AutoML algorithm would be superior to a logistic regression (LR) model for prediction of outcomes in HT. Methods The UNOS database was queried for patients receiving single-organ heart transplantation between 2006-2016. Pre-transplant variables for the donor and recipient were used for the prediction of one-year mortality or re-transplant. Auto machine-learning (AutoML) with stacking of Gradient Boosting Machine (GBM) derived algorithms was used to create a ML predictive meta-model. These results were compared to a traditional LR model using receiving operating characteristic (ROC) values. Results During this time period 18,612 patients with HT were identified. Observed one-year mortality or re-transplant was 11.5%. The AutoML derived model performed modestly (ROC=0.66, Figure 1) but showed improvement in outcome prediction over the LR model (ROC=0.62, Figure 2). Strongest predictive variables in the LR model were recipient bilirubin, creatinine, mechanical ventilation, donor age and ischemic time. The meta-model structure of AutoML precludes direct assessment of individual variable weight. Conclusion Using contemporary input from the UNOS database, AutoML meta-modeling outperformed LR for prediction of one-year outcomes in HT. Automation of predictive modeling using ML in HT is powerful, albeit limited by the “black box” effect on individual variables. AutoML in HT warrants further investigation.

Purpose Obesity is a risk factor for morbidity and mortality after heart transplant (HT). While rapid and substantial total body weight (TBW) gain is often seen after HT, little is known about the effect of the rate of weight gain on outcomes. We aimed to assess the pattern of post-HT change in TBW, its phenotype [fat mass (FM) vs fat free mass (FFM)], and its impact on outcomes. Methods Post-HT changes in TBW, FM and FFM were examined in 15,182 adult recipients of the ISHLT Transplant Registry transplanted between 1996 and 2016 who survived to 1 year and for whom serial body weight data was recorded. FFM was calculated: FFM=5.1×(height [m]1.14)×(weight [kg]0.41) for men and 5.34×(height [m]1.47)×(weight [kg]0.33) for women, based on height-weight models derived from bioelectrical impedance studies. FM was calculated as TBW minus FFM. Endpoints included cardiac allograft vasculopathy (CAV), treated rejection (TR) and all-cause mortality. Results Rate of TBW gain was highest during year 1 following HT, such that the proportion of obese patients increased from 23% at HT to 32% at one year after HT (p Conclusion A substantial increase in weight is seen in the first year after transplant. The rate of weight gain following HT is independently associated with an increased risk for CAV and TR. Mitigation of the increase of the FM portion of weight gain could reduce post-transplant morbidity.

Purpose There is limited information on regional variation in rates of cardiac recovery and left ventricular assist device (LVAD) explantation at a global level. We aimed to compare the rates of cardiac recovery and LVAD explantation across several world regions. Methods LVAD recipients registered in the International Registry for Mechanically Assisted Circulatory Support (IMACS) were analyzed. Cardiac recovery was defined as follow-up LVEF >40% and a pre-LVAD LVEF Results A total of 16,029 patients met our inclusion criteria and were included in the analysis. Of these, 9,381 patients had at least one follow-up echocardiogram and a minimum of 3 months of LVAD support. Cardiac recovery was achieved in 13.3% (n=1,249) of patients, with a rate of 55.3% (n=21) in BTR compared with 13.1% (n=1,228) in non-BTR patients. Rates of cardiac recovery varied significantly by region: 12.7% (n=1,079) in the Americas, 15.9% (n=94) in Asia-Pacific and 29.5% (n=76) in Europe (p Conclusion Global rates of both cardiac recovery and LVAD explantation are higher in patients implanted with a priori BTR strategy. Rates of cardiac recovery appear to be higher in Europe for reasons that warrant further investigation. The global rates of LVAD explantation are much lower compared to the corresponding cardiac recovery rates. This observation invites future investigations to identify the challenges in regards to LVAD weaning when recovery is identified, which could result in higher rates of LVAD explantation.

Purpose To compare the relative importance of several clinical, donor, and recipient factors on the risk for mortality following lung retransplantation (LRTx). Methods First-time adult recipients of deceased-donor LRTx between 5/2005 and 6/2017 reported to the ISHLT Registry were included in our analysis. Important risk factors for 1-yr mortality following LRTx were examined using the Somers' rank correlation statistic (Dxy) for censored data and included: inter-transplant interval, initial and retransplant procedure, indication of obliterans bronchiolitis, recipient retransplant factors (age, gender, diabetes, ECMO use, mechanical ventilation use, FVC, and FEV1), CMV serostatus match, and donor variables (cause of death, age, human leukocyte antigen (HLA) mismatch level, and ischemic time). Results 1597 LRTx recipients were included; since 2007, 138-188 retransplants (4-6% of all transplants) were reported annually to the Registry. The median inter-transplant interval was 1243 days (IQR: 573 to 2256). Most LRTx recipients had IPF (88%), 32% were retransplanted within 2 yrs, and 64% received bilateral transplant both times, whereas 36% received consecutive single transplants. The 3-mo, 6-mo, and 1-yr survival rates were 86%, 82%, and 76% for bilateral-bilateral recipients, and 82%, 76%, and 69% for single-single recipients (p=0.001). The 3 strongest risk factors for 1-yr mortality, as indicated by the 3 highest Somers' rank (and highest C-index) correlation statistics (i.e., Dxy absolute values in the figure) were the inter-transplant interval (decreasing hazard with longer intervals), donor age, and need for mechanical ventilation at LRTx. Conclusion The strongest predictor of 1-yr mortality is the duration of time since the initial transplant, with a persistent reduction in risk as more time elapses between the initial transplant and LRTx.

Purpose LVAD therapy has been primarily studied in patients with elevated pulmonary capillary wedge pressure (PCW) and low cardiac index (CI), “cold and wet”. In daily practice, LVADs are often also offered to patients with low PCW and low CI, “cold and dry”. The efficacy of LVAD therapy in this population is not well studied. Methods Patients implanted with LVAD with a baseline CI 18mmHg) or “dry” (PCW Results Serial invasive hemodynamics data was available for 92 pts (cold-dry group, n=34 and cold-wet group, n=58) (Table). Diuretic and vasodilator use pre-LVAD was comparable in both groups. Cold-dry patients had no change in CVP or PCW with a smaller increase in CI after LVAD. Adjusted 3-year mortality was higher for cold-dry patients (Figure). Age (HR=1.09, 95%CI 1.02-1.2; p=006) and cold-dry profile (HR=5.4, 95%CI 1.4-21; p=0.016) were identified as independent predictors of mortality. Conclusion “Cold and dry” patients with advanced heart failure may not derive equal benefit from LVAD therapy as those who are “cold and wet”. This observation warrants further investigation.

Purpose Predicting cardiac structural and functional improvement in advanced heart failure (HF) patients before durable left ventricular assist device (LVAD) implantation remains challenging. Identifying clinical predictors could improve patient selection and impact clinical management. Methods Advanced chronic HF patients (N=652) supported with continuous-flow LVADs were evaluated. After excluding patients with acute HF etiologies or without adequate post-LVAD follow up ( Results In total, 10% of the LVAD patients were R. Univariate analysis showed that R were younger, had shorter HF symptoms duration, less need for diuretics and their LV were less dilated pre-LVAD. Further, R had higher acuity disease as evidenced by the higher vasoactive agents need, higher BNP and higher incidence of abnormal liver enzymes. The multivariate Cox regression (AUC=0.74; p Conclusion Younger patients with less LV dilation and shorter duration of HF are more likely to improve their cardiac function during LVAD support. Whether these characteristics also predict sustainability of improved cardiac function after LVAD weaning warrants further investigation.

Purpose Donor thyroid hormonal (TH) resuscitation therapy is a widely used practice. Recently, concerns have been raised suggesting a possible “withdrawal effect” and early graft failure risk after heart transplant in recipients not receiving TH supplementation. Whether this could counteract the possible favorable effects of TH donor therapy is not known. Methods We performed a retrospective analysis of adult HT recipients in the ISHLT Transplant Registry transplanted between 2006 and 2015 for whom data regarding use of donor TH supplementation were provided. Early graft failure (EGF) was defined as death or retransplant due to graft failure within 48 hours of transplant. A logistic regression analysis and a propensity score analysis were performed. Results There were 15,821 recipients whose donors had received TH, and 7,181 who had not. Multivariable analysis showed donor TH therapy to be associated with an increased risk for early graft failure (OR 1.51, 95% CI 1.13-2.06, p Conclusion Donor thyroid hormone therapy is independently associated with an increased risk of early graft failure. Whether this is a result of the donor allograft intrinsic characteristics related to the reasons TH was given, or whether this may be a result of a TH withdrawal effect, which could be mitigated by administration of TH to the recipient, should be further studied.

Background: Currently, women represent Methods and Results: Using the International Society for Heart and Lung Transplantation Registry, we performed descriptive analyses and estimated overall freedom from posttransplant death stratified by sex using Kaplan-Meier survival methods. Male and female recipients were matched according to the Index for Mortality Prediction After Cardiac Transplantation and Donor Risk Index score using 1:1 propensity score matching. The study cohort comprised 34 198 heart transplant recipients (76.3% men, 23.7% women) between 2004 and 2014. Compared with men, women were more likely younger (51 [39–59] versus 55 [46–61] years; P P P P P =0.002), tobacco use (36.5% versus 52.3%; P P P P P =0.03) or durable ventricular assist device (22% versus 31.5%; P P P =0.57). Conclusions: Overall survival does not differ between men and women after cardiac transplantation. Women who survive to heart transplantation appear to have lower risk features than male recipients but receive hearts from higher risk donors.

Background Occasionally new onset cardiomyopathy patients (pts) present late and with such advanced disease stage that they cannot tolerate heart failure (HF) drug therapy. We sought to investigate the cardiac recovery (CR) potential following a combination of left ventricular assist device (LVAD) and guideline-directed HF drug therapy in this medication-naive population. Methods Chronic advanced HF requiring durable continuous-flow LVAD were prospectively evaluated. Patients with acute HF (myocarditis etc.) or post LVAD follow up Results Univariate analysis showed that “med-naive” patients were younger, more likely to be on intravenous vasoactive agents, temporary mechanical support and with lower INTERMACS profile before LVAD implantation. Interestingly, no differences were seen in HF symptoms duration or other comorbidities. Baseline and follow up hemodynamics were similar in both groups, besides higher right atrial pressure pre-LVAD in the “meds-naive” group (16 vs 11 mmHg; p=0.04). Baseline echocardiographic (including LV dilation) and biochemical parameters revealed no differences between the groups, besides lower LVEF and higher BNP in the “meds-naive” group (14 vs 19%; p=0.03 and 2352 vs 1270; p=0.03, respectively). CR rates were significantly higher on “meds-naive” versus “meds-failed” group (50.0 vs 13.8%; p=0.005). Despite higher cardiac recovery rates in the “meds-naive” group the time course and magnitude of the favorable functional and structural response was similar among the CR responders of each of the 2 groups. Conclusion Young patients with new onset dilated cardiomyopathy sometimes present late, with advanced disease stage, unable to tolerate HF medications and requiring durable LVAD support. This patient population appears to have a potential for CR up to 50% and this could be factored in decisions surrounding their long-term therapeutic options.

Background Predicting cardiac recovery (CR) in advanced heart failure (HF) patients before left ventricular assist device (LVAD) implantation remains challenging. This study sought to investigate whether CR after LVAD unloading can be predicted by cardiac functional and structural parameters together with clinical characteristics. Methods From 2008 to 2016, consecutive advanced chronic HF patients (N=347) supported with durable continuous-flow LVADs were prospectively evaluated. Patients with acute HF etiologies or without adequate post-LVAD follow up ( Results CR occurred in 13.7% of patients. Univariate analysis showed that responders were more likely to be young, female, non-ischemic cardiomyopathy, with shorter HF symptoms duration and no prior cardiac surgery. They had lower blood urea nitrogen and were more likely to be on temporary mechanical support before LVAD. The multivariable UCAR model (AUC=0.755; p Conclusion Univariate and multivariable predictors of CR include both modifiable and non-modifiable patient characteristics that are known prior to LVAD implantation. The UCAR score can serve as a practical tool for targeted patient selection to implement protocols that facilitate CR in the advanced HF patient subpopulation that is most likely to respond.

Purpose To compare 5-year survival of lung transplant (LTx) recipients in donation after circulatory death (DCD) versus donation after brain-death (DBD) donors. Methods We examined the ISHLT Thoracic Transplant Registry data for LTx patients transplanted between 2003 and 06/2017 at 23 centers in North America, Europe and Australia participating in the DCD Registry. Distribution of continuous variables was summarized as median and interquartile (IQR) values. Mann-Whitney test was used to compare distribution of continuous variables and chi-square or Fisher's exact test for categorical variables. Kaplan-Meier survival rates after LTx during 2003-06/2016 were compared between DCD-III [Maastricht category III withdrawal of life sustaining therapy (WLST)] only and DBD using the log-rank test. Risk factors for 5-year mortality were investigated using Cox multivariate proportional-hazards model. Results The study cohort included 11,516 lung transplants, of which 1,090 (9.5%) were DCD transplants. DCD-III category comprised 94.1% of the DCD cohort. Among the participating centers, the proportion of DCD-LTx increased from 0.6% in 2003 to 15.2% in 2017. DCD donor management included extubation in 91%, intravenous heparin in 51% and pre-transplant normothermic ex-situ pulmonary allograft perfusion in 15%. Median time interval from WLST to cardiac arrest was 15 min [IQR: 11-22 min] and to cold flush 32 min [IQR: 26-41 min]. Compared to DBD, donor age was higher (47 [IQR: 34-55] vs 40 [IQR: 24-52] years), bilateral LTx was performed more often (88.3% vs 76.6%), more recipients had COPD/emphysema as transplant indication, and recipient hospital stay was longer (25 [IQR: 17-39] versus 18 [IQR: 12-29] days) in DCD-III (all p Conclusion This ISHLT DCD Registry report with 5-year follow-up demonstrated similar excellent long-term survival in DCD-III and DBD lung donor recipients in 23 experienced centers. These data support measures to implement and increase DCD LTx more widely.

Purpose The RESTAGE-HF multicenter study demonstrated high rates of myocardial recovery after combining LVAD support with HF pharmacological therapy and regular cardiac function monitoring protocol. We sought to investigate whether the time course of LVAD-mediated reverse remodeling impacts the post-explantation long-term sustainability of myocardial recovery. Methods We studied 36 HeartMate II LVAD patients with advanced non-ischemic dilated cardiomyopathy who completed the study protocol. LVAD explantations occurred when patients met the reverse remodeling criteria with the LVADs turned-down to minimum speed: LVEF >45%, left ventricular end diastolic diameter (LVEDD) 2.4 L/min/m2. We investigated whether meeting these criteria 12 months post-LVAD support impacted long-term sustainability of the myocardial structural and functional response or long-term survival free of Transplant (Tx) or LVAD. Results Nineteen patients (53%) met criteria and underwent LVAD explantation. Patients explanted at 12 months post-LVAD were 2 (10.5%), 9 (47.4%) and 8 (42.1%), respectively. There were no significant differences (p=0.80) in the survival free of Tx or LVAD at 1, 3, and 5 years post-LVAD removal between patients explanted at Conclusion In RESTAGE-HF multicenter study the time course of reverse remodeling during LVAD support did not appear to impact the long-term sustainability of the post-explantation favorable clinical response either in terms of long-term survival free of HF recurrence or stability of the improved cardiac structure and function.

Purpose Patients awaiting heart transplant (HTx) with temporary mechanical circulatory support (tMCS) are at high risk of waitlist mortality and are accorded higher priority under the 2018 US adult heart allocation system. To examine the effect of policy changes on racial equity, we examined outcomes based on race in these high risk patients. Methods UNOS registry was queried for adults listed for heart transplant (HTx) 1-year before and after the October 18, 2018 policy change. We examined association of race with use of tMCS (IABP+ ECMO+ percutaneous LVAD+ surgical temporary LVAD), access to transplant organs within 1-year of listing in the pre- and post-era, and 1-year post-transplant mortality. Results Of 8,015 patients listed for HTx, 62.7 % were White and 37.3% Non-White. In the pre-policy era, 290 of 4,027 (7.2%) were listed with tMCS vs 649 of 3,988 (16.3%) in the post era (p Conclusion In the current allocation policy era, the proportion of non-White patients listed for HTx with tMCS appears to be lower compared to Non-White patients, the reasons for which need to be further elucidated. However, in patients who receive tMCS bridge, waitlist mortality, transplant rate, and 1-year post-transplant survival are similar, regardless of race.

Purpose Predicted heart mass (PHM) was neither derived nor validated in an obese population. Our objectives were to determine survival according to size mismatch defined by actual PHM and recalculated PHM using ideal body weight (IBW) in obese recipients or recipients of obese donors, and to evaluate whether size mismatch using IBW-adjusted PHM improves risk assessment. Methods We included HT recipients (≥18 y) with BMI ≥30 kg/m2 or recipients of donors with BMI ≥30 kg/m2 from the ISHLT registry between 2008-2017. IBW was calculated using Devine's formula. Donor-recipient PHM was evaluated as a continuous variable and according to established groups: 30%. We used Kaplan-Meier survival and multivariable Cox PH analyses to evaluate post-HT mortality by actual/IBW-adjusted PHM groups. We compared the 2 models using net reclassification index (NRI). Results We included 10,817 HT recipients, age 55 (IQR 46-62) yrs, 23% female, BMI 31 kg/m2 (28-33) with follow up of 3.1 (1.2-6.0) yrs. Included donors were 34 (24-44) yrs, 31% female, and BMI 31 kg/m2 (26-34). 692 (6%) and 335 (3%) recipient-donor pairs were reclassified as undersized by 20-30% and >30% respectively using IBW-adjusted PHM. 462 (4%) and 431 (4%) recipient-donor pairs were reclassified as oversized by 20-30% and >30% respectively when using IBW-adjusted PHM. Actual PHM was associated with lower 1-year survival (p Conclusion Calculation of PHM using IBW was not associated with post-HT survival. Actual PHM can be used for size matching when assessing mortality risk in recipients of obese donors or obese recipients.