JHLT Open

Pub Date : 2026-08-01 Epub Date: 2026-07-03 DOI: 10.1016/j.jhlto.2026.100624

Daisuke Yakabe, Kazuo Sakamoto, Komei Mizokami, Tsukasa Watanabe, Hirotake Yokoyama, Sayana Kuraoka, Kayo Misumi, Tomomi Nagayama, Keisuke Shinohara, Takeo Fujino, Toru Hashimoto, Shouji Matsushima, Akira Shiose, Kohtaro Abe

Background

The clinical impact of atrial fibrillation (AF) in patients undergoing left ventricular assist device (LVAD) implantation remains uncertain, particularly regarding whether the post-LVAD rhythm status carries prognostic value.

Methods

We retrospectively reviewed consecutive LVAD recipients at our institution between 2008 and 2023. Patients were categorized as no AF, new-onset AF, resolved AF, or recurrent AF according to rhythm status before and after implantation. The primary endpoint was hospitalization for heart failure, and the secondary endpoints were all-cause death, stroke, and major bleeding. Left atrial (LA) reverse remodeling was quantified as the percent reduction in LA diameter.

Results

Among 115 patients (mean age 46 years; 69.6% male; 14.8% ischemic etiology), 44 (38.3%) had AF before implantation. Over a median follow-up of 50.8 months, 29 of 44 patients (65.9%) had no AF recurrence by 3 months after implantation (resolved AF group), whereas 15 had AF (recurrent AF group); among the 71 patients without pre-LVAD AF, three developed new-onset AF. Compared with the recurrent AF group, the resolved AF group had a significantly lower risk of heart failure hospitalization (hazard ratio, 0.25; 95% confidence interval, 0.07–0.86; P = 0.027). LA diameter decreased to a greater extent in the resolved AF group than in the recurrent AF group (LA reduction rate: 24.5% vs. 10.8%; P = 0.032).

Conclusions

LVAD implantation was associated with LA reduction through reverse remodeling and led to AF resolution in a subset of patients. Patients with AF resolution experienced fewer heart failure events during LVAD support.

背景：接受左心室辅助装置（LVAD）植入的患者心房颤动（AF）的临床影响仍然不确定，特别是关于LVAD后心律状态是否具有预后价值。方法：我们回顾性分析了2008年至2023年间我院连续LVAD受者。根据植入前后的心律状态将患者分为无房颤、新发房颤、缓解房颤和复发房颤。主要终点是因心力衰竭住院，次要终点是全因死亡、中风和大出血。左房（LA）反向重构量化为左房直径缩小百分比。结果：115例患者（平均年龄46岁，男性69.6%，缺血性病因14.8%），植入前房颤44例（38.3%）。在50.8个月的中位随访中，44例患者中有29例（65.9%）在植入后3个月无房颤复发（AF消退组），而15例发生房颤（AF复发组）；在71例未发生lvad前房颤的患者中，有3例发生了新发房颤。与复发房颤组相比，房颤消退组发生心力衰竭住院的风险明显降低（风险比为0.25；95%可信区间为0.07-0.86;P = 0.027）。与复发性房颤组相比，消退性房颤组的LA直径减小幅度更大（LA减小率：24.5% vs 10.8%; P = 0.032）。结论：LVAD植入通过反向重塑与LA降低相关，并导致部分患者房颤消退。房颤消退的患者在LVAD支持期间发生的心力衰竭事件较少。

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引用次数: 0

Outcomes of lung transplantation using TorEx ex-vivo lung perfusion TorEx体外肺灌注肺移植的疗效。

JHLT Open

Pub Date : 2026-08-01 Epub Date: 2026-06-26 DOI: 10.1016/j.jhlto.2026.100615

Haruchika Yamamoto MD PhD, Aadil Ali PhD, Gabriel Siebiger MD, Elliot Wakeam MD, MPH, Laura Donahoe MD, Jonathan C. Yeung MD PhD, Andrew Pierre MD, Marc de Perrot MD, Kazuhiro Yasufuku MD, PhD, Thomas K. Waddell MD, Shaf Keshavjee MD MSc, Marcelo Cypel MSc, FACS, FRCSC

Purpose

Ex-vivo lung perfusion (EVLP) has expanded donor lung utilization, with over 1000 cases performed at our center since 2008. A next-generation Toronto EVLP system (TorEx EVLP) was introduced in December 2022, enabling simplified circuit setup by loading an organ chamber into an all‑in‑one device, potentially facilitating EVLP use at less experienced centers. This study reports the initial experience with TorEx EVLP and compares outcomes with (1) first‑generation EVLP and (2) conventional lung transplantation without EVLP.

Methods

In this single-center retrospective cohort study, 1067 EVLP procedures were performed from September 2008 to September 2024 (first-generation EVLP [G1], n=874; TorEx EVLP [G2], n=193). Post-transplant short- and long-term outcomes were compared among G1, G2, and contemporaneous direct transplants without EVLP (direct, n=1575).

Results

Of 1067 EVLP cases, 684 were accepted for transplant (utilization: G1 64.4%, G2 62.7%), and 700 transplants were performed (including 16 split singles). G1 and G2 had significantly higher DCD donor use (direct vs G1 vs G2: 17% vs 48% vs 60%, p<0.001) and lower donor P/F ratios (422 vs 368 vs 368 mmHg, p<0.001). Recipients in G1 and G2 were older than direct recipients (59 vs 61 vs 65 years, p<0.05). Post‑transplant outcomes were similar across groups, including PGD3 at 72 h (15% vs 16% vs 10%, p=0.21), extubation within 72 h (65% vs 64% vs 68%, p=0.67), overall survival, and CLAD‑free survival.

Conclusions

Despite higher-risk donor use, outcomes with both first- and next-generation Toronto EVLP systems were comparable to direct transplantation.

目的：体外肺灌注（EVLP）扩大了供肺的利用，自2008年以来，我中心已完成了1000多例供肺手术。下一代多伦多EVLP系统（TorEx EVLP）于2022年12月推出，通过将器官室加载到一体化设备中，简化了电路设置，可能有助于在经验不足的中心使用EVLP。本研究报告了TorEx EVLP的初步经验，并比较了(1)第一代EVLP和(2)无EVLP的常规肺移植的结果。方法：在这项单中心回顾性队列研究中，2008年9月至2024年9月，共进行了1067例EVLP手术（第一代EVLP [G1]， n=874; TorEx EVLP [G2], n=193）。比较G1、G2和同期无EVLP直接移植的移植后短期和长期结果（直接，n=1575）。结果：1067例EVLP中，接受移植684例（利用率：G1 64.4%, G2 62.7%），移植700例（包括16例分裂单侧）。G1和G2的DCD供体使用明显更高（直接相比G1和G2: 17% vs 48% vs 60%）。结论：尽管供体使用风险更高，但第一代和下一代多伦多EVLP系统的结果与直接移植相当。

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引用次数: 0

Cardiogenic shock in pregnancy: Prolonged axillary Impella 5.5 support during pregnancy and postpartum as bridge to heart transplantation 妊娠期心源性休克：妊娠期和产后延长腋窝Impella 5.5支持作为心脏移植的桥梁。

JHLT Open

Pub Date : 2026-08-01 Epub Date: 2026-06-30 DOI: 10.1016/j.jhlto.2026.100620

Shahar Laks MD, Rebecca Pierce-Williams DO, Ngina Connors MD, Kelecia Brown MD, Jennifer Philips MD, Diane Holmes FNP-BC, Catarina Canha MD, Nicole Cyrille-Superville MD, Esther Kim MD, Monique Oye DO

Background

Cardiogenic shock during pregnancy carries substantial maternal and fetal morbidity and mortality, and guidance on temporary mechanical circulatory support (tMCS) in this setting remains limited.

Case summary

A 36-year-old woman at 21 weeks' gestation presented with severe dilated cardiomyopathy (ejection fraction 20%, LVIDd 8.0 cm), cardiogenic shock (cardiac index 1.7 L/min/m²), and recurrent ventricular arrhythmias. She declined termination of pregnancy. An axillary Impella 5.5 was placed for hemodynamic stabilization with rapid improvement in cardiac output and filling pressures. Progressive ventricular arrhythmias at 23 weeks and 3 days necessitated urgent cesarean delivery; the neonate did not survive. The patient was supported with the Impella 5.5 for 66 days and underwent successful orthotopic heart transplantation.

Discussion

To our knowledge, this is one of the longest reported durations of Impella 5.5 support initiated during pregnancy and continued into the postpartum period. This case highlights important considerations that may inform individualized multidisciplinary decision-making on temporary mechanical circulatory support selection in pregnancy-associated cardiogenic shock.

背景：妊娠期心源性休克具有较高的母婴发病率和死亡率，在这种情况下关于临时机械循环支持（tMCS）的指导仍然有限。病例总结：一名36岁女性，妊娠21周，表现为严重扩张型心肌病（射血分数20%，LVIDd 8.0 cm），心源性休克（心指数1.7 L/min/m²），反复室性心律失常。她拒绝终止妊娠。放置腋窝Impella 5.5用于血流动力学稳定，心输出量和充盈压力迅速改善。进行性室性心律失常在23周零3天需要紧急剖宫产；新生儿没能活下来。患者使用Impella 5.5支撑66天，成功完成原位心脏移植。讨论：据我们所知，这是在怀孕期间开始并持续到产后持续时间最长的Impella 5.5支持之一。本病例强调了妊娠相关心源性休克中临时机械循环支持选择的个性化多学科决策的重要考虑因素。

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引用次数: 0

Eliminating circulating donor passenger leukocytes during clinical ex vivo lung perfusion does not attenuate inflammation 在临床离体肺灌注过程中消除循环供体乘客白细胞并不能减轻炎症。

JHLT Open

Pub Date : 2026-08-01 Epub Date: 2026-07-06 DOI: 10.1016/j.jhlto.2026.100619

M.A. Hu MD, Z.L. Zhang MD, R.F. Hoffmann PhD, C.T. Gan MD PhD, E.A.M. Verschuuren MD PhD, C. Van De Wauwer MD PhD, H.G.D. Leuvenink PhD, M.E. Erasmus MD PhD

Purpose

During Ex Vivo Lung Perfusion (EVLP), it is standard practice to incorporate a leukocyte filter to remove donor passenger leukocytes and attenuate their inflammatory effects. The widely used leukocyte filter, LeukoGuard 6, seems to be ineffective in reducing circulating leukocytes during EVLP. Therefore, we performed contemporary leukocyte filtration using BioR 02 plus leukocyte filters to reduce these leukocytes and investigate whether inflammation could be reduced.

Methods

EVLP was performed for a minimum of 180 min with 15 bilateral donor lungs. Perfusate samples were taken from the in- and outlet of the leukocyte filter, which was subsequently clamped after 60 min. Contemporary parallel leukocyte filtration was performed in 9 EVLPs (intervention group) and in 6 EVLPs without (control group).

Results

After EVLP, 6/6 donor lungs were transplanted in the control group and 6/9 in the intervention group. Leukocytes increased significantly from 30 to 180 min in the standard group compared with the intervention group. During EVLP IL-1, IL-6, IL-8, TNF-α, neutrophil elastase, CD-14, syndecan-1, hyaluronan and VCAM-1, levels were not significantly different between the groups at 90 and 180 min. Post-transplant, primary graft dysfunction (PGD) and 1-month survival were similar.

Conclusion

The intervention group showed significantly lower circulating donor passenger leukocytes. However, this did not lead to attenuated inflammatory cytokines, leukocyte activation, glycocalyx shedding or endothelial activation. Clinical outcomes were similar between groups. Further research is needed to determine the exact effect of these donor passenger leukocytes.

目的：在体外肺灌注（EVLP）过程中，标准做法是加入白细胞过滤器去除供体乘客白细胞并减轻其炎症作用。广泛使用的白细胞过滤器LeukoGuard 6似乎对EVLP期间减少循环白细胞无效。因此，我们使用BioR 02加白细胞过滤器进行当代白细胞过滤，以减少这些白细胞，并研究是否可以减少炎症。方法：用15双侧供肺行EVLP至少180 min。从白细胞过滤器的进出口处取灌注液样品，随后在60 min后夹紧。9例evlp患者（干预组）和6例evlp患者（对照组）进行当代平行白细胞过滤。结果：EVLP术后，对照组6/6供肺移植成功，干预组6/9供肺移植成功。与干预组相比，标准组白细胞从30增加到180 min。在EVLP中，IL-1、IL-6、IL-8、TNF-α、中性粒细胞弹性蛋白酶、CD-14、syndecan-1、透明质酸和VCAM-1的水平在90和180 min时各组间无显著差异。移植后，原发性移植物功能障碍（PGD）和1个月生存率相似。结论：干预组供体外周血白细胞明显降低。然而，这并没有导致炎症细胞因子、白细胞活化、糖萼脱落或内皮活化的减弱。两组临床结果相似。需要进一步的研究来确定这些供体乘客白细胞的确切作用。

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引用次数: 0

Rescuing lung transplant candidates with rapidly progressive interstitial lung disease who fail V-V ECMO: A case series of dual veno-arterial and veno-venous extracorporeal membrane oxygenation circuits 抢救V-V ECMO失败的快速进展间质性肺疾病肺移植候选人：双静脉-动脉和静脉-静脉体外膜氧合回路的病例系列

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-26 DOI: 10.1016/j.jhlto.2026.100495

Enock Adjei MD , Blaine Sklar DNP, AGACNP-BC , John W. Stokes MD , Whitney D. Gannon MSN, MS , Amir Teimouri Dereshgi MD , Anil J. Trindade MD , Caitlin T. Demarest MD, PhD , Matthew Bacchetta MD, MBA , Konrad Hoetzenecker MD, PhD

Background

Providing adequate, awake and ambulatory mechanical circulatory support to patients with rapidly progressive advanced intersitial lung disease (ILD) remains challenging. In a subset of ILD patients with refractory hypoxemia or hemodynamic instability, despite optimal veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) support, the addition of a veno-arterial (V-A) ECMO circuit may avoid the need for mechanical ventilation and protect against right ventricular dysfunction and subsequent end-organ dysfunction.

Methods

We herein report the first case series of three patients with ILD who received dual VV-VA ECMO support as a bridge to transplantation.

Results

All patients survived until lung transplantation 2 to 8 days after V-A ECMO initiation and had an unremarkable post-transplant recovery.

Conclusion

Although the addition a second ECMO circuit is a complex and resource-intensive strategy, it is a feasible approach to stabilze a subset of ILD patients who are indequately supported with V-V ECMO.

背景：为快速进展的晚期间质性肺疾病（ILD）患者提供足够的、清醒的、动态的机械循环支持仍然具有挑战性。在顽固性低氧血症或血流动力学不稳定的ILD患者亚群中，尽管有最佳的静脉-静脉（V-V）体外膜氧合（ECMO）支持，但增加静脉-动脉（V-A） ECMO回路可以避免机械通气的需要，并防止右室功能障碍和随后的终末器官功能障碍。方法我们在此报告首个病例系列，3例ILD患者接受双VV-VA ECMO支持作为移植的桥梁。结果所有患者在V-A ECMO启动后2 ~ 8天存活至肺移植，移植后恢复无明显差异。结论：虽然增加第二个ECMO回路是一个复杂且资源密集的策略，但它是一种可行的方法，可以稳定一部分V-V ECMO支持不足的ILD患者。

{"title":"Rescuing lung transplant candidates with rapidly progressive interstitial lung disease who fail V-V ECMO: A case series of dual veno-arterial and veno-venous extracorporeal membrane oxygenation circuits","authors":"Enock Adjei MD , Blaine Sklar DNP, AGACNP-BC , John W. Stokes MD , Whitney D. Gannon MSN, MS , Amir Teimouri Dereshgi MD , Anil J. Trindade MD , Caitlin T. Demarest MD, PhD , Matthew Bacchetta MD, MBA , Konrad Hoetzenecker MD, PhD","doi":"10.1016/j.jhlto.2026.100495","DOIUrl":"10.1016/j.jhlto.2026.100495","url":null,"abstract":"<div><h3>Background</h3><div>Providing adequate, awake and ambulatory mechanical circulatory support to patients with rapidly progressive advanced intersitial lung disease (ILD) remains challenging. In a subset of ILD patients with refractory hypoxemia or hemodynamic instability, despite optimal veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) support, the addition of a veno-arterial (V-A) ECMO circuit may avoid the need for mechanical ventilation and protect against right ventricular dysfunction and subsequent end-organ dysfunction.</div></div><div><h3>Methods</h3><div>We herein report the first case series of three patients with ILD who received dual VV-VA ECMO support as a bridge to transplantation.</div></div><div><h3>Results</h3><div>All patients survived until lung transplantation 2 to 8 days after V-A ECMO initiation and had an unremarkable post-transplant recovery.</div></div><div><h3>Conclusion</h3><div>Although the addition a second ECMO circuit is a complex and resource-intensive strategy, it is a feasible approach to stabilze a subset of ILD patients who are indequately supported with V-V ECMO.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100495"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Trends in primary graft dysfunction and early mortality following lung transplantation: A single center experience 肺移植后原发性移植物功能障碍和早期死亡率的趋势：单中心经验

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-15 DOI: 10.1016/j.jhlto.2026.100488

Yuriko Terada , Michael K. Pasque , Chad A. Witt , Ruben G. Nava , Benjamin D. Kozower , G. Alexander Patterson , Daniel Kreisel , Varun Puri , Ramsey R. Hachem , Tsuyoshi Takahashi

Objectives

Although the long-term prognosis after lung transplantation has improved recently, primary graft dysfunction (PGD) remains the major cause of early mortality. The aim of this study was to elucidate trends in PGD incidence and short-term mortality following lung transplantation in the contemporary era.

Methods

We analyzed a single-center database of lung transplantations performed across three periods (Era 1: 2009–2013, Era 2: 2014–2017, and Era 3: 2018–2021). PGD was graded according to the 2016 International Society for Heart and Lung Transplantation definition, and PGD grade 3 within T0–T72 was used as the primary outcome. Trends in PGD incidence, factors associated with PGD, and early mortality rates after lung transplantation were identified.

Results

This study included 856 lung transplants: 277 in Era 1, 296 in Era 2, and 283 in Era 3. PGD grade 3 incidence decreased significantly over time: 35.9% (99 cases) in Era 1, 26.4% (78 cases) in Era 2, and 18.4% (52 cases) in Era 3 (P<0.001). During the study period, the lung allocation score (LAS) and intraoperative cardiopulmonary bypass (CPB) use decreased, whereas the use of intraoperative nitric oxide and extracorporeal membrane oxygenation increased. Logistic multivariate modeling identified era, recipient sex (male), underlying disease, race, and blood transfusion as factors associated with PGD. No significant difference was observed in 30-day hospital mortality across the three eras (2.9%, 1.4%, and 1.4% for Era 1, Era 2, and Era 3, respectively; P=0.313).

Conclusion

This study demonstrated a significant reduction in PGD incidence over time, which coincided with a decrease in LAS and intraoperative CPB use. However, no significant changes were observed in short-term mortality after lung transplantation.

目的虽然肺移植术后的长期预后近年来有所改善，但原发性移植物功能障碍（PGD）仍然是早期死亡的主要原因。本研究的目的是阐明当代肺移植术后PGD发病率和短期死亡率的趋势。方法：我们分析了三个时期（第1时代：2009-2013年，第2时代：2014-2017年和第3时代：2018-2021年）进行肺移植的单中心数据库。PGD按照2016年国际心肺移植学会（International Society for Heart and Lung Transplantation）的定义进行分级，以T0-T72内的PGD 3级作为主要终点。确定了肺移植后PGD发病率的趋势、与PGD相关的因素和早期死亡率。结果本研究共纳入856例肺移植：1277例，296例，283例。PGD 3级的发病率随着时间的推移显著下降：第1时代为35.9%（99例），第2时代为26.4%（78例），第3时代为18.4%（52例）（P<0.001）。在研究期间，肺分配评分（LAS）和术中体外循环（CPB）的使用减少，而术中一氧化氮和体外膜氧合的使用增加。Logistic多变量模型确定了年龄、受体性别（男性）、潜在疾病、种族和输血是与PGD相关的因素。三个时代的30天住院死亡率无显著差异（第1、2和3时代分别为2.9%、1.4%和1.4%；P=0.313）。结论：该研究表明PGD的发生率随着时间的推移而显著降低，这与LAS和术中CPB使用的减少相一致。然而，肺移植术后短期死亡率未见明显变化。

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引用次数: 0

Heart transplantation graft survival following donation after circulatory death via thoracoabdominal normothermic regional perfusion 经胸腹恒温区域灌注心脏移植供体在循环性死亡后的存活

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2025-12-17 DOI: 10.1016/j.jhlto.2025.100470

Sarah Y. Park MD , Rocio Lopez MS, MPH , Michael J. Kirsch MD, MSCR , Elizabeth J. Bashian MD , Emily Hay-Arthur BA , Jack Zakrzewski MD , Jesse D. Schold PhD , Nicholas R. Teman MD , Jordan R.H. Hoffman MD, MPH , Michael T. Cain MD

Background

The impact of thoracoabdominal normothermic regional perfusion (TA-NRP) use in donation after circulatory death (DCD) on rates of graft survival after heart transplantation has yet to be established.

Methods

A cohort study of the Scientific Registry of Transplant Recipients was performed identifying all primary adult heart transplants performed in the United States between January 1, 2020, and May 31, 2024, comparing donation after brain death (DBD), DCD with direct procurement and perfusion (DPP) (defined as declaration of circulatory death to cross clamp <30 min), and DCD with TA-NRP (defined as declaration of circulatory death to cross clamp >40 min). The primary outcome was graft loss (re-transplant or death).

Results

There were 474 (3.5%) DCD TA-NRP, 899 (6.6%) DCD DPP, and 12,185 (89.9%) DBD heart transplants during the study period, with varying donor and baseline characteristics, including more male and non-Hispanic White DCD TA-NRP recipients, and fewer DCD TA-NRP recipients listed as Status 1. On multivariable analysis, graft survival rates did not significantly differ between cohorts [Adjusted Hazard Ratio (aHR) (95% CI): 0.98 (0.70, 1.37) for DCD TA-NRP vs. DBD; and 1.04 (0.69, 1.56) for DCD TA-NRP vs. DCD DPP].

Conclusion

DCD TA-NRP recovery in heart transplantation yields comparable rates of two-year graft survival compared to DCD DPP and DBD recovery, supporting greater utilization of TA-NRP recovery in DCD allografts.

背景胸腹常温区域灌注（TA-NRP）用于循环死亡（DCD）后捐献对心脏移植后移植物存活率的影响尚未确定。方法在移植受者科学登记系统中进行队列研究，确定2020年1月1日至2024年5月31日期间在美国进行的所有原发性成人心脏移植，比较脑死亡后捐赠（DBD）、DCD与直接获取和灌注（DPP）（定义为宣布循环死亡至交叉夹30分钟）和DCD与TA-NRP（定义为宣布循环死亡至交叉夹40分钟）。主要结局为移植物丧失（再移植或死亡）。结果在研究期间，有474例（3.5%）DCD TA-NRP， 899例（6.6%）DCD DPP和12185例（89.9%）DBD心脏移植，具有不同的供体和基线特征，包括更多的男性和非西班牙裔白人DCD TA-NRP受者，以及更少的DCD TA-NRP受者被列为状态1。在多变量分析中，各组间移植物存活率无显著差异[校正风险比（aHR）（95% CI）： DCD TA-NRP vs DBD 0.98 (0.70, 1.37)；DCD TA-NRP和DCD DPP分别为1.04（0.69,1.56）。结论与DCD DPP和DBD恢复相比，心脏移植中DCD TA-NRP恢复的两年存活率相当，支持TA-NRP恢复在DCD同种异体移植中的更大应用。

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引用次数: 0

Recent change in bridging strategy and improved clinical outcomes following durable left ventricular assist device implantation in Japan 日本持久左心室辅助装置植入后桥接策略的最新变化和改善的临床结果

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-28 DOI: 10.1016/j.jhlto.2026.100499

Makiko Nakamura , Teruhiko Imamura , Yoshikatsu Saiki , Minoru Ono , Koichiro Kinugawa , on behalf of J-MACS Investigators

Background

Destination therapy (DT) was approved in Japan in May 2021. Use of Impella device as a bridge to left ventricular assist device (LVAD) implantation has been increasing. The difference of clinical outcomes between Impella-bridge (a conversion from Impella to durable left ventricular assist device [LVAD]), bridge-to-bridge (BTB) (a conversion from extracorporeal LVAD to durable LVAD), and primary LVAD remains unclear especially in Japanese.

Methods

Patients who underwent durable LVAD implantation between October 2017 and March 2025 and were prospectively registered in the Japanese Registry for Mechanically Assisted Circulatory Support (J-MACS) were included. The baseline characteristics, cumulative mortality, and adverse events following durable LVAD implantation were retrospectively compared between 2 bridging strategies and primary LVAD cohort.

Results

A total of 964 patients who received durable LVAD implantation (median age: 49 years; primary LVAD: 77.4%; Impella-bridge: 11.6%; BTB: 11.0%) were analyzed. The prevalence of Impella-bridge strategy increased especially after DT approval and the introduction of Impella 5.5. The cumulative mortality during durable LVAD support was lowest in Impella-bridge cohort and highest in BTB cohort during a median follow-up of 1053 days (8.0% vs 21.0%). Among the total cohort, an Impella-bridge strategy tended to be associated with a lower mortality following durable LVAD implantation with an adjusted hazard ratio of 0.316 (95% confidence interval 0.095-1.048, p = 0.060).

Conclusions

Impella-bridge strategy increased after the introduction of Impella 5.5 in the era of DT and tended to be associated with a lower mortality following durable LVAD implantation. Further studies are warranted to validate the hypothesis.

目的疗法（DT）于2021年5月在日本获得批准。使用Impella装置作为左心室辅助装置（LVAD）植入的桥梁已经越来越多。Impella-bridge（从Impella到耐用左室辅助装置[LVAD]的转换）、桥对桥（BTB）（从体外左室辅助装置到耐用左室辅助装置的转换）和原发性左室辅助装置的临床结果差异尚不清楚，特别是在日本。方法纳入2017年10月至2025年3月期间在日本机械辅助循环支持注册中心（J-MACS）前瞻性注册的持久LVAD植入患者。对两种桥接策略和初始LVAD队列的基线特征、累积死亡率和不良事件进行回顾性比较。结果共分析964例接受持久LVAD植入的患者（中位年龄49岁，原发LVAD占77.4%，Impella-bridge占11.6%，BTB占11.0%）。特别是在DT批准和Impella 5.5引入之后，Impella-bridge策略的流行度增加了。在中位随访1053天期间，持续LVAD支持期间的累积死亡率在Impella-bridge队列中最低，在BTB队列中最高（8.0% vs 21.0%）。在整个队列中，Impella-bridge策略倾向于与持久LVAD植入后较低的死亡率相关，校正风险比为0.316（95%可信区间0.095-1.048,p = 0.060）。结论在DT时代引入Impella 5.5后，simpella -bridge策略增加，并与持久LVAD植入后较低的死亡率相关。需要进一步的研究来证实这一假设。

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引用次数: 0

Expedited Lung Allocation in The Era of Continuous Distribution 连续分布时代的快速肺分配

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-14 DOI: 10.1016/j.jhlto.2026.100487

Sajjad Ali , Robin High , Marian Urban , David Axelrod , Steven Potter , Aleem Siddique

Background

The frequency of use of expedited offers in lung allocation has increased.

Methods

This study retrospectively analyzed lung offers accepted for transplant in the United States for the period from the introduction of continuous distribution in allocation in March 2023 to March 2024 to identify characteristics of donors, recipients, and offers associated with expedited placement. Data were obtained from the Scientific Registry of Transplant Recipients and categorized by expedited vs non-expedited offers.

Results

Of the 3,136 lung organ offers transplanted, 9% (284) were expedited. Expedited offers were more likely for male donors with blood type O, while recipients were typically older, male, non-Hispanic, and diagnosed with lung condition category A. These recipients also demonstrated lower composite allocation and medical urgency scores, and were less likely to be hospitalized, ventilated, or on extracorporeal life support. Time on the waitlist and post-transplant 30-day survival rates were similar between expedited and non-expedited groups. One-year survival was higher in recipients of expedited lung placements. Expedited offers had a median sequence number at acceptance of 83.5, bypassing a median of 54.5 listed patients, and were more often placed at centers with higher offer acceptance ratios.

Conclusion

Expedited placements are associated with lower-acuity recipients. Further policy reform should aim to ensure equity while optimizing organ placement and recipient outcomes.

背景：在肺分配中使用加急报价的频率有所增加。方法本研究回顾性分析了美国从2023年3月至2024年3月引入连续分配分配以来接受移植的肺供体的特征，确定供体、受体和与加速安置相关的供体。数据从移植受者科学登记处获得，并按加急和非加急提供分类。结果3136例肺器官移植中，9%（284例）的肺器官移植得到了加速。O型血的男性献血者更有可能获得加急服务，而接受者通常是年龄较大的男性，非西班牙裔，并且被诊断为a类肺病。这些接受者也表现出较低的综合分配和医疗紧急评分，并且住院，通气或体外生命支持的可能性较小。等待名单上的时间和移植后30天存活率在加速组和非加速组之间相似。加速肺植入的接受者一年生存率更高。加急报价的中位数序列号为83.5，绕过了列出的患者的中位数54.5，并且更经常被放置在报价接受率较高的中心。结论快速安置与低视力受者相关。进一步的政策改革应旨在确保公平，同时优化器官安置和接受者的结果。

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引用次数: 0

First implantation of a bioprosthetic total artificial heart for a mediastinal paraganglioma 纵隔副神经节瘤首次植入生物假体全人工心脏

JHLT Open

Pub Date : 2026-05-01 Epub Date: 2026-01-09 DOI: 10.1016/j.jhlto.2026.100485

Ali Akamkam MD, MSc , Marie-Eve Garcia MD , Elie Fadel MD, PhD , Julien Guihaire MD, PhD

Resection of cardiac-invasive tumors is challenging, as transplantation is not a viable option for patients with cancer. We report the first implantation of the Aeson total artificial heart (TAH) (Carmat, Vélizy-Villacoublay, France), as a bridge to transplant in a patient with a mediastinal paraganglioma. A 54-year-old man presented with restrictive heart failure related to a paraganglioma. The tumor was invading the right ventricle. No tumor reduction was achieved after chemotherapy. A surgical resection of the tumor combined with the implantation of the Aeson TAH was decided. Embolization of the nutrient vessels of the tumor was performed before surgery to decrease hemorrhagic risk. A positron emission tomography scan at 3 months showed no tumor recurrence. The patient was transplanted 6 months after TAH implantation. No severe primary graft dysfunction or acute rejection was observed. However, the patient developed refractory vasoplegia, which ultimately led to multiorgan failure and death 6 months after transplantation.

心脏侵袭性肿瘤的切除是具有挑战性的，因为移植对癌症患者来说不是一个可行的选择。我们报告了第一例植入Aeson全人工心脏（TAH）（Carmat， v录影带- villacoublay，法国），作为纵隔副神经节瘤患者移植的桥梁。一个54岁的男人提出限制性心力衰竭与副神经节瘤。肿瘤正在侵入右心室。化疗后未见肿瘤缩小。决定手术切除肿瘤并植入Aeson TAH。术前对肿瘤营养血管进行栓塞以降低出血风险。3个月的正电子发射断层扫描显示肿瘤未复发。患者于TAH植入术后6个月进行移植。没有观察到严重的原发性移植物功能障碍或急性排斥反应。然而，患者出现难治性血管截瘫，最终导致移植后6个月多器官衰竭死亡。

引用次数: 0