In Hospital Outcomes in Adult Congenital Heart Disease Patients with Fontan Undergoing Heart Transplantation - A Decade Nationwide Analysis from 2004 until 2014

Purpose: Treatment of adult congenital heart disease (ACHD) patients who require heart transplantation (HT) remains challenging due to limited donors and high perioperative and wait-list mortality. Those patients with single ventricle physiology palliated with Fontan are at the highest risk of early mortality due to multi-organ involvement; in addition, few centers are capable of safely transplant them. We sought to evaluate trends and outcomes of HT in these patients. Methods: Using the U. S Nationwide Inpatient Sample (NIS) database, we identified all adults aged at least 18 years old who underwent HT from 2004-2014. We then identified those with specific ICD-9 codes to include tricuspid atresia, hypoplastic left heart syndrome and common ventricle, who in order to survive to age 18, must have been palliated with a Fontan procedure. Multivariate regression models were created to adjust for potential confounders. Results: A total of 93 Fontan patients underwent HT during the study time (0.5% of all heart transplants). Compared to non-Fontan heart transplantations, Fontan patients were younger, with higher incidence of liver disease and coagulopathy (baseline demographics are shown in table 1). Fontan patients receiving HT had higher mortality during transplant hospitalization compared to non-Fontan patients (26.3% vs. 5.3% OR 18.10, CI 5.06 - 65.0 p\u3c0.001). ECMO usage and bleeding were also higher in the Fontan cohort with an OR of 5.30 (p=0.016) and 5.32 (p=0.015) for ECMO and bleeding, respectively. The remaining outcomes were similar for both cohorts. Conclusion: Fontan patients undergoing HT have exceptionally high inpatient mortality, which is nearly 5 times that of non-Fontan heart transplant recipients. The role of delayed referral, underlying liver disease, and other factors in this high mortality need to be explored

Utilization of hepatitis C virus\u2013infected organ donors in cardiothoracic transplantation: An ISHLT expert consensus statement

The advent of therapies for successful treatment of hepatitis C virus has allowed the heart and lung transplant community to re-explore the use of hepatitis C virus\u2013positive donors for organ transplantation, with a benefit for many terminally ill patients. The consensus statements provided herein represent the current state of knowledge and expertise in this area, which we expect will continue to rapidly evolve over the next few years

Comparison Between Bench-Top and Computational Modelling of Cerebral Thromboembolism in Ventricular Assist Device Circulation

Despite improvements in ventricular assist devices (VAD) design, VAD-induced stroke rates remain remarkably high at 14–47%. We previously employed computational fluid dynamics (CFD) to propose adjustment of VAD outflow graft (VAD-OG) implantation to reduce stoke. Herein, we present an in-vitro model of cerebral vessel embolization in VAD-assisted circulation, and compare benchtop results to CFD predictions. The benchtop flow-loop consists of a 3D printed aortic bed using Accura 60 polymer driven by a continuous-flow pump. Three hundred spherical particles simulating thrombi of 2, 3.5, and 5 mm diameters were injected at the mock VAD-OG inlet. A water and glycerin mixture (3.8 cP viscosity) synthetically mimicked blood. The flowrate was adjusted to match the CFD Reynolds number. Catch cans were used to capture and count particles reaching cerebral vessels. VAD-OG geometries were evaluated using comparison of means Z-score range of −1.96 ≤ Z ≤ 1.96 to demonstrate overall agreement between computational and in-vitro techniques. Z-scores were: (i) Z = −1.05 for perpendicular (0°), (ii) Z = 0.32 for intermediate (30°), and (iii) Z = −0.52 for shallow (60°) anastomosis and confirmed agreement for all geometries. This study confirmed added benefits of using a left carotid artery bypass-graft with percent embolization reduction: 22.6% for perpendicular, 21.2% for intermediate, and 11.9% for shallow anastomoses. The shallow anastomosis demonstrated lower degrees of aortic arch flow recirculation, consistent with steady-flow computations. Quantitatively and qualitatively, contemporary steady-flow computational models for predicting VAD-induced cerebral embolization can be achieved in-vitro to validate the CFD equivalent