Impact of mechanical circulatory support on donor heart allocation: past, present, and future.

The United Network for Organ Sharing (UNOS) recently revised its heart allocation policy to address numerous shortcomings of the previous system. Implemented in 2018, the changes sought to reduce waiting list mortality, clearly define urgency status based on objective physiologic variables, decrease exemption requests, and introduce geographic modifications to ensure organ distribution favors the highest urgency candidates. In large part, UNOS policy revisions were driven by the growing use of continuous flow left ventricular assist devices (CF-LVADs) and the relevant device complications that led to an unacceptably high number of status exemptions. The new 6-tiered system assigns a comparatively lower urgency status to patients supported on CF-LVADs and higher urgency to patients supported on short-term mechanical circulatory assist (MCA) such as extracorporeal membrane oxygenation (ECMO) and intraaortic balloon pump (IABP) counterpulsation. LVAD use as bridge to transplant (BTT) therapy increased steadily throughout the preceding decade due to technological improvements and increased physician familiarity, but the recent policy changes introduce incentives for physicians to withhold this life-saving therapy in order to achieve higher urgency status for their patients. This paper will explore the technological evolution of MCA and the pertinent clinical trials that have led to their FDA approval as BTT and destination therapy. A review of the inception and development of the donor allocation system will be provided before examining available post-policy outcome data. Finally, we will highlight successes and shortcomings of the implemented changes before commenting on areas to potentially expand upon the existing policy

Atypical Reactivation of Varicella Zoster Virus Associated with Pancreatitis in a Heart Transplant Patient.

BACKGROUND Acute pancreatitis is rare following solid organ transplantation but is associated with high mortality. It has been most commonly reported following renal transplant but can occur with other solid organ transplantations. CASE REPORT A 46-year-old male who had an orthotopic heart transplant 6 months ago presented with a 3-week history of abdominal pain. The patient described it as intermittent, sharp, and stabbing, originating in the periumbilical area and radiating to the back. His lipase was elevated at 232 U/L. Given that the patient\u27s symptoms and lipase were elevated to greater than three times the upper limit of normal, he patient was diagnosed with acute pancreatitis. The patient also mentioned a diffuse itchy rash that started a few days prior to admission. Dermatology was consulted, and given the man\u27s clinical presentation, there was concern for atypical reactivation of varicella zoster virus (VZV). VZV polymerase chain reaction of the vesicles returned positive. The patient was started on acyclovir and his symptoms improved. CONCLUSIONS This is the first reported case of VZV-associated pancreatitis in a heart transplant patient. Our patient presented with acute pancreatitis and was treated supportively. However, he did not receive antiviral treatment until his rash was discovered. Timely treatment of VZV resulted in resolution of both the rash and pancreatitis. Timely diagnosis of pancreatitis and VZV is important to prevent development of multiorgan failure and death

Eclipsing binaries suitable for distance determination in the Andromeda galaxy

The Local Group galaxies constitute a fundamental step in the definition of cosmic distance scale. Therefore, obtaining accurate distance determinations to the galaxies in the Local Group, and notably to the Andromeda Galaxy (M31), is essential to determining the age and evolution of the Universe. With this ultimate goal in mind, we started a project to use eclipsing binaries as distance indicators to M31. Eclipsing binaries have been proved to yield direct and precise distances that are essentially assumption free. To do so, high-quality photometric and spectroscopic data are needed. As a first step in the project, broad band photometry (in Johnson B and V) has been obtained in a region (34'x34') at the North-Eastern quadrant of the galaxy over 5 years. The data, containing more than 250 observations per filter, have been reduced by means of the so-called difference image analysis technique and the DAOPHOT program. A catalog with 236238 objects with photometry in both B and V passbands has been obtained. The catalog is the deepest (V<25.5 mag) obtained so far in the studied region and contains 3964 identified variable stars, with 437 eclipsing binaries and 416 Cepheids. The most suitable eclipsing binary candidates for distance determination have been selected according to their brightness and from the modelling of the obtained light curves. The resulting sample includes 24 targets with photometric errors around 0.01 mag. Detailed analysis (including spectroscopy) of some 5-10 of these eclipsing systems should result in a distance determination to M31 with a relative uncertainty of 2-3% and essentially free from systematic errors, thus representing the most accurate and reliable determination to date.Comment: 12 pages, 9 figures; accepted for publication in A&A; see electronic tables and full resolution images at http://www.am.ub.es/~fvilarde/download/A+A

Census of Self-Obscured Massive Stars in Nearby Galaxies with Spitzer: Implications for Understanding the Progenitors of SN 2008S-Like Transients

A new link in the causal mapping between massive stars and potentially fatal explosive transients opened with the 2008 discovery of the dust-obscured progenitors of the luminous outbursts in NGC 6946 and NGC 300. Here we carry out a systematic mid-IR photometric search for massive, luminous, self-obscured stars in four nearby galaxies: M33, NGC 300, M81, and NGC 6946. For detection, we use only the 3.6 micron and 4.5 micron IRAC bands, as these can still be used for multi-epoch Spitzer surveys of nearby galaxies (=<10 Mpc). We combine familiar PSF and aperture-photometry with an innovative application of image subtraction to catalog the self-obscured massive stars in these galaxies. In particular, we verify that stars analogous to the progenitors of the NGC 6946 (SN 2008S) and NGC 300 transients are truly rare in all four galaxies: their number may be as low as ~1 per galaxy at any given moment. This result empirically supports the idea that the dust-enshrouded phase is a very short-lived phenomenon in the lives of many massive stars and that these objects constitute a natural extension of the AGB sequence. We also provide mid-IR catalogs of sources in NGC 300, M81, and NGC 6946.Comment: 21 pages, 15 figures, 11 tables. Accepted by ApJ on April 12, 2010. High resolution figures and full length versions of tables 6, 8 and 10 can be accessed at http://www.astronomy.ohio-state.edu/~khan/redstars

The Recent Star Formation in NGC 6822: an Ultraviolet Study

We characterize the star formation in the low-metallicity galaxy NGC 6822 over the past few hundred million years, using GALEX far-UV (FUV, 1344-1786 A) and near-UV (NUV, 1771-2831 A) imaging, and ground-based Ha imaging. From GALEX FUV image, we define 77 star-forming (SF) regions with area >860 pc^2, and surface brightness <=26.8 mag(AB)arcsec^-2, within 0.2deg (1.7kpc) of the center of the galaxy. We estimate the extinction by interstellar dust in each SF region from resolved photometry of the hot stars it contains: E(B-V) ranges from the minimum foreground value of 0.22mag up to 0.66+-0.21mag. The integrated FUV and NUV photometry, compared with stellar population models, yields ages of the SF complexes up to a few hundred Myr, and masses from 2x10^2 Msun to 1.5x10^6 Msun. The derived ages and masses strongly depend on the assumed type of interstellar selective extinction, which we find to vary across the galaxy. The total mass of the FUV-defined SF regions translates into an average star formation rate (SFR) of 1.4x10^-2 Msun/yr over the past 100 Myr, and SFR=1.0x10^-2 Msun/yr in the most recent 10 Myr. The latter is in agreement with the value that we derive from the Ha luminosity, SFR=0.008 Msun/yr. The SFR in the most recent epoch becomes higher if we add the SFR=0.02 Msun/yr inferred from far-IR measurements, which trace star formation still embedded in dust (age <= a few Myr).Comment: Accepted for publication in ApJ, 21 pages, 6 figures, 3 table

Continuous-flow left ventricular assist device outflow graft stenting: Indications and outcomes

Introduction: Stenosis in the continuous-flow left ventricular assist device (CF-LVAD) outflow graft can be caused by various mechanical and anatomical factors. Increasingly, percutaneous management has been utilized to re-establish adequate CF-LVAD flow. We sought to evaluate indications for such interventions and their outcomes. Methods: An electronic search was performed to identify all studies in the English literature reporting CF-LVAD outflow graft stenting for various etiologies. Twenty-one studies consisting of 26 patients were included in the analysis. Results: Median patient age was 59 years [45.8-67.0] and 65.4% (17/26) were male. 58.3% (14/24) of patients had HeartWare HVAD, 37.5% (9/24) had HeartMate II LVAD, and 4.2% (1/24) had HeartMate III LVAS. Median time from device placement to outflow graft stenting was 24.0 months [7.8-30.4]. 76.9% of patients (20/26) presented with heart failure. 34.6% (9/26) had outflow graft thrombosis, 34.6% (9/26) stenosis, 11.5% (3/26) kinking, 11.5% (3/26) pseudoaneurysm, 3.8% (1/26) external graft compression, and 3.8% (1/26) had a bronchialarterial fistula. 88.5% (23/26) procedures led to immediate flow improvement with the remaining 11.5% (3/26) receiving additional stenting. Post-intervention flows were significantly improved (4.7 L/min [4.1-4.8] post-intervention vs 2.9 L/min [2.0-3.5] initial, p=0.01). 96.2% (25/26) patients were discharged from the hospital. The 30-day mortality was 6.7% (1/15). Overall mortality during the median follow-up of 90 days [7.0-240.0] was 9.5% (2/21). Discussion: Outflow graft stenting appears to effectively alleviate CF-LVAD outflow graft obstruction with low mortality. Longer-term follow up is necessary to determine the longevity of such an intervention but early results are promising

On-Orbit Data and Validation of Astra\u27s ACE Electric Propulsion System

The first ACE propulsion system reached orbit on July 1st 2021 as part of Spaceflight’s demonstration of the Sherpa-LTE all-electric Orbital Transfer Vehicle (OTV). We are now able to share on-orbit data and have successfully verified the on-orbit performance of the ACE propulsion system, using xenon propellent. The mission objective was to lower altitude and use on-orbit data to derive performance, correlating the propulsion system’s performance to ground test data. The demonstration consisted of activating the propulsion system for 5- minute durations at a total input power of 340 W into the Power Processing Unit (PPU). Altitude change and propellant usage were used to derive thrust and total specific impulse. On-orbit performance is compared to ground test data in Table 1. Averaged performance is within one standard deviation of ground test data. Astra considers this a validation of system performance, as well as the ground test facilities used to test propulsion systems. On-orbit thrust has a large standard deviation as a result of the limited data sampling rate and measurement errors, rather than variability in thruster performance. Figure 1 shows the thruster operating on-orbit. The Astra team gratefully acknowledges the support of Spaceflight, Inc., the U.S. Air Force, and Defense Innovation Unit (DIU) without which this mission would not have been possible

Does Concomitant CABG Influence the Outcomes of Post-Myocardial Infarction Ventricular Septal Defect Repair?

Introduction: Ventricular septal defect (VSD) following myocardial infarction (MI) is a relatively infrequent complication with high mortality. Over time, understanding of the pathology and its management has resulted in improved outcomes; however, controversies remain. Objective: We sought to investigate the effect of concomitant coronary artery bypass graft (CABG) on outcomes following post-MI VSD repair. Methods: Electronic search was performed to identify all relevant studies published from 2000 to 2018. After assessment for inclusion and exclusion criteria, 66 studies were selected for the analysis. Data were extracted and pooled for systematic review and meta-analysis. Results: Average age was 68.7 years (95% CI 67.3-70.1) with 57% (95% CI 54-60) males. Coronary angiogram was available preoperatively in 94% (95% CI 92-96) of patients. Single-vessel disease was most common (47%, 95% CI 42-52) with left anterior descending coronary artery the most commonly involved vessel (55%, 95% CI 46-63). Concomitant CABG was performed in 52% (95% CI 46-57) of patients. Of these, infarcted territory was revascularized in 54% (95% CI 23-82). No significant survival difference was observed between those who had concomitant CABG versus those without CABG at 30 days (65%, 95% CI 58-72) vs (60%, 95% CI 47-72), 1 year (59%, 95% CI 50-68) vs (51%, 95% CI 41-61), and 5 years (46%, 95% CI 38-54) vs (39%, 95% CI 27-52) respectively. Discussion: Overall, concomitant CABG did not have a significant effect on survival following VSD repair, therefore, decision on revascularization should be weighed against the risks associated with prolonged cardiopulmonary bypass