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Advances in Heart Transplantation from Neonatal to Adult Age
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Advances in Heart Transplantation from Neonatal to Adult Age

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 April 2023) | Viewed by 5133

Special Issue Editors

Prof. Dr. Massimo Griselli

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Guest Editor
Royal Brompton and Harefield Hospitals, NHS Trust, London, UK
Interests: neonatal cardiac surgery; adult congenital cardiac surgery; mechanical circulatory support; Heart and Heart/Lung transplantation
Dr. Rebecca Ameduri

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Guest Editor
Mayo Clinic, Rochester, MN, USA
Interests: congenital cardiology; pediatric and adult congenital heart failure; mechanical circulatory support and heart transplantation
Dr. Margarita Brida

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Guest Editor
Royal Brompton and Harefield Hospitals, NHS Trust, London, UK
Interests: adult congenital cardiology; adult congenital heart failure; mechanical circulatory support and heart transplantation
Dr. Richard C. Daly

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Guest Editor
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
Interests: adult cardiac surgery; mitral valve repair; robotic-assisted mitral valve repair (minimally invasive); heart transplantation; lung transplantation; robotic-assisted CABG (minimally invasive)

Special Issue Information

Dear Colleagues,

There have been many recent advances in neonatal, pediatric, and adult heart transplantation that are contributing to improved outcomes across all age groups. Some of these, which we would like to highlight in this issue, involve the advanced diagnosis and treatment of antibody mediated rejection, newer induction agents utilized to minimize steroid use or mitigate toxicities of other immunosuppressive agents, and alternative immunosuppressive strategies such as everolimus- or sirolimus-based regimens. In addition, advances in our understanding of donor factors that can affect short- and long-term outcomes following heart transplantation are of recent interest in the field, particularly in the area of predictive outcome models.  We would also like to highlight surgical advances in the field of cardiac transplantation across all age groups, including the use of the Trans Medics Organ Care System (OCS) for donor organ management. Finally, we would like to report on the recent advances in mechanical circulatory support (MCS) as a bridge to heart transplantation, from veno-arterial extra-corporeal membrane oxygenators (VA-ECMO) to ventricular assist devices (VAD) and total artificial hearts (TAH).

Prof. Dr. Massimo Griselli
Dr. Rebecca Ameduri
Dr. Margarita Brida
Prof. Dr. Richard C. Daly
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiac transplantation
  • pediatric
  • adult
  • adult congenital

Published Papers (3 papers)

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Research

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12 pages, 2301 KiB  
Article
The Role of Left Atrial Longitudinal Strain in the Diagnosis of Acute Cellular Rejection in Heart Transplant Recipients
by Sara Rodríguez-Diego, Martín Ruiz-Ortiz, Mónica Delgado-Ortega, Jiwon Kim, Jonathan W. Weinsaft, José J. Sánchez-Fernández, Rosa Ortega-Salas, Lucía Carnero-Montoro, Francisco Carrasco-Ávalos, José López-Aguilera, Amador López-Granados, José M. Arizón del Prado, Elías Romo-Peñas, Laura Pardo-González, Francisco J. Hidalgo-Lesmes, Manuel Pan Álvarez-Ossorio and Dolores Mesa-Rubio
J. Clin. Med. 2022, 11(17), 4987; https://doi.org/10.3390/jcm11174987 - 25 Aug 2022
Cited by 2 | Viewed by 1483
Abstract
Our aim was to investigate the role of left atrial longitudinal strain (LALS) in the non-invasive diagnosis of acute cellular rejection (ACR) episodes in heart transplant (HTx) recipients. Methods: We performed successive echocardiographic exams in 18 consecutive adult HTx recipients in their first [...] Read more.
Our aim was to investigate the role of left atrial longitudinal strain (LALS) in the non-invasive diagnosis of acute cellular rejection (ACR) episodes in heart transplant (HTx) recipients. Methods: We performed successive echocardiographic exams in 18 consecutive adult HTx recipients in their first year after HTx within 3 h of the routine surveillance endomyocardial biopsies (EMB) in a single center. LALS parameters were analyzed with two different software. We investigated LALS association with ACR presence, as well as inter-vendor variability in comparable LALS values. Results: A total of 147 pairs of EMB and echo exams were carried out. Lower values of LALS were significantly associated with any grade of ACR presence. Peak atrial longitudinal strain (PALS) offered the best diagnostic value for any grade of ACR, with a C statistic of 0.77 using one software (95% CI 0.68–0.84, p < 0.0005) and 0.64 with the other (95% CI 0.54–0.73, p = 0.013) (p = 0.02 for comparison between both curves). Reproducibility between comparable LALS parameters was poor (intraclass correlation coefficients were 0.60 for PALS, 95% CI 0.42–0.73, p < 0.0005; and 0.42 for PALS rate, 95% CI −0.13–0.68, p < 0.0005). Conclusions: LALS variables might be a sensitive marker of ACR in HTx recipients, principally discriminating between those studies without rejection and those with any grade of ACR. Inter-vendor variability was significant. Full article
(This article belongs to the Special Issue Advances in Heart Transplantation from Neonatal to Adult Age)
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10 pages, 1612 KiB  
Article
De Novo Complement-Binding Anti-HLA Antibodies in Heart Transplanted Patients Is Associated with Severe Cardiac Allograft Vasculopathy and Poor Long-Term Survival
by Guillaume Baudry, Matteo Pozzi, Matthieu Aubry, Elisabeth Hugon-Vallet, Raluca Mocan, Lara Chalabreysse, Philippe Portran, Jean-François Obadia, Olivier Thaunat, Nicolas Girerd, Valérie Dubois and Laurent Sebbag
J. Clin. Med. 2022, 11(13), 3731; https://doi.org/10.3390/jcm11133731 - 28 Jun 2022
Cited by 3 | Viewed by 1562
Abstract
Introduction: De novo anti-HLA donor specific antibodies (DSA) have been inconsistently associated with cardiac allograft vasculopathy (CAV) and long-term mortality. We tested whether C3d-binding de novo DSA were associated with CAV or long-term-survival. Methods: We included 282 consecutive patients without preformed DSA on [...] Read more.
Introduction: De novo anti-HLA donor specific antibodies (DSA) have been inconsistently associated with cardiac allograft vasculopathy (CAV) and long-term mortality. We tested whether C3d-binding de novo DSA were associated with CAV or long-term-survival. Methods: We included 282 consecutive patients without preformed DSA on coronary angiography between 2010 and 2012. Angiographies were classified according to CAV ISHLT grading. The primary outcome was a composite criterion of severe CAV or mortality. As the impact of de novo antibodies should be assessed only after appearance, we used a Cox regression with time-dependent covariables. Results: Of the 282 patients, 51(18%) developed de novo DSA during follow-up, 29 patients had DSA with C3d-binding ability (DSA+C3d+), and 22 were without C3d-binding ability (DSA+C3d-). Compared with patients without DSA, DSA+C3d+ patients had an increased risk for the primary outcome of severe CAV or mortality (adjusted HR = 4.31 (2.40–7.74) p < 0.001) and long-term mortality (adjusted HR = 3.48 (1.97–6.15) p < 0.001) whereas DSA+C3d- did not (adjusted HR = 1.04 (0.43–2.47) p = 0.937 for primary outcome and HR = 1.08 (0.45–2.61) p = 0.866 for mortality). Conclusion: According to this large monocentric study in heart transplant patients, donor specific antibodies were associated with worse clinical outcome when binding complement. DSA and their complement-binding ability should thus be screened for to optimize heart transplant patient follow-up. Full article
(This article belongs to the Special Issue Advances in Heart Transplantation from Neonatal to Adult Age)
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Review

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10 pages, 262 KiB  
Review
Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant—Change of Paradigm
by Dubravka Šipuš, Kristina Krželj, Željko Đurić, Hrvoje Gašparović, Davor Miličić, Jadranka Šeparović Hanževački and Daniel Lovrić
J. Clin. Med. 2022, 11(23), 7101; https://doi.org/10.3390/jcm11237101 - 30 Nov 2022
Cited by 2 | Viewed by 1514
Abstract
Despite advances in medical therapy and mechanical circulatory support (MCS), heart transplant (HT) remains the gold standard therapy for end-stage heart failure. Patients in cardiogenic shock require prompt intervention to reverse hypoperfusion and end-organ damage. When medical therapy becomes insufficient, MCS should be [...] Read more.
Despite advances in medical therapy and mechanical circulatory support (MCS), heart transplant (HT) remains the gold standard therapy for end-stage heart failure. Patients in cardiogenic shock require prompt intervention to reverse hypoperfusion and end-organ damage. When medical therapy becomes insufficient, MCS should be considered. Historically, it has been reported that critically ill patients bridged with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) directly to HT have worse outcomes. However, when the heart allocation system gives the highest priority to patients on VA-ECMO support, those patients have a higher incidence of HT and a lower incidence of death or removal from the transplant list. Moreover, patients with a short waiting time on VA-ECMO have a similar hazard of mortality to non-ECMO patients. According to the reported data, bridging with VA-ECMO directly to HT may be a solution in the selection of critically ill patients when the anticipated waiting list time is short. However, when a prolonged waiting time is expected, more durable MCS should be considered. Regardless of the favorable results of the direct bridging to HT with ECMO in selected patients, the superiority of this strategy compared to the bridge-to-bridge strategy (ECMO to durable MCS) has not been established and further studies are mandatory in order to clarify this issue. Full article
(This article belongs to the Special Issue Advances in Heart Transplantation from Neonatal to Adult Age)
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