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links imageIN THE SPOTLIGHT:

ISHLT 2014 in Sunsational San Diego!


Featuring meeting highlights in:

•  Mechanical Circulatory Support
•  Nursing, Health Sciences, and Allied Health


Since this month's newsletter focuses on Mechanical Circulatory Support and Nursing, Health Sciences, and Allied Health, below are highlights of the upcoming meetings related to these disciplines.


Mon-Tues, April 7-8, 2014:

Two MCS Academies will be offered simultaneously at the Loews Coronado Bay Resort on the beautiful island of Coronado, California, across the bay from San Diego:

For more information, visit www.ishlt.org/meetings/ishltAcademy.asp.

Wednesday, April 9, 2014:

ISHLT will host three Academies simultaneously at the Manchester Grand Hyatt Hotel in San Diego (which is also the venue for the ISHLT 2014 Annual Meeting):

For more information, visit www.ishlt.org/meetings/ishltAcademy.asp.

Thursday, April 10, 2014:

MCS: Despite the unequivocal benefits of continuous flow devices over preexisting pulsatile technologies, certain clinical scenarios and new complications continue to challenge heart failure clinicians. These vexing problems include pump thrombosis, late onset right heart failure and de novo aortic insufficiency. In addition, the success of surgical repair of congenital cardiac disorders has resulted in a growing population of young adults with failing ventricles and complex anatomies in need of mechanical support as a bridge to transplantation. Lastly, the entity of acute cardiogenic shock in the setting of anterior wall MI continues to challenge clinicians who have a wide armamentarium of options (PCI, CABG, short term support, long term support and even TAH) but no clear algorithm as to how to best approach these difficult cases. Pre-meeting Symposium 1: Preventing VAD Complications will present singular and detailed case presentations with stop points during the medical and surgical management that can be used to generate "what do you do next" questions for a panel of experts and for the audience.

ISHLT 2014

• Annual Meeting website
• Academy website
Online Registration
• 2014 Preliminary Program

REMINDER: The 2 MCS Academies on Monday and Tuesday will take place at the Loews Coronado Bay Resort on Coronado Island. The 3 Wednesday Academies will take place at the Manchester Grand Hyatt Hotel in San Diego, as will the ISHLT 2014 Annual Meeting which begins on Thursday (one day later than usual) and concludes mid-day on Sunday.

NHSAH: Transition is defined as "the process by which adolescents and young adults with chronic childhood illnesses are prepared to take charge of their lives and their health in adulthood." Effective transition programs have the potential to decrease morbidity and mortality associated with transfer of care and can improve quality of life. Pre-meeting Symposium 6: Joint ISHLT/IPTA Symposium: Here They Come: Preparing Pediatric Patients For Transition To Adult Care will discuss issues essential to successful transition of pediatric patients to adult care, including patient and family challenges, as well as potential strategies/interventions to meet these challenges.

MCS: Anticoagulation is common in most practice areas represented by the ISHLT membership. Although most clinicians use anticoagulation therapies, questions often arise around how these medications compare with others within this class, interpretation of labs testing, and the function of new and future medications. The goals of Pre-meeting Symposium 7: Making Bloody Sense of Anticoagulation are to discuss: 1) Where anticoagulation therapy has been, 2) The status of anticoagulation in 2014, and 3) Appropriate interpretation and application of anticoagulation monitoring; and then use this information in discussion of MCS recipients and their thrombotic and bleeding risk after implantation where multiple different regimens, goals and management strategies that employed across centers and between devices.

MCS: Heart Transplantation and Mechanical Circulatory Support are therapies that result in improvement in survival and quality of life in patients with end-stage heart disease. Heart transplantation has a long track record with current estimated survival of about 60% at 10 years. Mechanical circulatory support, on the other hand, is a relatively young field, but current survival with second generation devices is approaching 80% at two years, similar to transplantation in some instances. As the technology improves, the expected survival with mechanical support should continue to increase and maybe even equate that of transplantation. The purpose of Pre-meeting Symposium 12: To VAD or to Transplant? is to compare transplantation to mechanical support in regards to survival, quality of life and morbidity.

The Nursing, Health Sciences and Allied Health Scientific Council Meeting will take place on Thursday, April 10, from 12:30 PM - 1:30 PM during the lunch break.

MCS: Mechanical circulatory support, through the advent of continuous-flow left ventricular assist devices, has dramatically altered our management of patients with advanced heart failure. Despite over a decade of experience with continuous-flow pumps, we only have a basic understanding of the human cellular and molecular response to mechanical support. Gene expression, metabolomics and other translational techniques should provide some key insights into the human response to continuous blood flow and will perhaps lead to strategies to predict and prevent the morbidities of VAD therapy. links imageFinally, the "holy grail" of MCS is myocardial recovery which may indeed involve therapy with stem cells, but only if aided by an integrated analysis of the entire human genome and its downstream transcriptional and translational products. Pre-meeting Symposium 13: Drilling Down on Myocardial Recovery - Basics and Clinical will review our current understanding of translational research in the setting of MCS with an emphasis on its clinical utility and translation.

MCS & NHSAH: Frailty has been defined as a low level of physiologic reserve and reduced ability to withstand stress to the body. One study estimated that twenty five percent of transplant patients met the criteria for frailty, a figure three times higher than in elderly adults who live at home. Other studies of abdominal transplant recipients classified as frail were nearly twice as likely to have early post-transplant complications, and this increased risk of a poor outcome occurred regardless of the age of the transplant recipient. Pre-meeting Symposium 17: Frailty - How Do We Assess this Physiologic Variable and at What Point Does it Represent a Contraindication to Transplant? will describe clinical assessment tools to identify patients at risk for frailty, will determine if frailty is an indicator of poor outcome in the thoracic transplant patient, and will identify interventions to improve outcomes of frail recipients.

MCS & NHSAH: The objectives of Pre-meeting Symposium 18: Developing A Pediatric VAD Program are to 1) To understand and review what is required to develop a VAD program at a pediatric center. 2) To review the outcomes of children discharged home on implantable VAD support, 3) To understand important pediatric-specific medical and social obstacles impacting home VAD, and 4) To discuss the future of VAD support for children.

MCS: Pre-meeting Symposium 18: The Times they are A-changing offers education focused on new applications of current available devices and a review of current and upcoming trends in mechanical circulatory support interventions.

Friday, April 11, 2014:

MCS: Sunrise Symposium 1: Building For The Future addresses the key issues involved as the MCS field expands. Firstly how to build a VAD program for new and evolving centers, secondly whether and how shared care should be performed for the large number of ongoing patients together with whether it works for the center and its partner, and thirdly the controversial and important topic of whether or not centers should be allowed to perform DT alone without having heart transplantation.

MCS: Concurrent Symposium 26: Infections in Mechanical Circulatory Support Devices - Understanding and Conquering the Beast will focus on pathogenesis, recent guidelines on diagnosis, as well as medical and surgical approaches for the management and prevention of Mechanical Circulatory Support Device-associated infections.

Saturday, April 12, 2014:

MCS: Sunrise Symposium 6: The Aortic Valve - An Open and Shut Case? will address how to run the pump - the advantages of running the pump full speed, giving maximal flow and offloading, versus running the pump slower, letting the valve open and maintaining some pulsatility. The advantages and disadvantages of just sewing the valve over will then be discussed. This session will also touch on providing full versus partial support.

NHSAH: Although treatments have improved symptoms, exercise tolerance, and quality of life for patients with pulmonary arterial hypertension, PAH remains a progressive, life limiting disease. The purposes of Sunrise Symposium 6: The Effects of Prostaglandin Therapy in Pulmonary Arterial Hypertension: The Seen and Unseen Risk/Benefit Profile are to raise awareness of the physical (seen) and psychological (unseen) effects of IV prostaglandin, the current mainstay for treatment for PAH, culminating in a case presentation/panel discussion.

MCS & NHSAH: At the end of Sunrise Symposium 11: VAD Teams Working Across Different Countries: How to Do It, the attendees will be able to discuss the challenges associated with International VAD care. Driveline options, traveling post-MCS, and the care of the VAD patient in the community will be presented with an open panel discussion at the end of the session.

The MCS Scientific Council Meeting will take place on Saturday, April 12, from 12:05 PM - 12:55 PM during the lunch break.


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