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Inflammation, Combination Therapy Debates, Sport Model-ECMO, and Unflappable Oratory - Pulmonary Hypertension Highlights From the 2016 ISHLT Scientific Sessions

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Amresh Raina, MD
Allegheny General Hospitaln
Pittsburgh, PA, USA

The 2016 ISHLT Scientific Sessions were a virtual 'tour de force' encompassing essentially all diagnostic categories of PH. Kicking off the sessions were two pre-meeting symposia on PH in interstitial lung disease and PH in left heart disease, culminating in a lively debate regarding the utility of the diastolic pulmonary gradient to assess for pulmonary vasculopathy in left heart-related PH.

New this year was an entire symposium on the physiology of inflammation and inflammatory cytokines in PAH and the impact of metabolic and neurohormonal alterations on right heart function. This reopened a debate on the potential benefits of neurohormonal modulation with beta-adrenergic blockers in PAH.

Combination therapy has been the focus of a major paradigm shift in the treatment of PAH, but there remain many nuances regarding specific combinations of drugs, and the timing of their initiation. This formed the locus for another session and we were reminded by Dr. Paul Corris that in many countries, combination therapy is in essence sequential as directed by governmental payors.

With regards to bridging strategies for PAH patients to lung transplantation, Erika Rosenzweig described the implantation of "Sport Model" VA ECMO in PAH patients requiring bridging to lung transplant. This cannulation strategy from the jugular vein and subclavian artery has allowed a number of PAH patients at Columbia University to be extubated and ambulate while on VA ECMO, avoiding complications of muscular deconditioning and mechanical ventilation while awaiting lung transplantation.

Perhaps most memorably, Dr. Richard Channick presented an analysis from the GRIPHON trial, assessing the impact of anticoagulation with vitamin K antagonists on the combined morbidity/mortality endpoint in the largest PAH clinical trial to date. Though there was no effect of vitamin K antagonists in this analysis, the effect of the presentation on the audience was "markedly positive" as Dr. Channick presented his entire lecture, completely 'off the cuff' as his slides were not loaded due to a technical issue - a true scholar!

Thanks again for a memorable meeting and see you next year in sunny San Diego! ■

Disclosure Statement: The author has no conflicts of interest to disclose.

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