THIS MONTH'S FOCUS:

MECHANICAL CIRCULATORY SUPPORT
PEDIATRICS

(PDF VERSION)

Many thanks to Evgenij Potapov, Martin Schweiger & Brian Feingold for coordinating the content for this month's issue.




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VINCENT'S VALENTINE'S SENSE

This month Valentine's Day is upon us. In this issue of the Links we have exciting and innovating summaries for the love of what we do and for our children. The focus is on the machinations and miniaturizations of mechanical circulatory devices and care of our pediatric population with much cordial or heartfelt attention from abroad. In the spotlight, Martin Schweiger steers our attention to the first Core Competency Course on Pediatric MCS in San Diego. From across the borders with European Networking from the ECTTA meeting Drs Masetti and Carbone share their experience for us. From Belgium, Fabienne Dobbels provides us with the Many Faces of e-Health and its Application in End-Stage Organ Failure and Transplantation in via a Webinar free to us. From Germany, Dr Potapov gives us a race as a way for life by comparing with each heart beat the various ventricular assist devices. From Italy, Dr Amodeo shares with us a report on LVAD as Destination Therapy for Patients with Duchenne Muscular Dystrophy. From the North American front, Dawn Christensen informs us about ICCAC - the International Consortium of Circulatory Assist Clinicians, while Dr West furnishes us with a Current Review of Pediatric Mechanical Circulatory Support. Along with these spectacular summaries provided by our members near and far, we have a few extras from Dr Weill and Dr Khalid. With much heart and attention, we know you will enjoy this truly global and timely issue of the Links.

Vincent Valentine, MD
Links Editor-in-Chief



IN THE SPOTLIGHT:


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Looking Forward to San Diego: 1st Core Competency Course on Pediatric MCS

Martin Schweiger, MD

While the cold and icy winter has us firmly in its grip, we are looking forward to the warm and sunny San Diego, where the annual scientific meeting will take place. Besides the weather, there are some other good reasons to be excited about the upcoming conference. Especially the pediatric community caring for congenital heart disease (CHD) patients supported by mechanical circulatory support (MCS) can rejoice. The proportion of children bridged to transplantation with MCS has been steadily increasing over the past years, reaching 38% of all pediatric heart transplant recipients. Accompanying this is an increased use of ventricular assist devices (VAD) and total artificial hearts (TAH). The armamentarium of VAD options for adults has expanded drastically over the last decade and the pediatric population has benefited greatly by the surge in device development, with increased miniaturization of device design allowing for implantation in smaller patients. Nevertheless, there are huge differences between adult patients supported with VAD and children and adults suffering from CHD and needing MCS. Therefore, for the first time ever, there will be a core competency course on pediatric MCS. Read more →



ISHLT NEWS AND ANNOUNCEMENTS:



New Webinar Now Available On Demand Free to ISHLT Members

We are pleased to announce the latest addition to the ISHLT Webinar Series:

The Many Faces of e-Health and its Application in End-Stage Organ Failure and Transplantation

Presented by: Fabienne Dobbels, PhD, Academic Centre for Nursing and Midwifery, KU Leuven, Belgium
Duration: 1 hour

Click here to register




FOCUSING ON PEDIATRICS:



LVAD as Destination Therapy for Patients with Duchenne Muscular Dystrophy

Antonio Amodeo, MD

Typically, patients with Duchenne muscular dystrophy (DMD) are not considered candidates for heart transplantation because of the global nature of their skeletal muscle disease with high likelihood of respiratory failure. An alternative treatment for end-stage heart failure in dystrophinopathies we have explored at the Bambino Gesù Children's Hospital in Rome is the use of left ventricular assist devices (LVAD) as destination therapy (DT). To date we have treated seven DMD patients with a Jarvik 2000 LVAD as destination therapy (DT). The main advantage of this device in DMD is related to the positioning of the power cable exit site from the retroauricular area. For wheelchair-dependent patients we believe this provides a lower risk of infection compared with an abdominal driveline exit site. Read more →



Current Review of Pediatric Mechanical Circulatory Support

Shawn C West, MD, MSc

Mechanical circulatory support with a ventricular assist device (VAD) is often lifesaving in the setting of circulatory collapse. VAD use as a bridge to heart transplant has been shown to decrease waitlist mortality. Pediatric VAD use has increased over the last decade in the US, especially with the FDA approval of the Berlin Heart EXCOR. The Berlin Heart is the first pediatric specific VAD. Next generation adult VADs are also being used for older pediatric patients. Unlike the adult experience, there are few multicenter studies of pediatric patients. Knowledge in the pediatric VAD field is moving quickly and there have been a number of publications of interest in the last 12 months. Below are synopses of two key articles, the first by Elizabeth Blume and the second publication by Marie Steiner. I have also provided a list interesting articles for further reading. Read more →




FOCUSING ON MECHANICAL CIRCULATORY SUPPORT:



Racing as a Way of Life

Evgenij Potapov, MD, PhD

links imageAlmost four years ago (see here), I dreamed about a competition between the ventricular assist devices that were commercially available at the time. Now Abbot (previously Thoratec) has carried out a comparison between HeartMate 2 and HeartMate 3. The study shows that the new technology is not worse than the old. But is it better? So far it seems that the new system produces less pump thrombosis, while overall early survival remains similar. However, the study is still running and it may discover some survival advantages for the HeartMate 3 during the long-term follow-up. This study, although meticulously conducted, compared two pumps from the same company and, moreover, let technology from the past century run against the new one. No real competition. And, to be honest, the time for HeartMate 2 is gone, with or without long-term results. Read more →




SPECIAL INTEREST:



ICCAC (Eye-Kak) what? I keep hearing about this group? Who are they, what do they do, and why do I care?

Dawn M. Christensen, MS, FNP-BC, ACNP-BC

links imageThe International Consortium of Circulatory Assist Clinicians (ICCAC) is a partner organization of ISHLT and continues to be actively involved with ISHLT MCS Council initiatives. The ICCAC was founded in 2007 and was created to serve as a professional mentoring organization of mechanical circulatory assist device clinicians whose mission is to share information, educate and support individuals in this field to achieve optimal outcomes for patients requiring mechanical circulatory support, and to support efforts in the area of device clinical research and development. Members of the group include international VAD coordinators, Surgeons, Physicians, Engineers, Industry Members and anyone who is dedicated to the care of patients and advancement of all aspects the MCS field. Read more →



Education and Science Across the Borders: European Networking at ECTTA Meeting

Marco Masetti, MD, PhD
Javier Carbone, MD, PhD

Last October, the second European Cardio Thoracic Transplant Association (ECTTA) Meeting took place in Barcelona, Spain. This small part of European Society for Organ Transplantation (ESOT), born in 2013, organizes every other year a congress in Europe (the first took place in Budapest in 2014). The birth of this Society originated from two necessities: the need of representing the scientific issues of heart and lung transplantation and mechanical circulatory supports within ESOT, and the aim of improve the network between European people working in this field. One of the main goals of ECTTA, like the other international scientific societies, is to encourage research networking and the exchanges programs between young people within the small Europe. Beside the objectives of the Society, last ECTTA Meeting was stimulating both from the point of view of a young member attending the Meeting for his first time, and for an expert senior physician in the field of heart and lung transplantation. Read more →



Should I Accept This Heart? Addressing Uncertainty Associated with Increased Risk Donor Organs

Khadieja Khalid, MBBch, BAO

links imageA 28 year old woman with no known past medical history is found down on a train with drug paraphernalia on her person. She is taken to the local hospital but unfortunately progresses to brain death by hospital day 3. Due to active intravenous drug use, she is deemed an increased risk donor, and you are offered her heart. Pertinent laboratory testing of the donor includes undetectable human immunodeficiency virus (HIV) and hepatitis C virus (HCV) nucleic acid tests (NAT), negative hepatitis B surface antigen, and negative hepatitis B core antibody. Do you accept the organ for a 45 year old woman with non-ischemic cardiomyopathy currently listed as a 1A at your center? Scenarios such as this are becoming increasingly common, and transplant infectious disease providers are frequently asked, "How much risk does 'increased risk' pose?" Part of this answer lies in the definition of "increased risk." In 2013, the United States Public Health Service (PHS) published guidelines for reducing the transmission of HIV, hepatitis B virus (HBV), and HCV through organ transplantation. Read more →




EDITOR'S CORNER:

Lung Transplant Resourcing Scarce Resources

David Weill, MD

links imageDo you want to know what's keeping me up at night (besides of course the 2 AM donor call)? It's actually who is going to take that donor call in 5, 10 or 20 years. Having been involved for more than 20 years in the education of fellows interested in lung transplantation, a transformation has occurred over the last several years. And not a good one. While at Stanford, a sharp decrease in the number of applicants for our lung transplant fellowship spot was noticed, despite that fact that we had the oldest and best established lung transplant training program anywhere, started by Jim Theodore. As the years went by and the number of people applying for the spot dwindled, I began to check around with my colleagues around the country who had a history of training fellows. Same problem everywhere. Although relieved to know it wasn't just a Stanford problem, some years we struggled to find even one person who wanted to train with us - this past July, for the first time in the twenty plus years of the Stanford fellowship program, there is no dedicated person training in lung transplantation. In the carefully chosen words of our new President: Sad. Read more →





Contact

Vincent G Valentine, MD
Editor-in-Chief
vvalentine@uabmc.edu


Editorial Staff


"You are so brave and quiet I forget you are suffering."
— Ernest Hemingway

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Disclaimer: Any opinion, conclusion or recommendation published by the Links is the sole expression of the writer(s) and does not necessarily reflect the views of the ISHLT.