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Focus on the 2017 Annual Meeting - Heart Failure and Transplant Scientific Council

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David Nelson, MD
Integris Baptist Medical Center
Oklahoma City, OK, USA

Editorial Comments

  1. There is a growth industry in registry mining that threatens the quality of registry-based abstracts. While the number of high quality registry-based abstracts remains constant, an increasing number draw conclusions from data inherently limited for the question asked.
  2. Our Council has become a thing of beauty. It is superbly organized and run, and this year's Council meeting was well attended, informative, had actively engaged membership, was productive and generated interesting and useful discussion.
  3. It was noted during the Council meeting that more time needs to be allocated specifically to heart transplant training in the Academy courses. MCS volume at training programs creates experience, confidence and, therefore, interest amongst trainees. Transplant exposure is less at most programs, which is a gap that the Society can address through our council.

Favorite Session
The Primary Graft Dysfunction/Vasoplegia, symposium 3, produced well-directed shoptalk like a good consensus conference. Some take-home bullets for me were:

  1. Recipient amiodarone, recipient obesity (with its associated inflammatory markers ), continuous flow as opposed to pulsatile pumps, VADS in general, IV heparin and anything else expected to increase the inflammatory condition of the recipient (multiple redo, hepatic congestion) all suspected risk factors for either or both of these conditions(PGD/vasoplegia).
  2. Plasmapheresis may improve the inflammatory state and outcomes from severe primary graft dysfunction, see favorite abstracts below.
  3. There is an ongoing shift towards ECMO and away from VAD for PGD. I don't mean that it is the predominant technological rescue yet, but it's gaining in popularity. You can close the chest.

Favorite Abstracts
Note, this by no means suggests these were the best abstracts, they just happened to be the ones that got me the most excited at this time.

  1. "Predicted Heart Mass is the Optimal Metric for Size Matching in Heart Transplantation," Kransdorf E, et al #278 and "Donor Predicted Heart Mass is Superior to Total Body Weight in Predicting Primary Graft Dysfunction in Undersized Donors," Gong, TA et al, #375 - both these were good follow-ups to Reed's JACC Heart Failure 2 (1), 2014:73-83.
  2. "Sirolimus-based Immunosuppression Mitigates Propagation of Cardiac Allograft Vasculopathy and Improves Cardiac Outcomes after Heart Transplantation: A single center 15 year follow-up study," Asleh, R et al #359 from Mayos is a great follow-up to Eisen's editorial "A Novel Definition of Cardiac Allograft Vasculopathy" AJT 2012;12:2571-2.
  3. "Treatment of Primary Graft Dysfunction with Plasmapheresis Improves Outcome," Chang D.H. et al from Cedars, #373 - a good follow-up to "Let There Be Light."

Favorite Comment
Someone asked Jig Patel, Andreas Zuckerman and Howie Eisen what their MFI practices were and they responded:

Patel: "8-10,000 avoid"
Zuckerman: "1000 - have a discussion on a case by case basis; 5-10,000 - alarm bells go off"
Eisen: "Same as Zuckerman" ■

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

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