Aortic Root Thrombosis in HeartMate 3 LVADs; A "Sex Paradox" in PAH

Published 05 June 2024
  • Advanced Heart Failure & Transplantation
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  • Pulmonary Vascular Disease (PAH & CTEPH)
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In the June episode of JHLT: The Podcast, The JHLT Digital Media Editors explore two studies from the June issue of The Journal of Heart and Lung Transplantation. This episode is hosted by Digital Media Editor Van-Khue Ton, MD, a transplant cardiologist from Massachusetts General Hospital.

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Headshot of Matt Carey dressed in a sport coat in front of an outdoor backgroundHeadshot of Justin Fried in a white lab cat in front of an indoor backgroundDr. Ton and Digital Media Editor Marty Tam, MD, interview their first guests, first author Matthew Carey, MD, MBA, and senior author Justin Fried, MD, both of the Columbia University Irving Medical Center in New York City. Together, they discuss the study “ Aortic Root Thrombosis in patients with HeartMate 3 left ventricular assist device support.”

This retrospective study of all patients receiving a HeartMate 3 LVAD at a single center between November 2014 and August 2020. The study evaluated findings related to patients with aortic root thrombosis, classified as having at least 1 echocardiogram or contrast-enhanced CT scan with thrombus. In the population of 197 patients, 19 had aortic root thrombus, which was ultimately associated with an increased risk of developing significant aortic regurgitation during the study period.

Drs. Carey and Fried discuss whether aortic valve opening is associated with increased risk of aortic root thrombus, how to balance the bleeding-thrombosis scale in patients, and how the study fits in the context of prior generations of LVAD.

Jackie DesJardin HeadshotNext, Dr. Ton and Digital Media Editor Erika Lease, MD, FCCP interview their next guest, Jacqueline DesJardin, MD, a Fellow in the department of medicine at the University of California San Francisco. Dr. DesJardin is first author on the study “Investigating the “sex paradox” in pulmonary arterial hypertension: Results from the Pulmonary Hypertension Association Registry (PHAR).” 

PHAR is a multicenter US-based registry of patients with PAH, and this study analyzed 1,891 patients from the registry, 1,425 (75%) of whom were female. At baseline, compared to men, women had worse functional status and worse hemodynamics. Women were more likely to be on triple therapy or parenteral prostacyclin therapies at baseline. Interestingly, women had better survival than men, even after adjusting for numerous variables.

In the discussion, Dr. DesJardin explains what collider stratification bias is, and how it may illuminate the complex epidemiological system that creates this disparity. She shares the three potential causal models posed in the study, and considers how the study might be followed up.

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