Temporary Left Ventricular Support Device as a Bridge to Heart-Liver or Heart-Kidney Transplant: Pushing the Boundaries of Temporary Support.

In patients with severe cardiogenic shock, temporary mechanical circulatory support has become a viable strategy to bridge patients to heart transplantation. However, end-stage heart failure is often associated with progressive organ dysfunction of the liver or kidney. This can require a dual organ transplant for definitive management (combined heart-liver [HL] or heart-kidney [HK] transplantation). We evaluated temporary mechanical support to bridge patients to HL or HK transplant at a single, high-volume center. All patients who underwent Impella 5.0 placement from January 2014 to October 2018 were identified. From this dataset, patients who underwent placement as a bridge to dual organ transplant were selected, as were those who underwent Impella as a bridge to isolated heart transplant. Over the 5 years of evaluation, 104 patients underwent Impella 5.0 placement. Of these, 14.3% (n = 15) were identified as potential dual organ recipients (11 HK, 4 HL). In total, 80% (12/15) successfully underwent dual organ transplant (8 HK, 4 HL), with a 1-year survival of 100% in both transplanted groups. Among patients undergoing Impella 5.0 placement as a bridge to isolated heart transplant (n = 33), 78.8% (26) were successfully bridged, and 1-year survival was 92% after transplantation. Impella 5.0 is a viable bridge to dual organ transplantation and should be considered as a management strategy in these complex patients at experienced institutions.

Effects of a home-based exercise program on clinical outcomes in heart failure.

BACKGROUND: The aim of this study was to determine the effects of a home-based exercise program on clinical outcomes. Exercise training improves exercise capacity in patients with heart failure (HF) but the long-term effects on clinical outcomes remain unknown. METHODS: We randomized 173 patients with systolic HF to control (n = 87) or home-based exercise (n = 86). The primary end point was a composite of all-cause hospitalizations, emergency department admissions, urgent transplantation, and death at 12 months. Functional performance (as assessed by cardiopulmonary exercise testing and the 6-minute walk test), quality of life, and psychological states were measured at baseline, 3 months, and 6 months. RESULTS: There was no significant difference between experimental and control groups in the combined clinical end point at 12 months and in functional status, quality of life, or psychological states over 6 months. Patients in the exercise group had a lower incidence of multiple (2 or more) hospitalizations compared with the control group: 12.8% versus 26.6%, respectively (P = .018). CONCLUSIONS: A home-based walking program that incorporated aerobic and resistance exercise did not result in improved clinical outcomes at 1-year follow-up in this cohort of patients with systolic HF. However, the exercise program resulted in reduced rehospitalization rates.

Evaluation of the HeartMate II™ left ventricular assist device in obese heart failure patients: effects on weight loss.

BACKGROUND: The purpose of this study is to evaluate the effect on weight loss of the newer generation continuous flow HeartMate II™ left ventricular assist device (VAD) in obese heart failure (HF) patients. MATERIAL/METHODS: We retrospectively reviewed 3-year surgical data from a large heart transplant facility and identified obese patients with advanced heart failure who underwent successful implantation of either the HeartMate XVE(®) or the HeartMate II(®) VAD. For each patient weight and BMI at time of VAD implantation and at 6 months post-operatively were documented. Between group comparison was achieved with Student's T tests. RESULTS: We identified 14 patients who had received the HeartMate XVE™ and 8 who had received the HeartMate II™. At 6 months, patients who received a HeartMate XVE™ demonstrated a significant reduction in mean body weight (249.6 ± 35.4lbs vs. 217.4 ± 20.5 lbs; P<0.05), while patients who received the HeartMate II™ demonstrated no significant change in weight (234.5 ± 41.7 lbs vs. 234.7 ± 43.0lbs; P=0.3). CONCLUSIONS: The HeartMate XVE™ results in significant reductions in weight at 6 months in obese patients with heart failure while the HeartMate II does not. Further research is necessary to better understand the effects of VADs on weight loss in obese HF patients.