March 5, 2019 e1 WRITING GROUP MEMBERS Emelia J. Benjamin, MD, ScM, FAHA, Chair Paul Muntner, PhD, MHS, FAHA, Vice Chair Alvaro Alonso, MD, PhD, FAHA Marcio S. Bittencourt, MD, PhD, MPH Clifton W. Callaway, MD, FAHA April P. Carson, PhD, MSPH, FAHA Alanna M. Chamberlain, PhD Alexander R. Chang, MD, MS Susan Cheng, MD, MMSc, MPH, FAHA Sandeep R. Das, MD, MPH, MBA, FAHA Francesca N. Delling, MD, MPH Luc Djousse, MD, ScD, MPH Mitchell S.V. Elkind, MD, MS, FAHA Jane F. Ferguson, PhD, FAHA Myriam Fornage, PhD, FAHA Lori Chaffin Jordan, MD, PhD, FAHA Sadiya S. Khan, MD, MSc Brett M. Kissela, MD, MS Kristen L. Knutson, PhD Tak W. Kwan, MD, FAHA Daniel T. Lackland, DrPH, FAHA Tené T. Lewis, PhD Judith H. Lichtman, PhD, MPH, FAHA Chris T. Longenecker, MD Matthew Shane Loop, PhD Pamela L. Lutsey, PhD, MPH, FAHA Seth S. Martin, MD, MHS, FAHA Kunihiro Matsushita, MD, PhD, FAHA Andrew E. Moran, MD, MPH, FAHA Michael E. Mussolino, PhD, FAHA Martin O’Flaherty, MD, MSc, PhD Ambarish Pandey, MD, MSCS Amanda M. Perak, MD, MS Wayne D. Rosamond, PhD, MS, FAHA Gregory A. Roth, MD, MPH, FAHA Uchechukwu K.A. Sampson, MD, MBA, MPH, FAHA Gary M. Satou, MD, FAHA Emily B. Schroeder, MD, PhD, FAHA Svati H. Shah, MD, MHS, FAHA Nicole L. Spartano, PhD Andrew Stokes, PhD David L. Tirschwell, MD, MS, MSc, FAHA Connie W. Tsao, MD, MPH, Vice Chair Elect Mintu P. Turakhia, MD, MAS, FAHA Lisa B. VanWagner, MD, MSc, FAST John T. Wilkins, MD, MS, FAHA Sally S. Wong, PhD, RD, CDN, FAHA Salim S. Virani, MD, PhD, FAHA, Chair Elect On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

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/pdf/acc-aha-2005-guideline-update-for-the-diagnosis-and-4hik65ngbe.pdf

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure).

Mariell Jessup, MD, FACC, FAHA, Chair [*][1]

William T. Abraham, MD, FACC, FAHA[†][2]

Donald E. Casey, MD, MPH, MBA[‡][3]

Arthur M. Feldman, MD, PhD, FACC, FAHA[§][4]

Gary S. Francis, MD, FACC, FAHA[§][4]

Theodore G. Ganiats, MD[∥][5]

Marvin A. Konstam, MD, FACC[¶][6]

Donna M.

/pdf/2009-focused-update-incorporated-into-the-acc-aha-2005-3z9lhvyqwq.pdf

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation

During the past decade, catheter ablation of atrial fibrillation (AF) has evolved rapidly from an investigational procedure to its current status as a commonly performed ablation procedure in many major hospitals throughout the world. Surgical ablation of AF, using either standard or minimally invasive techniques, is also performed in many major hospitals throughout the world.

In 2007, an initial Consensus Statement on Catheter and Surgical AF Ablation was developed as a joint effort of the Heart Rhythm Society, the European Heart Rhythm Association, and the European Cardiac Arrhythmia Society.1 The 2007 document was also developed in collaboration with the Society of Thoracic Surgeons and the American College of Cardiology. Since the publication of the 2007 document, there has been much learned about AF ablation, and the indications for these procedures have changed. Therefore the purpose of this 2012 Consensus Statement is to provide a state-of-the-art review of the field of catheter and surgical ablation of AF and to report the findings of a Task Force, convened by the Heart Rhythm Society, the European Heart Rhythm Association, and the European Cardiac Arrhythmia Society and charged with defining the indications, techniques, and outcomes of this procedure. Included within this document are recommendations pertinent to the design of clinical trials in the field of AF ablation, including definitions relevant to this topic.

This statement summarizes the opinion of the Task Force members based on an extensive literature review as well as their own experience. It is directed to all health care professionals who are involved in the care of patients with AF, particularly those who are undergoing, or are being considered for, catheter or surgical ablation procedures for AF. This statement is not intended to recommend or promote catheter ablation of AF. Rather the ultimate judgment regarding care of a particular patient …

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design

Paracorporeal support for children with superior cavopulmonary connection (bidirectional Glenn [BDG] shunt) has innate challenges due to their physiology. In this issue of the Journal, Bedzra and colleagues describe in detail their experience with long-term ventricular assist device (VAD) support in a patient with Glenn physiology who was successfully bridged to transplantation. The patient had a transitional atrioventricular septal defect, double-outlet right ventricle with a subaortic ventricular septal defect, a subaortic obstruction from atrioventricular valve tissue, and moderate to severe pulmonary stenosis. While supported on extracorporeal membrane oxygenation, he received an innominate artery and right atrial cannula, which provided sufficient decompression of the Glenn circuit. A Berlin arterial cannula was placed in the Damus–Kaye–Stansel (DKS) anastomosis, and an inflow cannula was implanted into the left ventricular apex. This strategy was successful because this lesion mixes at several levels, and streaming from the inferior vena cava (IVC) was avoided with this cannula placement. Decision making regarding long-term cannula placement is paramount to the successful bridge to transplantation in patients with a BDG. For example, in a patient with

Commentary: Ventricular assist device and bidirectional Glenn-mixing required.

Myocardial support of the failing heart in adult congenital heart disease.

Purpose Total Cardiac Volume (TCV) is a novel method of donor‒recipient size matching in pediatric heart transplantation (HT). However, usage of donor-recipient TCV ratio, instead of the donor-recipient weight ratio (DRWR) is still controversial. This study sought to determine whether estimated (e)TCV ratio is associated with infant post-transplant survival. Methods The United Network for Organ Sharing (UNOS) was used to search for infants (age: <1 year) who were listed for and received HT in 1987-2020. Donor and recipient eTCV were calculated from weight using previously published data. This equation is derived and validated from measured TCV in 140 donor-like CT scans. Cubic spline was used to determine optimal eTCV ratio range that significantly predicts survival. Patient cohort was divided according to the significant range and survival was compared. Results A total of 2864 infants were identified. The optimal eTCV ratio predictive of infant survival was 1.05-1.85. 70% (n=2166) patients had an optimal TCV ratio, while 16.7% (n=517) were in the lower (LR) and 5.9% (n=181) in the higher (HR) group. Kaplan-Meier analysis showed better survival for patients within the optimal vs LR (p<0.001), and similar survival compared to HR (p=0.08; figure). A 2-year conditional survival showed that LR had similar survival to the optimal group (p=0.76), and HR had worse survival than the other groups (optimal, p=0.002; LR p=0.02) (figure). Infants with optimal eTCV ratio (n=2166) had DRWR ranging from 1.09-5. Of these 33.6% had DRWR 2-3, and 5.8% DRWR>3. Conclusion Currently, an upper DRWR limit has not been established in infants. Therefore, the eTCV range determined is important since it identifies a potential upper limit that significantly predicts survival. This also implies that this finding can increase donor utilization since the eTCV range includes DRWR ranges that are frequently not used. Total Cardiac Volume (TCV) is a novel method of donor‒recipient size matching in pediatric heart transplantation (HT). However, usage of donor-recipient TCV ratio, instead of the donor-recipient weight ratio (DRWR) is still controversial. This study sought to determine whether estimated (e)TCV ratio is associated with infant post-transplant survival. The United Network for Organ Sharing (UNOS) was used to search for infants (age: <1 year) who were listed for and received HT in 1987-2020. Donor and recipient eTCV were calculated from weight using previously published data. This equation is derived and validated from measured TCV in 140 donor-like CT scans. Cubic spline was used to determine optimal eTCV ratio range that significantly predicts survival. Patient cohort was divided according to the significant range and survival was compared. A total of 2864 infants were identified. The optimal eTCV ratio predictive of infant survival was 1.05-1.85. 70% (n=2166) patients had an optimal TCV ratio, while 16.7% (n=517) were in the lower (LR) and 5.9% (n=181) in the higher (HR) group. Kaplan-Meier analysis showed better survival for patients within the optimal vs LR (p<0.001), and similar survival compared to HR (p=0.08; figure). A 2-year conditional survival showed that LR had similar survival to the optimal group (p=0.76), and HR had worse survival than the other groups (optimal, p=0.002; LR p=0.02) (figure). Infants with optimal eTCV ratio (n=2166) had DRWR ranging from 1.09-5. Of these 33.6% had DRWR 2-3, and 5.8% DRWR>3. Currently, an upper DRWR limit has not been established in infants. Therefore, the eTCV range determined is important since it identifies a potential upper limit that significantly predicts survival. This also implies that this finding can increase donor utilization since the eTCV range includes DRWR ranges that are frequently not used. 

Impact of Size Matching on Survival Post Heart Transplant in Infants: Estimated Total Cardiac Volume Ratio is Better Than Donor-Recipient Weight Ratio

PurposeDespite advances in the field of pediatric heart failure, black patients continue to experience inferior outcomes. Studies have reported that ventricular assist device (VAD) bridge to transplant (BTT) is associated with similar or better post-transplant survival (PTS) versus no MCS, but whether race/ethnicity affect this is unclear.MethodsUNOS was used to identify patients <18 years old at listing who received heart transplantation during or after 2006. Patients were grouped by race/ethnicity - black (B; n=1,294), Hispanic (H; n=1,218), and white (W; n=3,395) - and demographics, VAD utilization, clinical status, and PTS were compared. Multivariate (MV) Cox proportional analysis was performed to identify predictors of survival.ResultsBlack patients were oldest and heaviest (p<0.01 for both). Dilated cardiomyopathy was more prevalent in non-whites (p<0.01) and congenital heart disease more prevalent in whites (p<0.01). Less consistent trends were seen in functional impairment and organ dysfunction (Table). VAD utilization at time of transplant was greatest in black patients (B-28%, H-23%, W-21%, p<0.01). Kaplan-Meier PTS was higher in whites than in blacks or Hispanics (W-B, p<0.01; W-H, p=0.01) (Figure). On MV analysis of PTS, white BTT with VAD was protective (HR 0.66 (95% CI 0.52-0.84), p<0.01).ConclusionVAD utilization is greatest in black children. The post-transplant survival benefit portended by VAD in whites is not seen in non-whites despite a greater percentage having a more favorable cardiac diagnosis and controlling for preoperative variables. Despite advances in the field of pediatric heart failure, black patients continue to experience inferior outcomes. Studies have reported that ventricular assist device (VAD) bridge to transplant (BTT) is associated with similar or better post-transplant survival (PTS) versus no MCS, but whether race/ethnicity affect this is unclear. UNOS was used to identify patients <18 years old at listing who received heart transplantation during or after 2006. Patients were grouped by race/ethnicity - black (B; n=1,294), Hispanic (H; n=1,218), and white (W; n=3,395) - and demographics, VAD utilization, clinical status, and PTS were compared. Multivariate (MV) Cox proportional analysis was performed to identify predictors of survival. Black patients were oldest and heaviest (p<0.01 for both). Dilated cardiomyopathy was more prevalent in non-whites (p<0.01) and congenital heart disease more prevalent in whites (p<0.01). Less consistent trends were seen in functional impairment and organ dysfunction (Table). VAD utilization at time of transplant was greatest in black patients (B-28%, H-23%, W-21%, p<0.01). Kaplan-Meier PTS was higher in whites than in blacks or Hispanics (W-B, p<0.01; W-H, p=0.01) (Figure). On MV analysis of PTS, white BTT with VAD was protective (HR 0.66 (95% CI 0.52-0.84), p<0.01). VAD utilization is greatest in black children. The post-transplant survival benefit portended by VAD in whites is not seen in non-whites despite a greater percentage having a more favorable cardiac diagnosis and controlling for preoperative variables. 

http://www.jhltonline.org/article/S1053249822003953/pdf

David L.S. Morales

Papers

Commentary: Ventricular assist device and bidirectional Glenn-mixing required.

Myocardial support of the failing heart in adult congenital heart disease.

Impact of Size Matching on Survival Post Heart Transplant in Infants: Estimated Total Cardiac Volume Ratio is Better Than Donor-Recipient Weight Ratio

Racial disparity exists in the utilization and post-transplant survival benefit of ventricular assist device support in children.

Does Oversizing Donors Have Any Benefit for Pediatric Heart Transplant Recipients With Elevated Pulmonary Vascular Resistance